Why would a doctor let his patient take on a risk that he isn't willing to perform? Patients should not get 100% say in their treatments. If there's a high mortality rate for something as trivial as knee pain, then the compassionate thing would be to refuse that operation and look at alternatives like pills or physical therapy. Having that person's family deal with 'suicide by doctor' is a non-starter here. This is like saying mechanics should respect the wishes of people who want to output their exhaust into the cabin. Afterall, the customer is always right!
Also, people in pain aren't terribly rational and don't make good decisions. Doctors should be the gatekeepers here on a certain level. I shouldn't be able to demand surgery willy-nilly and expect doctors and surgeons to act like a concierge service. Surgery is a serious risk and no one is going to casually perform malpractice here. Worse, knee repair is a tricky thing. If your knee can't support 300+lbs then a repair is only going to be a temporary solution until you damage it again, which will probably be soon after. We're not engineered to handle these kinds of loads, thus the weight loss recommendation.
I don't know anyone who would disagree with this sentiment. And the article doesn't present any evidence that there are blanket refusals. Sure, the article presents a few anecdotes, but that's not enough to show that blanket refusals are happening on a larger scale.
> You can inform people of the increased risks and possible outcomes and let them make their own decisions about their bodies.
It's really not that simple. A medical doctor's mission is to help people and very specifically to "do no harm". When the data suggests that they are more likely to do harm by operating, then the doctor is following their oath by not performing a surgery.
"A recent survey of more than 700 hip and knee surgeons confirmed Dr. Yates’s impressions. Sixty-two percent said they used body mass index scores as cutoffs for requiring weight loss before offering surgery."
It sounds to me like "cutoffs" and "requiring" would indicate a blanket refusal, and 62% seems like a fairly large scale to me. What evidence are you looking for?
Other common conditions can also increase risks of complications, and patients are routinely given opportunities to weigh those risks before deciding on surgeries. My suggestion isn't that the doctor throw his duties out the window, but that with high-BMI patients, those duties should not suddenly become more dictatorial than with other patients.
"But there should not be blanket refusals to operate on fat people, the committee wrote. Those with a body mass index over 40 — like a 5-foot-5-inch woman weighing 250 pounds or a 6-foot man weighing 300 — and who cannot lose weight should be informed that their risks are greater, but they should not be categorically dismissed, the group concluded."
It's really simple. You can inform people of the increased risks and possible outcomes and let them make their own decisions about their bodies. The article here is not saying that doctors should ignore weight as a factor, but that they shouldn't make decisions to deny or provide care based solely on BMI.