Context

Cosmetic doctors and plastic surgeons around the world have reported surges in bookings for surgical and non-surgical treatments following lockdown. This also brings to focus broad ethical issues involving surgeon, patient and society as major stakeholders.

Background

• Aesthetic plastic surgery has become extremely popular. It could be due to an increase in demand by consumers.
• Some view aesthetic plastic surgery as a solution for issues in their lives.
• Active and aggressive media, which were almost absent 50 years ago, have made our society ambitious and globalized the perception of what is attractive and desirable.
• The abuse of ethical principles in plastic surgery has become more noticeable, especially where the mental and emotional state of the patient is a concern.

Analysis

Cosmetic and Reconstructive Surgery

• Cosmetic surgery is a surgical expertise that aims at correcting or improving body imperfections.
• These may be congenital, acquired, due to illness, or due to traumatic or para-physiological events such as aging.
• Cosmetic surgery also includes surgical procedures requested by patients to improve their appearance.
• In this regard, cosmetic surgery differs from reconstructive surgery, which deals with the treatment of morphological alterations that can be related to pathological conditions
• If, on one hand, the aesthetic dimension cannot be ignored in reconstructive surgery, then on the other hand, reconstructive surgery is strictly required in any cosmetic surgery.

Cosmetic Surgery being unethical

• If ethical principle of ‘first do no harm’ is followed then cosmetic surgery or any surgical specialty would be unethical.
• The patient develops suffering through several stages: the perception of the image, the processing of distress, finding imperfections, and attempting to search for possible solutions by appealing to the doctor.
• Cosmetic surgery is not available to all, based on personal finances, and therefore does not meet this ethical requirement of justice- being fair and equitable.
• It exposes patients to unneeded and unjustified risk, for example, risk of infection, risk of anaesthesia side effects, and even risk of death.
• It is wasteful of resources that could be used for better purposes, for example, curing illness, improving education, or reducing poverty.
• In the long run, it does not change other people’s opinions of you. The people who matter, if they liked you before surgery, then they will still like you after surgery.
• The key role of the body, which is fragmented and manipulated, implies the risk of objectification, both by the physician and by the patient.
• Distorts the traditional relationship between doctors and diseased patients into one between doctor and a healthy individual who deliberately chooses to undergo clinically unwarranted surgery.

Arguments in favour

• Due to the affirmation of a wider notion of health, which also includes the psychological well-being of individuals, and therefore lead to the recognition of a therapeutic function for cosmetic surgery.
• The request for an intervention that aims at improving the physical and psychological well-being of the person, therefore, cannot be labelled as a heteronomous evaluation, but needs to be considered as an expression of the full and conscious self-determination of the person
• It is also called “the surgery of the soul.” It should be noted that the effects of plastic surgery are not simply the result of the search for external perfection, implemented through the correction of a physical defect, but have consequences on individuals in their entirety, that is, body and spirit.
• Since patients are responsible for the cost of their own care, then cosmetic surgery does not affect the overall availability of health care resources.

What needs to be done?

• A full understanding of the desires of the patient, who is aware and fully accepting of the risks related to the surgical procedure
• An understanding that every surgical procedure itself, although it may be modified, cannot be reversed, and in fact results in permanent physical alteration with enduring marks (scars that cannot be completely eliminated).

Conclusion

In order to address this ethical dilemma, the contemplated cosmetic procedure needs to undergo a risk-benefit analysis collaboratively by the patient and surgeon otherwise cosmetic surgery will be recognized as ‘crazy surgery’.