Bariatric Surgery and Consent

This continues the previous post, which introduced a description of patient Elizabeth Wolinsky’s bariatric surgery, as related by journalist Colleen de Bellefonds. She writes,

For a week after gastric bypass surgery, many patients have a bag hanging outside of the body connected to a thin tube attached to the stomach; this allows any excess fluids to drain from the abdomen… And every day you have to clean it, Wolinsky says. “It’s excruciatingly difficult. It’s such a gross and painful feeling, knowing it’s attached to an organ in your body and you can see it.”

After surgery, the patient will need to sleep in a semi-sitting position for quite a few nights. Then, she or he can never again take non-steroidal anti-inflammatory medications, and will always be more susceptible than a normal person to the effects of alcohol. It will always be necessary to drink a lot of water, and kidney stones might develop. The desire to eat will probably be as strong as ever, and giving in to that impulse causes physical pain.

Despite all the enormous expense, work, and pain involved in weight-loss surgery, the potential is there to go ahead and overeat anyhow, to the point where additional surgery might be needed to repair the damage. There is strong suspicion that the microbiome is adversely affected. This point would not apply so much to small children, but a teenager who previously attempted or seriously contemplated suicide might be at greater risk, especially if there is a history of sexual abuse.

And what about the children?

Imagine explaining all this to a child who has barely learned to read, and expecting true comprehension of how much “compliance” will be required next week, next month, next year, and in all the succeeding years on earth. Where is the motivation expected to come from? Is that seven-year-old supposed to get all enthusiastic about slimming down to attract their soulmate?

What if the adults in this child’s life have been in the habit of motivating good behavior with treats? You can hardly tell a kid, “Stay on this special eating regime and you can have a bag of chips and a soda every night — oh wait, we can’t do that anymore.”

What seven-year-old is able to understand the risks and benefits, or has the stability, self-efficacy, resilience and coping resources to be a perfectly conscious and responsible human being? As for current stressors, a typical child is hardly in a position to even pinpoint them, much less do anything about them.

There is no way a 13-year-old who just wants to not be made fun of is going to be able to give informed consent and understand what the surgery really means.

Those are the words of Dr. Charlie Seltzer, a weight loss specialist from Philadelphia who, while willing to make an exception for a teen with heart disease and diabetes, is generally not a fan. Children lack medical autonomy, as they should. That’s why they have parents or guardians to be their proxies in legal matters.

In the case of a minor child, what the guidelines really mean is that the parents need to have the qualities described. Are they fooling themselves? If the parents are so woke, how did things come to this pass, anyway? If the patient really has such an admirable support system, how did the situation ever become so dire?

Dr. Seltzer told journalist Kristen Fischer,

A teenager (and his or her parents) will probably see the surgery as a magic cure-all and be likely to gloss over the negatives and overplay the benefits. I have a real problem with a teenager even being offered bariatric surgery as an option unless it truly is a last resort.

Dr. Pretlow says,

Bariatric surgery is major surgery that radically and permanently changes a child’s anatomy. Can a teen, much less a pre-teen, genuinely consent to such a life-changing procedure?

In considering this, for comparison purposes, we look at research from the University of Iowa, where 485 credentialed and experienced social workers were asked about age and responsibility:

A survey presented at the Academy of Pediatrics annual conference found that a majority of social workers believe children should be at least 12 before being left home alone for four hours or longer…

[I]f the child is under 10 […] the majority of those surveyed would call it neglect.

[F]our-fifths agreed it should be illegal for children under 10 years. A smaller percentage would categorize it as neglect even if the child is 12 or 14.

(To be continued…)

Your responses and feedback are welcome!

Source: “9 Things I Wish I Knew About Gastric Bypass Surgery Before I Had It,” WomensHealthMag.com, 01/18/17
Source: “Should Children Have Weight Loss Surgery?,” Healthline.com, 01/09/18
Source: “When It’s OK to Leave Your Child Home Alone, According to Social Workers,” Parents-Together.org, 11/07/19
Image by Open Grid Scheduler/public domain