64. CASE: Implementing an Anti-Obesity Strategy

The local health district is in the final stages of adopting a comprehensive organizational anti-obesity policy. Its development was led by a working group of diverse stakeholders from across the district and included an extensive consultation process.

One aspect of the policy that generated a lot of discussion and debate at the working group was the suggestion that messaging should be designed to increase stigma and social pressure around obesity.  This strategy was defended recently in a leading bioethics journal and has been implemented in other jurisdictions.  Ultimately the group was convinced to include this suggestion in the policy because of the success that such messages had in decreasing smoking rates.

Prior to ratifying the new policy, senior leadership requested that the district medical advisory committee review it.  One of these reviewers is clearly upset by the policy; he sent feedback in very personal terms implying that increasing stigma and social pressure around obesity made the policy unreasonable and unethical.

  • What values are relevant to the policy issues under consideration?
  • Why would the reviewer deem the policy to be unethical?
  • What are the conflicting values among the reviewer and the policy makers?
  • Is there other information you would like to have before responding to the reviewer?
  • How will you (the working committee) respond to the reviewer and why?

Some Values and Ethics Issues to Consider

  • Empathy
  • Respect for autonomy
  • Respect for dignity
  • Community health ethics
  • Living at risk
  • Organizational ethics
  • Compliance with policy
  • Social justice
  • Social determinants of health
  • Responsibility for health

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