I have been pondering what is probably a non-issue ethically, but one that has niggled at the back of my mind and my consciousness for a while. A year or two back, I watched a Discovery channel special on people who have lots of plastic surgery performed. The person I remember particularly was one who they called the “Barbie woman.” She had had numerous operations, looking younger and younger and more like the Barbie doll.
Her money is hers, to do with what she wants. But what about the doctor(s) who are performing these surgeries? Do they just take the money and do what the patient wants, operation after operation? Does this satisfy the Hippocratic oath? In the Barbie woman’s case, perhaps so. She appears happy with the results and in fact has made a career and a skin care line out of it. But some women (and men) have worse results.
What about the doctors? I don’t see where they are following any of the ethical theories, utilitarianism, deontology, any of these. They are performing for pay, and appear tp be paying no attention to the concepts of beneficence, non-malificence, utilitarianism or justice. Perhaps they are serving autonomy. However, were I them, I might have a twinge of consciousness at continuing to perform operations for some people, for what most would consider diminishing returns (Michael Jackson’s nose, Jocelyn Wildenstein’s face). Are these doctors just making money? Are they performing an important service? I don’t think the case is clear.
Is this a non-issue?
Are doctors who perform elective plastic surgery in exactly the same ethical place as emergency room physicians or surgeons?
Do they feel they are doing the same type of good?
In some cases, I believe they are, but I don’t believe all cases are clear.
How do they reconcile with themselves some of the things they are asked to do?
Do they fall back on the ethical principals we are learning about?
5 comments:
If you want to see really interesting take on the ethics of cosmetic surgery, you ought to check out the series Nip/Tuck, which is on the FX cable network -- it is a fascinating in-a-can't-look-away-from-the-train-wreck sort of way. I often take clips and show them in my classes to demonstrate a particular ethical dilemma.
I think this topic is difficult because you cannot prove a negative. While some who have cosmetic surgery do suffer side effects, my understanding is that the risk is minimal so there is not an obvious breach of ethics. Gray's Anatomy did an episode on a similar topic, but with osteopathic surgery. Dr. Tores was performing a 4th joint replacement on a sixty-year-old man who was in excellent condition, but his joints just couldn't keep up with his active lifestyle (participating in several marathon, triatholon type events each yer). In most cosmetic surgery, the doctors are not doing anything as severe as replacing joints. If the doctor develops a standard of what he or she will not do (limit the number of surgeries per patient or the amount of time between surgeries, or under what conditions certain procedures are performed, etc...), and the patient insists on the surgery, I don't think there is an ethical reason to not do the surgery. However, I think you have excellent points and agree repeat cosmetic surgery does seem a bit unethical is some ways.
Living in Los Angeles where people (women particularly)treat elective cosmetic surgery like buying a new pair of shoes (a gal I recently freelanced with gushed shamelessly in anticipation about her upcoming lunchtime boob-job), it is so not a big deal here. As far as the ethics go, it hardly ever comes into play out here. If you have the money, you can find a doctor to do it.
My own position is that elective surgery is just that--elective and the choice of the patient. I do draw the line re: safety and the matter of what this patient can expect in 5-10 years in electing the surgery. I believe physicians who take the whole patient in mind when performing these procedures, as any other, would serve to make the "Barbie-doll" patient less of a possibility.
And no, no way are the risks minimal--just take a look at any woman with a failed breast augmentation, or someone suffering from breathing problems because of a poorly done rhinoplasty, or women suffering major side effects requiring further surgeries to correct vaginal cosmetic procedures. Invasive procedures are just that: invasive procedures with major risks in many cases. I've seen many proven negatives with these surgeries. The problem I have is with the perception that these are "piece of cake" procedures with no risk, and little recovery time required.
The woman getting the lunchtime breast augmentation was bragging about how she'd be back at the office "in a couple of hours, good as new". Yeah, right. Good luck with that.
But I've also had friends who've had lunchtime tummy tucks, eye lifts, lipo, and other procedures. My tummy tuck friend was back in the same boat in less than 6 months since she didn't pick up on the fact that she needed to make lifestyle changes, too. I wonder if the docs are going over all of these "minor details" with their patients before putting them on the table?
The same ethics should be in place for someone getting a midline lift as a patient having a liver transplant.
Following in the vein of the other posters in citing a reference to cosmetic surgery on television shows, Scrubs, of all shows, did an episode on a 16-year-old getting breast augmentation surgery. The girl's mother advocated the surgery, but the surgeon weighed the ethical dilemma of performing the surgery on a minor. Eventually the surgeon came to terms with the fact that the surgery was the patient's choice, after some comedic commentary on her choice as well as the surgeon's reservations. Ultimately, I view elective cosmetic surgery as the patient's choice, even though I do think that "going under the knife" when you don't have to is an absolutely ridiculous risk to take. Also-a doctor can refuse to do the surgery if s/he feels it is too much, though with plastic surgery, it may be that money talks. If one doctor refuses, the patient may easily find another doctor to perform the surgery.
Somewhat similar to this, today the New York Times published an article on "elective, preventive" surgery-regarding women at high risk of developing breast cancer having mastectomies before the disease is detected. Worth a read. I would have submitted my blog on this subject, but as a women, I am still considering all the points of the article. http://www.nytimes.com/2007/09/16/health/16gene.html?ref=health
The main aspect of this for me is the fact that it is "elective" surgery. It is the patient's choice. If the plastic surgery were performed on someone who could not consent that would be a different issue. Although there are potential adverse effects from the surgery, the "good" benefits (ie, the patient's happiness) outweigh the AEs if the surgical procedure has been documented, practiced, and the physician has been trained.
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