Solveig Hansen¹, Leonie Renelt ¹

¹ Institute for Public Health and Nursing Research, University of Bremen

Disease management programmes (DMPs) are established management tools within the German healthcare system that aim to provide structured care for chronic conditions. Despite their significance in terms of policy and healthcare organisation, ethical reflection on their normative objectives and implementation has so far been inadequate. Using the example of a planned DMP for obesity, this article examines key ethical issues that arise in relation to DMPs in general.

Obesity is characterised by high prevalence, complex biopsychosocial causes and pronounced experiences of stigmatisation, and has not yet been incorporated into standard care via a DMP. As part of an empirically informed ethical analysis, 20 guided interviews with patients on a weight-loss programme were retrospectively analysed to identify the moral requirements of the DMP. The principles of relational autonomy, care and justice served as the ethical framework.

The results show that those affected are often left to their own devices and frequently make attempts at weight loss that are not sustainable. Access to structured support services depends heavily on time, financial and organisational resources, and the coverage of costs by health insurance funds is regulated inconsistently. Furthermore, interviewees reported experiences of discrimination, emotional strain and the importance of social support.

From an ethical perspective, a DMP should be understood neither primarily as an instrument for behaviour control nor as a mere efficiency tool. Rather, the analysis highlights the normative challenges that are inherent in DMPs: programmes must promote autonomy, facilitate care and reduce rather than reproduce structural inequalities. Using obesity as an example, it is possible to demonstrate how key ethical requirements for DMPs – such as fairness in access and respect for the lived experiences of those affected – can be analytically clarified and reflected upon in practice. The study thus contributes to the ethical evaluation and further development of disease management programmes within the German healthcare system.