GESTIÓN EN SALUD PÚBLICA: BioEdge: Should fat stigma be banned?

domingo, 24 de febrero de 2019

BioEdge: Should fat stigma be banned?

BioEdge: Should fat stigma be banned?

Bioedge

Should fat stigma be banned?

by Michael Cook | 24 Feb 2019 |

Fat stigma is pervasive in the United States (and other countries). In an era where stigma is a dirty word, “overweight people remain one of the last acceptable targets of humor and ridicule in North American television and film”. Some bioethicists who regard obesity as a serious public health issue have even defended it as a way of helping the population to slim down.

Writing in Bioethics, Rekha Nath, of the University of Alabama, argues that stigmatization is both wrong and wrong-headed. She tackles the question on two fronts.

The first defence of fat stigma is consequentialist. Stigma is need to reduce public health costs. But this is not necessarily true, says Nath. First of all, fat stigma leads to unhealthy behaviour like binge eating and lack of exercise. Besides, despite on-going stigma, “little progress has been made in reducing the rates of obesity and overweight in recent decades”.

The second defence is that fat people deserve to be stigmatized because they are morally blameworthy. But “As far as we can tell from available evidence, fat avoidance would imply serious difficulties for many, if not most, overweight and obese people – individuals who typically have repeatedly tried and failed to lose and keep off large amounts of weight.”

Even if some fat individuals deserve to be stigmatized, from a practical standpoint, it will be virtually impossible for public policies and social norms to be so fine grained as to adequately distinguish between those who are and those who are not blameworthy.

What consequences will repudiating fat stigma have? Nath confines herself to pointing out its injustice. But perhaps her ultimate aim is to protect fat people from discrimination on the basis of their weight, just as discrimination on the basis of race, sex, and even sexual orientation is banned.

It’s hard to think of a more volatile topic than transgender transitions for children entering puberty. The number of kids demanding puberty-blockers so that they can transition to the opposite sex is exploding all over the developed world. It’s a mysterious and poorly understood phenomenon which involves a range of bioethical issues.

Is gender dysphoria really a medical issue at all? Or is it just a waystation on a spectrum of sexualities? How do we decide? Is it ethical to offer treatments which have yet to prove their efficacy? Is it ethical to offer treatments which will have negative side-effects? How can children make decisions which will affect their whole lives without understanding the medical, sexual and psychological implications? There is enough here to fill a library with contending points of view.

But this is far from being a theoretical issue. Children with gender dysphoria are suffering now. Who is to decide how can they be best cared for? A bioethicist writing in the American Journal of Bioethics effectively argues that parents are not the best judges. (See article below.) They are in the same position as loving, well-intentioned parents who want to use herbal remedies for their child’s cancer. Doctors, backed by governments, should decide. The state has to step in to save the child from suffering and even death.

It’s a controversial, even incendiary, point of view. But that is the way the debate is heading. We can expect to hear more, much more, in the future.