AMA Journal of Ethics®

Illuminating the art of medicine

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AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. April 2010, Volume 12, Number 4: 325-326.

Medical Narratives

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Plus Seating

Questions of safety and courtesy can be raised by the presence of people of differing sizes sharing space on commercial airline flights.

Audiey C. Kao, MD, PhD

I am shackled by my frequent flyer miles. Taking a flight that is not on my “home” airline is a rare thing. On a recent business trip, I had to do just that.

As I settled into 6C, I realized that my seat space did not have the extra legroom to which I have become accustomed as a frequent flyer. A tall person, I need the few inches that economy plus seating affords me, especially on longer trips. Fortunately, this flight was going to take fewer than 90 minutes.

Learning Objective Consider the questions of safety and courtesy raised by the presence of people of differing sizes sharing space on commercial airline flights.

As the plane was about to close its doors in preparation for takeoff, a late-arriving passenger of extreme girth walked onto the plane and sat down in his row 5 seat. When he did so, I thought the seat was going to break. I thanked god his seat wasn’t 5C because its back would have severely intruded into my space, as it did on the passenger’s who sat behind him.

Should he have purchased two seats as a matter of courtesy to his fellow passengers? I had read that some airlines were requiring travelers who could not reasonably fit into their seats to purchase an adjoining seat. Is such a policy discriminatory? Supposing there are no extra seats to purchase, would such passengers have to deplane and take a later flight where an extra seat was available?

I am not sure whether it was the doctor in me or the fact that I knew we were publishing an issue of Virtual Mentor on the topic of obesity, but my attention was riveted to this individual during the flight.

He was so large that he could not buckle his seatbelt. I am not sure if the flight attendants just didn’t notice or simply ignored it as an unwritten and accepted violation of air safety rules in these situations. Supposing we had to deplane due to an emergency, as the safety video overhead was just now discussing, would this passenger slow down the deplaning process or, worse, block the exit routes of the other passengers? Can someone’s size constitute a safety hazard for others? Could an airline justifiably restrict travel of people who are obese on safety grounds? Or have they designed exit plans so that passengers who are obese do not obstruct others?

This passenger appeared to be fairly young, and I wondered whether he had seen a physician about the fact that his weight was placing his health at risk. Maybe he had seen a doctor and had already lost many pounds. Was he on an exercise plan? Was he on a proper diet? Did he or will he get bariatric surgery? Medical questions to which I will never know the answers. All I learned was that he ordered a Diet Coke when asked for his beverage choice by the flight attendant.

In a strange way, I admired him for getting on a plane. Were I his size, I would probably have been too embarrassed to be seen in public. On the other hand, social isolation can itself exacerbate behavioral patterns that contribute to obesity. Yet, I couldn’t get over how uncomfortable he looked squeezed into his seat. His abdomen reached the seat back in the row ahead of him, and he had to raise his armrest so his left leg could find some extra room in the aisle. I figured he also must have been happy that our plane trip was short.

As the flight began its descent, I slipped on the shoes I had taken off and brought my chair back to its upright position, squeezing myself back into my non-plus seat.

Audiey C. Kao, MD, PhD, is a 6-foot, 1-1/2-inch tall Chinese-American and the vice president of the ethics group at the American Medical Association.

Weight Bias in Health Care, April 2010

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