OU on the BBC: Inside The Ethics Committee 2010 - Obesity surgery

An NHS surgeon runs a busy service offering weight loss surgery to obese patients. The NHS funds 200 hundred procedures a year, but this doesn't meet the soaring demand. Patients are rigorously assessed so that the surgeon can select those most likely to benefit from surgery and lose weight.

Many obese people believe they don't stand a chance of an operation on the NHS. Desperate to lose weight, many spend thousands of pounds on weight loss surgery at private clinics. Many have a gastric band fitted is it's the simplest and cheapest operation. But it doesn't suit everyone. Patients only lose weight if they maintain the eating pattern and diet that the band demands. And without adequate follow up and support, bands can fail and patients can gain weight.

Waiting list

Over the past few years, the NHS surgeon has become concerned by the increasing number of patients he is being asked to see needing treatment after private surgery. They've often gone to great lengths to pay for their op, and now can't afford any more care. Most weren't properly assessed beforehand and are now living with a weight loss procedure that doesn't suit them.

When patients arrive at A&E with a serious complaint the surgeon treats them. But he's increasingly being asked by GPs to see patients with non-urgent problems. Each time he treats one, he denies another on the NHS waiting list. Given the rising obesity epidemic and the paucity of obesity surgery currently available on the NHS, he knows his dilemma is only going to become more acute.

Prioritise

What should the surgeon do - should turn patients away? If not, he can't treat them all, so which should he treat? What is the most ethical way to prioritise who to treat?

Joan Bakewell is joined by her panel of experts to discuss these complex ethical issues.