Intended for healthcare professionals

Observations Ethics Man

Bariatric surgery and justice in an imperfect world

BMJ 2011; 343 doi: (Published 02 August 2011) Cite this as: BMJ 2011;343:d4944
  1. Daniel K Sokol, honorary senior lecturer in medical ethics, Imperial College London, and barrister
  1. daniel.sokol{at}

The Court of Appeal did not, as some headlines suggest, make a moral judgment on the merits of Tom Condliff’s case

“Dying granddad loses appeal for gastric band op” read one headline. The dying granddad is Tom Condliff, 62. He is morbidly obese and has diabetes, renal failure, and various other comorbidities. His deteriorating condition has left him depressed, incontinent, and unable to shower or dress himself. With a life expectancy of less than 12 months, he desperately needs to lose weight. Non-surgical attempts at weight loss—diet, changes in lifestyle, and drug based interventions—have failed. The remaining option, given his frail condition, is laparoscopic gastric bypass surgery.1

His primary care trust offers bariatric surgery, but a criterion for eligibility is a body mass index in excess of 50. Mr Condliff’s is 43. As he was not eligible under the trust’s general policy on bariatric surgery, his GP asked the trust to consider him an exceptional case. The GP noted that Mr Condliff’s misfortunes included confinement to a wheelchair and to his home, inability to pursue his interests of attending church and playing the guitar, and being a …

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