Obesity as Disease and the Health Care Culture’s Take on Personal Responsibility and Suffering

Doug OlsenBy Doug Olsen, PhD, RN, associate professor, Michigan State University College of Nursing, and AJN contributing editor. Olsen regularly addresses topics related to nursing ethics. His most recent article for AJN was “Helping Patients Who Don’t Help Themselves” (July issue; free until August 15).

Why does the American Medical Association’s recognition of obesity as a disease (AMA, 2013) stir strong feelings? People are just as heavy as before, their health is suffering as much, and the therapies for obesity remain the same. The main difference is that the label may give clinicians a better rationale to seek reimbursement for obesity-related services, which might help increase treatment rates. No one yet knows if the new label will really have an effect on treatment rates; in any case, this is not what people are concerned about.

The issue is what labeling a health problem with a behavioral component as a “disease” implies about personal responsibility—or what people think it means. How does personal responsibility relate to individual suffering?

The relationship between decision making, suffering, and personal responsibility is at the heart of bioethics as it is practiced in the United States. But bioethics didn’t invent our cultural tendency to connect personal responsibility and sympathetic regard for suffering, and our current approach to the issue was developed through […]

2017-04-03T12:12:36-04:00July 11th, 2013|Ethics, patient engagement, Public health|0 Comments
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Incomplete Combustion: Crohn’s, Motherhood, a New Normal

April Gibson is an essayist, poet, and ostomate. She holds an MFA in creative writing from Chicago State University. In her writing she seeks to address and renegotiate societal beliefs about motherhood, illness as alienation, beauty as a shell. Her work is published or forthcoming in Tidal Basin Review, Reverie, The New Sound, Aunt Chloe, AsUs and elsewhere. She lives in Chicago with her two sons. 

AprilGibsonTwenty-one days pass. I am a 90-pound bag of skin. Legs like peanut butter drapes thrown over femur bones, no muscle, no pronounced curve. A lover would look past me quickly in the street. I do not want these scars, or this strange body. I want to wear a red bikini. I want a kiss on my belly.

Three weeks felt like spans of small forevers. I didn’t believe my legs and arms were mine. My abdomen sunk to a cave, save for the rustling bag. My aunt hurled the word “unconscionable” on each visit, until the hospital knew her voice. My mother, grandmother, aunts, they stayed in mornings, my little brother stayed through late nights, nodding off once the drugs snatched my eyes to sleep. So many people, one could’ve mistaken my bed for a box. I can’t remember them all, or even all the days.

The nurses were there everyday, same ones. This is their wing. The doctors came […]

2016-11-21T13:07:18-05:00June 14th, 2013|Nursing, patient experience, Patients|10 Comments
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On Its Own Terms: An ICU Nurse Considers Human Adaptability

By Marcy Phipps, RN, a regular writer for this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN. Some of the patient’s identifying details in this post have been changed to protect privacy.

by ashraful kadir/ flickr by ashraful kadir/ flickr

I caught an airing of The Shawshank Redemption the other day. It’s one of my favorite movies—full of irony and rich with messages of hope and perseverance.

There’s one line from the movie, in particular, that I love:

“Get busy living, or get busy dying.”

It’s one of my favorite movie quotes, and one that plagued me at work recently as I took care of a woman who’d suffered such a high-level fracture to her cervical spine that her injury was compared to an internal decapitation.

Her doctors had talked with her and her family at length about her injuries and prognosis, and although she’d initially indicated that she wanted to withdraw aggressive care, as time passed her directives became inconsistent—she’d tell her husband one thing, her medical team something else. On the day I was her nurse, she looked at me and very clearly mouthed the words “I don’t want to die,” then shut her eyes tight, ending our brief conversation as effectively as if she’d stood and left the room.

I think that most of the time, at least in the ICU where I work, people aren’t “getting […]

2016-11-21T13:07:26-05:00May 30th, 2013|Nursing, nursing perspective, Patients|3 Comments
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‘The Nurse Who Changed My Treatment’

By Annalisa Ochoa, for AJN. All rights reserved. By Annalisa Ochoa, for AJN. All rights reserved.

Two years ago, when I was diagnosed with advanced lung cancer in the ED of a large urban hospital, I asked a nurse if I could borrow her cell phone. Without hesitation, she handed me her Blackberry—this simple gesture was a first indication of the solidarity I’d come to feel with the nurses whose kindnesses have helped me heal.

We think it’s important to sometimes include a patient perspective in our monthly Reflections essay. “The Nurse Who Changed My Treatment,” the June Reflections essay, is by Nila Webster, who writes about the gestures by nurses, the little kindnesses and words of wisdom and encouragement, that helped her during her treatment for lung cancer and made her feel seen and understood. The essay is free, and short, so please click the link and give it a read.—JM, senior editor

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2016-11-21T13:07:27-05:00May 29th, 2013|Nursing, patient experience|1 Comment
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The Best Nurses Day Gift: Enough Time With Patients

What's Left Behind, oil, graphite, and mixed media on wood panel. 18" by 18." Copyright J. Paradisi. What’s Left Behind, oil, graphite, and mixed media on wood panel. 18″ by 18.” Copyright J. Paradisi.

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

I can’t remember which handle on Twitter asked nurses last week for their stories about the best or worst Nurses Day gifts from their employers, so I will tell mine here. It began badly, but became the best.

Nurses Day in May is a cute little rhyme. In Oregon, where I live, May also brings hay fever allergy, which is neither cute nor rhymes, but like Nurses Day, is an annual event.

I woke up on the morning of Nurses Day with a headache and my voice hoarse from allergy. Previously, I had traded shifts to work this day in place of another nurse with an acutely hospitalized family member. If she and I were playing Rock, Paper, Scissors, her need was scissors to my paper.

Calling in sick was not an option. It’s part of the unwritten Nurse’s Code, which is really more of a guideline, but don’t test it. Calling in sick after agreeing to work for a coworker will not garner sympathy from your unit.

When I arrived for work, another nurse remarked that my hoarse voice sounded sexy, like actress Kathleen Turner’s. Despite my crankiness from inadequate respiratory gas […]

2016-11-21T13:07:32-05:00May 22nd, 2013|career, Nursing, nursing perspective, patient experience, Patients|2 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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