to think that Human Rights has a lot to answer for in this obesity related death.

[meyesmyeyes]

A lot people are saying, Well why were people getting him that food? Why weren't they saying No? and why weren't the 'Carers' refusing to give him his takeaways etc.... OK, he would have sworn at them, but he couldn't get out of bed, so wouldn't have been able to harm them for not getting him his junk food.

the human rights act allows him to do what he wants if carers do not comply they are in the wrong and are liable to lose their jobs psychiatrists have to prove they do not have the capacity -- very few people come under this sadly

So surely, this poor man was failed miserably by a system that was supposed to help him?

People should have been in a position where they were able to say 'no' to him. But because of a flawed human rights system, this man has lost his life.

mamadoc
I don't get your assisted suicide comparison either.

Suicide is not illegal. Assisting suicide is.

A capacitous, not mentally ill person can kill themselves without fear of state interference and can refuse life saving treatment. Kerrie Wooltorten did just that and was allowed to die

Though not illegal, my point was that our society seeks to discourage suicide (regardless of whether individuals have capacity). We value life and its preservation. Untimely death is seen as tragic. Steps are taken to reduce suicide rates. People who attempt suicide are treated with the objective of making them better. Kerrie Wooltorton's case was unusual because doctors were obliged to follow her clearly set out wishes to be allowed to die, which she had taken care to document - not something that is actively encouraged for those intent on suicide, for obvious reasons. I would expect there to be a greater alignment between attitudes towards suicide (to be avoided and generally considered a tragic waste of life) and attitudes towards this man's death (seen by some on this thread as little more than an unfortunate consequence of 'choices' that he was, and should be, free to make, with almost no focus on how it could have been avoided).

Should assisted suicide become legal I will exercise my right to conscientiously object to participating in it but I will not seek to stop anyone from making a legal choice

I'm interested to know why you would 'conscientiously object to participating'. (Your comment appears not to support the views and values you have expressed.)

I do find some attitudes on this thread towards those questioning this man's care, bizarre. People who disagree with the care provided are assumed to:

• reject the man's right to make choices (because he can't move);
• think those being cared for in the community should have fewer rights than others;
• think carers should make decisions for those in their care;
• want greater state intervention;
• not understand the concept of capacity.

None of those things are representive of my views or understanding.

At the same time, those focusing on the man's right to make unwise choices seem to ignore the fact that his overriding wish was not to die, but to receive treatment and get better. According to one report, what he actually wanted was to be hospitalised so that he could lose weight (no doubt a prohibitive option resource-wise for the NHS, and unlikely to be something that they offered). It's not hard to understand that he was very unlikely to make progress whilst incapacitated in his home setting.

Why would I conscientiously object? Because I believe that all life has value and that a Drs job is to preserve life not to destroy it. That is not to say that I would 'strive officiously' to keep someone alive who is dying but I would never seek to hasten a person's death.

I don't think my views are contradictory. They are not to me anyway. I am happy for abortion and for assisted suicide to be legal ( I don't even mind if drugs are made legal) but I would not choose those options for myself and I would not participate in them. I would however support others to exercise their informed choices and rights just as I exercise mine (within the limits of the law) whether I agree with them or not. I think it's a classically liberal position, nothing unusual.

You have summarised what you don't think but I haven't understood what you do think was wrong or should have been done differently in this case. Is your concern that it was due to lack of resources or discrimination? I don't think it was.

Of course this guys death was sad and was an undesirable outcome but we have really no idea what care and intervention was offered to him to change that over the years. I really doubt that it was nothing at all. Specialist obesity clinic services exist and whilst I don't know if he was referred it would seem a racing certainty that he would have been.

Inpatient treatment probably not. I would make an analogy with alcoholism on that one. Almost every alcoholic and every alcoholic's family think that if only they were checked into inpatient rehab they would be cured. The reason that inpatient detox is very limited on the NHS is not that it costs a lot but that it does not work. They relapse as soon as they are discharged because it is super easy not to drink in a hospital but super hard not to drink at home in the situation that led you to drink in the first place. That's why inpatient alcohol detox is only available to those who engage with community alcohol services and start to make some changes. In fact most people do not medically need inpatient detox. It is offered to those who might have withdrawn seizures not just those who want a short cut and no temptation. Private alcohol detox clinics in my view are profiteering and not usually acting in patients best interests (cf Amy Winehouse)

I would say that the same is probably true of overeating.
I have not heard of any specialist centres for inpatient obesity treatment. Admission just to a normal general hospital would really not meet his needs at all. It would need to be for months and months and include psychotherapy and a general hospital is just not set up for that.
If you can't engage with a diet plan at home then admitting you to hospital would very likely be a short term fix and you would relapse straight away on going home thus making it a huge waste of resources.

I think that you are overestimating how much other people or services can actually do for addictions in general. A person needs to change their thinking very fundamentally before they can change their behaviour and they cannot be forced into doing that. They need a very high degree of motivation. Not just saying 'oh I would really like to change' because just about every addicted person will say that sometimes but actually taking steps to achieve it. If the consequences of the behaviour are reversed without changing the thinking then relapse is inevitable.

It is horrible to watch. I am a psychiatrist and every day I wish that I could make patients take different decisions instead of the ones that I can see are harming their health but I have no right to do so. Even where I am given that right for people detained under the MHA it is only until they are recovered and then they may choose to stop their meds and take drugs and relapse. It is frustrating but it Is their choice. Usually after a few goes round the system people learn from experience and they start to make different choices for themselves and that is how change happens not by taking away choice.

Interesting post mamadoc.

That's an excellent link, Garlick. Here's a shortcut to the article from the Institute of Medical Ethics that it cites: "Positive affect as coercive strategy: conditionality, activation and the role of psychology in UK government workfare programmes".

...the view that unemployment is evidence of both personal failure and psychological deficit. The use of psychology in the delivery of workfare functions to erase the experience and effects of social and economic inequalities, to construct a psychological ideal that links unemployment to psychological deficit, and so to authorise the extension of state—and state-contracted—surveillance to psychological characteristics.

Particularly interesting to read in parallel with the current thread on Forever Living and pyramid scams. The "motivational" language is scarily similar, and to the same end: to manipulate the vulnerable so the upstream can feed off them.

Sorry, a side-issue for this thread. But not wholly irrelevant.

mamadoc
Is your concern that it was due to lack of resources or discrimination? I don't think it was.

Not discrimination but a lack of resources and a lack of provision for non surgical treatment for life threatening overeating disorders. The man wanted inpatient treatment and care and I think that should have been an option, just as it might be for somebody with anorexia and an extremely low body weight placing them at a high risk of dying (a better comparator I think than somebody with an alcohol addiction). He had rejected bariatric surgery as too dangerous (he had reportedly had five heart attacks in the past year) and according to one report, had unsuccessfully tried to negotiate a long-term inpatient place at a hospital with a bariatric unit, where he hoped to be able to lose weight without surgery (presumably an option that did not exist). Outpatient treatment was clearly not possible for him. He may well have been offered some therapeutic help at home, but I don't think that would have been enough.

If you can't engage with a diet plan at home then admitting you to hospital would very likely be a short term fix and you would relapse straight away on going home thus making it a huge waste of resources.

I am surprised you talk about it in terms of 'engaging with a diet plan'. His illness was serious and complex. I think given the consequences of his eating disorder (rendered immobile, confined not just to a room but to a bed within a room; at a high risk of death), home would be an incredibly difficult environment in which to start breaking habits and regaining health. He wanted help to remove himself from immediate danger and to change his relationship with food. I wonder and doubt whether an individual in his situation has ever been able to get better at home, in the very place where their eating habits have become so entrenched that all mobility has been forfeited. It would have been an extraordinary challenge both mentally and physically and presumably it would have taken months and months of sustained effort before he could very gradually regain his mobility and be in a position where he was not confined to one room.

A person needs to change their thinking very fundamentally before they can change their behaviour and they cannot be forced into doing that. They need a very high degree of motivation.

I agree with the not forcing but disagree with the rest. Fundamental changes in thinking do not always have to precede changes in behaviour. There are plenty of examples where a procedure or treatment can enable changes to take place or where changes and treatment can take place together over time. In this case, time wasn't on this man's side and presumably the more ingrained his habits became, the harder it would have been for him to see a way out of his situation. Again, I would draw parallels with an anorexia sufferer needing to reach a safe weight as a priority.

On a purely technical, legal level anorexia is a mental illness under the MHA but overeating is not and that is why compulsory intervention is possible for anorexia and not for extreme obesity.

Very low weight is much more imminently life threatening than very high weight.

Extremely low weight has been shown to cause distorted thinking in itself ie the overvalued ideas about body image are a consequence as well as a cause of low weight in anorexia. For instance people in concentration camps who were starved displayed anorexic cognitions which disappeared on refeeding.
Therefore refeeding is a direct treatment of anorexia not just a correction of its consequences. Refeeding will help to change the thought processes that brought about the weight loss.
I don't think the same can be said for overeating. Weight loss will help the physical consequences but not necessarily change the mindset.

I think that these are the reasons the state intervenes in anorexia treatment but not in obesity treatment.

I think the comparison with alcohol addiction is more apt than with anorexia. The psychological process in overeating is more like an addiction; loss of control rather than over rigid control. Body image distortions I don't think occur in overeating. I think that people who are very obese are not usually denying that in the way anorexics do.

I would take it one step further to wonder if anyone in this man's position ever got better at all with any treatment. The one person I met in my hospital career died very soon after admission from a blood clot on the lung due to immobility, due to extreme obesity.
I'm sure that if the inpatient option existed and he agreed to it it should have been offered but it may be that he was past the point of no return after so many heart attacks and being bed bound.

I would take it one step further to wonder if anyone in this man's position ever got better at all with any treatment

Will respond later to your other post, but do you mean without bariatric surgery? (If you are including surgery, then Paul Mason is one example.)

mamadoc
On a purely technical, legal level anorexia is a mental illness under the MHA but overeating is not and that is why compulsory intervention is possible for anorexia and not for extreme obesity.

I appreciate that. And I realise that a lot of inpatient treatment for anorexia may be through compulsory intervention, but I'm really thinking about voluntary inpatient treatment here.

Very low weight is much more imminently life threatening than very high weight.

I agree that it's likely to be more imminently life threatening, but I think we're talking about fairly marginal differences. Both are time critical.

Refeeding will help to change the thought processes that brought about the weight loss.
I don't think the same can be said for overeating. Weight loss will help the physical consequences but not necessarily change the mindset.

Actually there is a possible parallel. Immobility would have been both a consequence and a contributory factor in relation to this man's weight. I'm guessing that he could only reach and sustain his weight of 65 stone by becoming immobile, which meant that he was only able to expend minimal energy, at the same time essentially stripping his life of anything else but an increasing focus on food, eating being one of the few functions he was still able to undertake. Treatment allowing changes in food and eating habits would enable a gradual improvement in health, mobility, activities and focuses. A result of that could be the reinforcement of non eating behaviours, facilitating a shift in mindset.

I think that these are the reasons the state intervenes in anorexia treatment but not in obesity treatment.

Interventions aside, I think the provision and range of treatment available (including seemingly no inpatient options for patients with life limiting overeating disorders) is possibly more down to a longer history and greater experience of treating life threatening cases of anorexia. Cases of overeating at this severity must be relatively recent (and partly facilitated by changes in the way we live, greater availability of food etc). I also think that an inpatient facility would be very costly and logistically difficult (patient mobility).

I think the comparison with alcohol addiction is more apt than with anorexia. The psychological process in overeating is more like an addiction; loss of control rather than over rigid control. Body image distortions I don't think occur in overeating. I think that people who are very obese are not usually denying that in the way anorexics do.

I take your point about body image distortions but I disagree that alcoholism is a better comparator. As well as some broad similarities in issues and consequences for very severe cases of anorexia and overeating, it's possible for individuals to experience both of those things. Regardless of the type of eating disorder, recovery requires the adoption of different eating strategies, whereas recovering alcoholics might abstain from alcohol altogether.