The Ethics of Plastic Surgery Funding Based on the Reason for Surgery and Other Factors: A Literature-Based Briefing
Since the beginnings of recorded history at least, and indeed even earlier from what archaeologists have been able to ascertain, human beings have been obsessed with their own bodies. This is evident in the earliest works of art and in some of the earliest texts, and can also be seen in certain early practices of ancient civilizations that had identified specific features and/or proportions as more aesthetically pleasing than others and worked to achieve greater compliance with these standards of beauty through artificial means. These means were not limited to make-up, haircuts, and clothing, either, though all of these were employed by many ancient civilizations as a means of enhancing aesthetic beauty for both males and females, but in fact more permanent modifications were also made to the body.
In the modern era, such modification has, through a serious of cultural developments and trends, landed under the auspices of the medical community. Plastic surgery is capable of both subtle and drastic changes to the shape and appearance of the human body and pretty much any of its individual features. The ethics of funding this plastic surgery either through public health programs or even private insurance dollars remain in serious question, however, especially when plastic surgery is sought due to issues with self- image or for purely cosmetic pursuits. This literature brief will examine current research and commentary on the issue in order to develop an understanding of current perspectives on the ethics of plastic surgery and its funding.
There are, of course, many individuals that seek plastic surgery not for purely cosmetic reasons, but to correct certain damage that has been done that is both structural and aesthetic in nature, such as dysmorphia caused by auto accidents and other damage. Research has shown that disfigurement or dysmorphia is often accompanied by psychiatric maladies, and that correction of dysmorphic issues through plastic surgery can be highly beneficial, making the funding of such plastic surgery far more ethically certain (Castle et al. 2004). Medical practitioners and plastic surgery patients that had suffered some form of dysmorphia prior to their surgery also reported observations or experiences of improved attitude and outlook, and lifting of depressive states (Achauer et al. 2000). This strengthens the conclusion that the funding of plastic surgery is ethically warranted in cases of dysmorphic correction.
Of course, the improvement of mood and/or feelings of happiness are not enough in and of themselves to clarify the ethical issues surrounding plastic surgery and its funding. Many individuals report a great deal of enjoyment and satisfaction from plastic surgery even without prior dysmorphia, and can even become addicted to it (Papel 2009). This has led some in the medical, psychological, and social research communities to view plastic surgery as impairment-inducing or enabling rather than truly beneficial in many instances, and especially in most cosmetic undertakings (Kirzek 2002). These findings cloud the non-dysmorphic plastic surgery issues even further, as there are both individual benefits and significant drawback to these procedures.
Cultural pressures also exist regarding body modification, and while these are a major factor in influencing individual feelings about appearance that might drive some to repeated cosmetic procedures under the operating scalpel, they also act in different and independent ways that are less strictly concerned with aesthetics and concepts of beauty (Kumar & Zhang 2010). May procedures are performed not to achieve a culturally dominant standard of beauty, but in order to look how an individual feels culturally pressured into thinking they are "supposed" to look (Kumar & Zhang 2010). These pressures combined with aesthetic pressures have led to what some have dubbed the "colonization" of women's bodies, as women are (in most cultures and perhaps especially in the Western/European culture of the modern era) most often the gender more pressured to fit certain visual standards (Morgan 1991).
An examination of the cultural issues surrounding plastic surgery reveals that while similar practices have exited in many societies, they have rarely become as pervasive or as extreme in their ongoing nature or effects on health and psychology as they are in the current are of Western civilization (Davis 2003). Many in the medical community largely regard cosmetic plastic surgery as something of a bastardization of medical training and knowledge, and even an improper use of medical school space and an individual doctor's knowledge and skills (Munson 2007). Seen in this light, it would seem clear that public funds and pooled insurance dollars should not be used to fund cosmetic and even culturally-encouraged plastic surgery, as these tend to perpetuate rather than solve problems.
The question is still not quite that simple, however, as there are some instances that seem to fall between cases of true dysmorphia and purely cosmetic pursuits. Recently, for example, new methods for reducing the signs of aging in skin -- wrinkles, reduced elasticity, "age spots" and other discolorations, etc. -- have emerged that employ certain surgical techniques in addition to a dermatologists usual repertoire (Ringel 1998). Is this a worthy pursuit for medical professionals, or for tax funds? Or should this type of plastic surgery be seen, if not as a purely cosmetic or a purely corrective feature, as a type of "medical enhancement" that contributes to personal well-being and potential prosperity, yet cannot be considered a restoration of natural elements and functions as can other medical procedures (Little 1998)? These are the questions that still persist, and the reason that further reflection is necessary on the issues involved before a determination is made in this matter.
The literature certainly presents a broad view of the ethicality of plastic surgery and its funding, demonstrating the multitude of perspectives that exist on this issue and the complexity of their interaction. While the issue seems rather clear-cut when it comes to cases of dysmorphia, it is less clear whether or not plastic surgery procedures should be performed without such direct and medically warranted impetus for a surgical intervention. There is potentially some good that is accomplished through plastic surgery even on a purely cosmetic basis, including the potential for increased economic productivity, and improved happiness is certainly a laudable outcome for most endeavors.
At the same time, the happiness that is derived from plastic surgery procedures is, for many individuals, a temporary feeling, and can lead to repeated visits to plastic surgeons for multiple procedures. Real addictions can develop fro cosmetically-minded plastic surgery seekers, making any public involvement in the procurement or funding of cosmetic plastic surgeries a potential complicity in a medical nightmare. There are also other complicating factors in determining the ethicality of plastic surgery and its funding, such as procedures that do not fall clearly into one category or another in terms of cosmetic or medically warranted, and in terms of culturally pressured plastic surgery. These instances represent somewhat specialized cases, but go directly to the heart of the question as to what plastic surgeries are warranted and in what specific situations there is a civic responsibility to fund them.
Cultural motives for plastic surgery tend to be more normative impulses, and in certain instances can drastically impact the way a person is perceived in society and the ways in which they perceive themselves. Some scholars see this as evidence of continuing social ills while others see it as the outcome of certain natural human tendencies, but regardless of which perspective is taken the effects have been empirically observed. Other similar quandaries exist in regards to issues such as the surgical correction of certain features of aging, which can also dramatically alter societal and self-perception for the better. A careful weighing of the benefits and potential personal and public detriments must be made in these cases in order to derive fair and balanced judgments that are indicative of current societal values.
Given the current findings in the literature on the subject, it is clear that plastic surgery for the correction of dysmorphia should be treated as any other medical procedure, and accorded the same prioritization in funding and the provision of public access. It is only slightly less clear that plastic surgery for purely cosmetic purposes should not be funded by the public in any way, and in fact that physicians have an ethical duty to ensure that over-use f plastic surgery for cosmetic reasons does not develop into an addition or otherwise detrimental condition for their patients. When it comes to less clear-cut motivations for plastic surgery, it is recommended that further research into common specific occurrences in these ethically grey areas be conducted, and in the meantime that cases are reviewed by appropriate medical staff before determinations are made as to the advisability of the surgery itself and the level of duty incumbent upon society to secure the provision of a surgical procedure.
Body modification has existed for many millennia, and will doubtless continue for as long as human beings have bodies to…