Article Text
Abstract
Prader-Willi syndrome (PWS) is one of the 25 syndromic forms of obesity, in which patients present—in addition to different degrees of obesity—intellectual disability, endocrine disturbs, hyperphagia and/or other signs of hypothalamic dysfunction. In front of a severe/extreme obesity and the failure of non-invasive treatments, bariatric surgery is proposed as a therapeutic option. The complexity of the clinical condition, which could affect the long-term effects of bariatric surgery, and the frequent association with a mild to severe intellectual disability raise some ethical concerns in the treatment of obese PWS adolescents. This article analyses these issues referring to the principles of healthcare ethics: beneficence/non-maleficence (proportionality of treatments; minimisation of risks); respect of autonomy; justice. Based on these principles, three hypothetical scenarios are defined: (1) obese PWS adolescent, capable of making an autonomous decision; (2) obese PWS adolescent with a severe intellectual disability, whose parents agree with bariatric surgery; (3) obese PWS adolescent with a life-threatening condition and a severe intellectual disability, whose parents do not agree with bariatric surgery. The currently available evidence on efficacy and safety of bariatric surgery in PWS adolescents with extreme or severe obesity and the lack of adequate long-term follow-up suggests great caution even in a very life-threatening condition. Clinicians must always obtain a full IQ assessment of patients by psychologists. A multidisciplinary team is needed to analyse the clinical, psychological, social and ethical aspects and organise support for patient and parents, involving also the hospital ethical committee or, if necessary, legal authorities.
- surgery
- minors/parental consent
- clinical ethics
- autonomy
Statistics from Altmetric.com
Request Permissions
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Copyright information:
Read the full text or download the PDF:
Other content recommended for you
- Roux - en - Y gastric bypass and sleeve gastrectomy for obesity - associated hypertension
- A gastrointestinal simulation system for dissolution of oral solid dosage forms before and after Roux - en - Y gastric bypass
- Effect of Roux - en - Y gastric bypass on the bioavailability of metoprolol from immediate and controlled release tablets: a single oral dose study before and after surgery
- Prospective multicentre randomised trial comparing the efficacy and safety of single - anastomosis duodeno – ileal bypass with sleeve gastrectomy (SADI - S) versus Roux - en - Y gastric bypass (RYGB): SADISLEEVE study protocol
- Recent advances in clinical practice challenges and opportunities in the management of obesity
- Bariatric surgery: a best practice article
- An overview of the management of morbid obesity
- Changes in risk factors and their contribution to reduction of mortality risk following gastric bypass surgery among obese individuals with type 2 diabetes: a nationwide, matched, observational cohort study
- Weight regain after Roux - en - Y gastric bypass has a large negative impact on the Bariatric Quality of Life Index
- Obese patients after gastric bypass surgery have lower brain - hedonic responses to food than after gastric banding