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.

Klayden
Way off in what respect?

Firstly, his care would have been most likely funded by social care.

The Guardian (and I think other media) referred to 'a team of NHS carers'. Were they incorrect? How do you know that he was supported by social care rather than NHS contuining healthcare?

Where have I suggested denying basic care? And how is facilitating someone (who by all accounts wanted to get better) to make choices that result in their fatality in any sense humane?

With the example of the liver transplant not being given to someone who carries on drinking alcohol that is basically a resources and likelihood of success decision not a moral one.

Since there are very limited livers available for transplant they go to the recipient where they are most likely to be successful. Continuing to drink will render the op not successful and the person most likely not fit for any op. It is not a moral judgement.

Same reason why people are told to lose weight before being allowed joint replacement surgery. Not a moral judgement on being overweight but just that operative risk increases and chances of successful repair reduce as weight increases.

The people in these cases are making their own choices. They are not being dictated to or bribed just facts are facts and over a certain weight an op may not be safe.

mamadoc If you're talking about my post which mentioned liver transplants, I was not talking in terms of moral judgements. My point was about treatment which is not unconditional.

You can say what you like and use every random example in the world but we cannot legally nor morally stop someone with capacity from eating themselves to death.

It's frightening the level at which lay people expect the state to intervene. If you're not sectionable under the MHA nor lacking capacity, you can eat yourself to death or slash your wrists.

If it was your relative though you wouldn't do it. If one of my kids was that obese and unable to feed themselves I wouldn't feed them excessive caloried crap no matter how much they asked for it. It does seem like the state gives a lower standard of care. He was only able to eat himself to death because other people were willing to bring him the food and cook it. It is like buying a house bound alcoholic alcohol. Not illegal but bloody stupid and not in their best interests.

Nobody has answered how he could afford all this food?

Klayden - what was your reasoning for suggesting the man was supported by social care rather than the NHS?

It's frightening the level at which lay people expect the state to intervene.

Most people (the state too, and those working for it) value the prevention of unnecessary deaths, especially when death is not intentional, and an individual has requested help to get better. The state actually makes it very hard for some people to end their lives, when they actively want to do so.

If you're not sectionable under the MHA nor lacking capacity, you can eat yourself to death or slash your wrists.

You say that like it's a good thing. It's not, and it's at odds with the values of the medical profession.

As per 2Rebecca's point - would you help a close family member to do something that would damage their health and possibly kill them, particularly when the help they asked for was essentially to feed an addiction, and was at odds with their longer term goal to get better?

It is a good thing.

It sometimes creates some horrible circumstances. Please believe me there have been times when I have absolutely wished with every fibre of my being I had some sort of power to stop clients from doing the things I knew they were about to do. But other than attempting to be very persuasive there's not much.

But it's a hell of a lot better than the alternative - taking away people's right to make choices just because we decide that we know better. That gets very very dodgy very quickly because where you draw the lines is difficult.

Oh and not at odds with medical values either really, if you use the four principles as your basis of medical ethics - respect for autonomy, beneficence, non-maleficence, and justice anyway.

Respecting the autonomy of the person to make that choice is a valid ethical decision. Denial of his autonomy could cause him distress (maleficence). Allowing someone to slash their wrists perhaps might bring them relief from emotional trauma (beneficence). And if you're going to let me decide what I to have for my dinner even though I've already eaten more calories today than I need it's only just to allow others the same choice.

fakename
m.pediatrics.aappublications.org/content/120/1/e61.short
This link is to one study showing much higher rates of obesity amongst a group who had experienced sexual abuse.
Many of us can become mildly to moderately overweight/ obese through our natural propensity to store fat combined with obesogenic modern environments. However, I believe that many at the extreme end of obesity will either have some as of yet unidentified genetic anomaly that predisposes to extreme obesity or will have a psychological cause. As this article suggests past abuse can have an influence on weight in a number of ways including behavioural effects (eg binge eating) and also physiological effects (ie the influence of cortisol).

m.jpubhealth.oxfordjournals.org/content/36/1/81.short
This study suggests that multiple adverse childhood experiences gives a 3x risk of morbid obesity (BMI 40+).

However, just because a person may have psychological factors that have led to obesity, it does not mean they have a treatable psychiatric condition that could be helped through sectioning or that they lack capacity.

For those arguing to deny a person the autonomy to make bad choices, what do you hope to achieve - do you really think you would save a life? I suspect in this case he would have lost enough weight to regain control then piled it back on again. In much the same way as you could force a drug addict to withdraw but ultimately they have to be ready and willing to make some major life changes if they are not to go back to the same situation.

MiscellaneousAssortment Your story made for saddening and angering reading, I am very sorry that you went through all that. The incident you describe where you were left on the floor sounds horrific and inhumane. I'm glad to hear you have better carers now, but sorry that you had to go through all of that in order to have your wishes respected.

It doesn't matter if he was funded under continuing health care - he still gets to make his own choices. That's a red herring. My son may have his future social care funded either by CHC or by the LA. Either way, his choices should be central to his care plan. He won't be deemed to have capacity, but even then if he wants to eat something unhealthy every day he can't just be overruled by carers. Imposing a diet on someone - even when they are deemed not to have capacity isn't straightforward. It would have to
imvolve best interest meetings, & could be challenged pretty easily & would be unlikely to say ban allowing crisps & cakes for someone overweight. Even people without capacity are allowed to make 'unwise' choices. As they should be, unless you think those with disabilities are sub-human.

Misc - your case sounds horrible. The whole system is so screwed. I pay anyone employed on DP's more than they get if contracted via the council & agencies & still cost the LA les than half the agencies are paid.

saintlyjimjams
The social care point (and implied difference) was raised by somebody who works within the profession. The accounts I've read would suggest that the man was cared for by the NHS.

Mandatorymongoose
Oh and not at odds with medical values either really, if you use the four principles as your basis of medical ethics - respect for autonomy, beneficence, non-maleficence, and justice anyway.

From the BMA website (on reasons for the BMA's objection to assisted dying):

the principal purpose of medicine is to improve patients’ quality of life, not to foreshorten it.

bma.org.uk/practical-support-at-work/ethics/bma-policy-assisted-dying

As to those arguing in favour of the freedom to make 'bad' or 'unwise' lifestyle choices. There's a vast difference between supporting individuals' rights to make daily lifestyle choices (that might not lead to optimal health) and facilitating what is to all intents and purposes the addiction of somebody in extremely poor health, that will result in their untimely death.

I'm struggling to think of other examples where this would be considered a good idea and would be supported by others, including those within the medical profession. Why, for example, do medics treat people who attempt suicide, rather than leave them to die?

If you truly believe in supporting/facilitating the freedom of individuals to make life threatening choices, who here would help an incapacitated 65 stone relative (who has stated their wish to get better) to order takeaways? Who would help a family member to feed an addiction that is likely to prove fatal?

I think there are some enormous contradictions in both attitudes and practices.

You don't get it, do you? It isn't about codes of conduct nor the NHS, it's about the law. Seriously, read up on the 5 principles of the Mental Capacity Act 2005. It's written simply enough for anyone to understand. A doctor nor social worker nor carer does not have any duty or power to stop person X from making a bad choice - even if it leads to death - with capacity in a community setting.

Klayden, you've mentioned the law several times and told me I'm wrong, or don't understand - without addressing a single point, question or anomaly that I've raised. You may only be interested in the legal aspects of this case, but I think it's of little value to keep on referring to legal positions without addressing the seeming inconsistencies - professionally, legally, morally - in attitudes and practices in our society concerning preserving or ending life, depending on the circumstances and environments in which events take place.

Perhaps you'd like to show me where I've suggested that anybody has acted/should act illegally or where I've quoted the law incorrectly.

Klayden is correct fascicle. Quite simply - everyone (including those without capacity actually) have the legal right to make CHOICES. That overrides everything. And it should. If you want to make a decision that goes against someone's choice you quite simply can't if they have capacity, and even if they don't have capacity it is not a simple process.

And of course morally EVERYONE should be able to make choices. We live in a liberal country. How would you feel if you couldn't move and had some carer who decided that your cup of tea/glass of wine/bacon sandwich/packet of crisps/ was unhealthy and from now on you would only be given boiled potatoes, steamed fish to eat and water to drink. All adults (even those who are disabled, even those who lack capacity) have the right to make choices and be listened to.

Maybe he should have been an in-patient at this point in his life, but if his condition wasn't deteriorating and organs weren't failing etc then it's not so clear.

What is clear is that if you erode people's rights whilst they still have full capacity to make decisions, simply because they have to have carers... Then you are making those people second class citizens. Dehumanising disabled people is just not acceptable whatever the benevolent 'we know best' reason you give.

And my point about sharing the terrible abuse I suffred at the hands of carers is to illustrate this point:
If you take away disabled people's rights, you are agreeing that people have a right to treat them however they want.

Disabled / ill and elderly people are vulnerable enough already but if you take away their basic human rights, you are condemning them to a life of cruelty, neglect and abuse.

The man was judged to have capacity, therefore he was responsible for his own decisions .That included eating himself to death if he chose to. If that's not to your taste, well, don't eat yourself to death. But not interfering with a rational adult's choices is not about the Human Rights Act; it's grounded in the fundamental assumptions we make in this country about adult rational capacity and responsibility.

And people want to chip away at that, just because someone has carers? Honestly, MN is so authoritarian sometimes it's frankly terrifying

No it's his own fault , he's a grown man who can make his own choices.
The state is not his mum

saintlyjimjams
everyone (including those without capacity actually) have the legal right to make CHOICES.

Where have I said that people shouldn't have the right to make choices? I'm very much in favour of people making their own decisions with minimal state intervention.

I am in favour of assisted dieing - are you, and can you explain why that's illegal in our society, given the importance of choice? Or why some people who attempt suicide receive medical care against their wishes?

Someone must have actually been feeding him, putting it into his mouth - he doesn't look at though he could even lift his arms to be honest.

I can understand the point about him having right to eat that way.

But I'd see this through the lense of assisted suicide. An addict has the right to use drugs, but if I prepare the needle I can be criminally responsible?

If a parent feeds a child like this, it is neglect? If a patient demands medication that will cause harm, should a doctor prescribe it?

I think he does have the right to eat himself to death, but a carer does not have the right to assist in that death.

FakeName As soon as food has become plentiful people (and animals for that matter) have started getting fat, this has been the case all over the world and across every culture as far as I know. I am very will to be corrected on this though if I'm wrong.

I'm not sure if food is the whole picture - despite the obvious evolutionary not needing a 'stop' mechanism and craving sweet things.

Apparently, being stressed, or suffering a lack of resources or a perceived lack of resources causes the body to crave high-sugar, high-carb foods. And to cling to it and try to put weight on. So there's one factor to bear in mind when we look at the insecurity and chronic stress a lot of overweight peope live with in our unequal society...

The main point I was going to make involves rabbits . I keep rabbits, they have loads of space, interesting environment etc. If I feed them too much they just don't eat it. OTOH rabbits that are lonely, don't have enough space or stimulation often become overweight.

I've just realised there's an exception to this... one bunny would walk over hot coals to get cheap white bread - the cheaper and more plasticy the better! Even if it's frozen he sniffs it out and goes mad! (I don't eat it anymore, scarily addictive!)

So as well as life factors I think the problem is stuff that isn't really suitable 'human food'. It's not food; it's addictive substances masquerding as food!

Um saying no doesnt go anywhere near addressing his problem. Its wasnt just greed whereby someone could come in and ration his intake & voila, sorted. That would work in the short term but long term he'd still have the underlying reasons he over ate: its an emotional coping strategy in his case as he admitted it really escalated when his mother died. Long term therapy and maybe getting him to a weight safe for gastric band surgery that could be removed later once his issues were not so out of control would maybe have been the way to go. (too fat and your body cant cope with an anaesthetic/you die on the table)