Living in Scotland, our civil law (known as "delict") provides that a "victim" to harm must ensure that they take sufficient and proactive steps to both minimise and prevent harm, otherwise they face the very real possibility that their claim is denied or at the very least, severely restricted. A person who contributes to their own harm, excaberating the degree or severity of harm that they suffered in the first place is said to be guilty of "contributory negligence" and therefore their claim is reduced on a proportionate basis.
Therefore, a person who owns a bookstore and hires the services of a plumber to fix a leaky tap, and then finds the place flooded will not be able to reclaim as much in the way of damages if they subsequently left the books to fester.
Associated with this is the notion of "volenti non fit injuria", a Latin maxim which translates as: "Harm does not befall one who is willing." This is the doctrine whereby a person who actively engages in a risk, does so fully aware of the potential and actual risks and therefore has given their consent tacitly as a result. Again to use an example, a smoker under this doctrine who knew that the smoking of cigarettes would place them at risk of contracting a particular health condition would find themselves defending such a counter claim.
In relation to obese patients then, from this perspective there is compelling evidence to suggest that they are indeed responsible for their own problems as well as to the severity of them. However, it is crucial that we do not mistake cold hearted pragmatism for outright discrmination which is certainly not what this author is trying to suggest in any shape, way or form.
Emmaneul Kant identified what he called the "Categorical Imperative", a philosphical construct whereby if a particular action can be applied universally, then it is moral.
If we take the argument that "Obese people should be denied coronary surgery because they are responsible for their own ill health" and then apply it in a global sense, this then would mean that ANYONE in the world, who contributed to their own ill health, IRRESPECTIVE of the degree to which they so did so, should also be denied treatment. We live in a society where risk and calculated dangers are evident. Using this perspective then, does this mean that a professional taxi driver or typist should be denied treatment to relieve arthitis that they have contracted after years of strain on the same joints? That people who work with dangerous chemicals who develop lung cancer and other breathing disorders should be denied treatment on the same grounds?
Our health care system is intended to be democratic and accessible for all. I feel then, that not only should obese patients be rightfully entitled to coronary bypass surgery, but that they should also be entitled to counselling in order to allow them to overcome their compulsive eating.