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Plastic surgery is often described by proponents of its use as "medical enhancement" but it should be viewed more properly as whether or not it is medically necessary (Miller). The question should be asked whether or not such surgery is needed for the maintenance or restoration of health. The medical enhancement approach would point out that there is a segment of society that seek plastic surgery as a method of ending feelings of alienation and embarrassment caused by some physical feature but such argument still fails to rise to the level of medical necessity. The potential risks associated with plastic surgery simply do not justify the results and it is time that the medical profession re-examine its role and refashion its position on the use of plastic surgery for purposes beyond medical necessity (Darisi). The medical profession must determine for itself whether it is appropriate for it to provide services that have little or nothing to do with issues of health. It must decide whether or not they should be involved in cosmetic surgery.
The discussion over the issue of the medical professions role in cosmetic surgery is not a new one. It has been discussed for decades and parallels the development of improvements in plastic surgery. Over the past fifty years the specialized field of plastic surgery has grown into a highly respected field that performs wonderful procedures but has also, along the way, created an industry whose focus is directed toward vanity (Haiken).
As plastic surgery has become more and more oriented toward altering the appearance of individuals the debate over the role that medical practitioners should play in the process has intensified. The traditional view is that health care professionals should not participate in the process that essentially satisfies fads and fashions and involves significant medical risk without providing any medical benefit. Supporters for cosmetic surgery, however, ask why medicine should not be involved in the process of providing a little bit of pleasure? Why should medicine only concern itself with alleviating pain?
Cosmetic surgery, as opposed to other forms of surgery, directs itself toward alleviating concerns that individuals have regarding some form of social attitude or norm that states that a certain part of one's appearance demands alteration (Wolgemuth). Patients seeking such treatment have developed an attitude or belief that their appearance must conform to some value or aesthetic norm or else their entire existence is compromised somehow.
Few would argue that cosmetic surgery used to alleviate a condition that causes an individual to become the subject of ridicule or to becoming ostracized by society is a proper subject for treatment (Harris). Facial birthmarks or features that detract from one's appearance such as badly protruding ears or cleft palate can lead to a socially difficult life and seeking cosmetic surgery under such circumstances is understandable. Certainly there is little question as to the morality of physicians taking part in such surgeries. The pain and anguish felt by those afflicted with such conditions is every bit as real as someone suffering from a broken leg or an ailing gall bladder.
The moral question arises when someone seeks cosmetic surgery for the sole purpose of enhancing one's appearance. Whether it is breast augmentation, botox injections, or a face or brow lift, such procedures are entirely elective and serve no other purpose than the enhancement of one's appearance. The question becomes whether or not it is within medicine's purview to pass judgment on the use of such procedures (Sullivan). There is a school of thought that states that performing surgery is not to agree with the values of the patient but that a surgeon must simply respect the right of his or her patient to make an independent decision. Society, in general, may pass judgment on such decisions but it is not the responsibility of the physician to do so.
There is, however, a strong argument against this form of moral detachment. It contributes to the promotion of the superficial values such as possessing larger breasts and attempting to look younger than one is. The issue is not just the physician's responsibility to his or her individual patient but, more importantly, to society at large. The issue of whether or not it is morally acceptable for the individual to decide that he or she wants these enhancements and is willing to accept the antecedent risks involved is a personal one but the decision of the medical profession to participate in this process is a much broader one.
There is a strong argument to be made that the medical profession in general and plastic surgeons, in particular, have sold out to the pressures of society that favor looking younger, sexier, and more appealing (Berer). In the process, the role of the physician as counselor and advisor has been sacrificed and the risks inherent in any surgical procedure have been ignored.
The medical profession, by ignoring its responsibilities to society in general, has essentially endorsed the morally suspect practice of cosmetic surgery. It has essentially endorsed the shallow norms and practices that encourage the creation of some ideal physical image that everyone in society must try to achieve and that endorses the use of medical science to accomplish this goal. The medical profession has done this with earnest as it has adopted the use of widespread advertising to create demand for its services, of failing to adequately explain the risks involved and overemphasizing the advantages, and actively encouraging patients to consider other procedures than the ones originally contemplated by the patient. When physicians suggest post advertisements that play to women's anxieties that anything above a size four is undesirable or anything below a D. cup is too small the profession has endorsed morally suspect values and norms. Endorsing such values and norms by participating in such procedures is deplorable but placing the profession in the position of garnering huge profits as a result of such promotion is reprehensible.
At this point it can be argued that one of the reasons that individuals seek a career in medicine is to make money and that there is nothing morally corrupt in doing so, however, doing so by performing surgeries in order to accommodate morally suspect norms for the purpose of personal gain is a different issue. The medical profession has involved itself in the proliferation of suspect norms and values but has also placed itself in the position of profiting from such system but also invested itself to the point where the profession actively promotes its continued operation.
What has developed in the United States is a significant portion of the medical profession dedicated to promoting the enhancement ideals that present the Barbie doll ideal of beauty. These medical practitioners have essentially sided with that segment of society that promotes this imagery and, in the process, these practitioners have abandoned their other ethical responsibilities.
This is not to say that every cosmetic surgeon has adopted this position. There are a great number of cosmetic surgeons that have proper motives for practicing their profession. These individuals have adopted standards that belie the promotion of physical enhancement for purposes of attaining social ideals of beauty and they have ignored the social pressures to develop a practice directed at profiting from such procedures. Instead, such professionals have dedicated their career toward using their skills for performing reconstructive surgery in cases involving disfiguring conditions. These are surgeons with finely developed moral compasses and who appreciate the role of a physician in society.
The issue of cosmetic surgery is a sensitive one. There are arguments on both sides of the issue but special concern must be given when a respected profession like medicine participates in an activity that promotes suspect norms. The field of medicine must examine what role it wants to take in contributing to the creation of ideals and perceptions that are highly superficial. There is strong evidence that this is exactly what has occurred in the past several years as cosmetic surgeons have not only provided the means for performing enhancement procedures but have actively engaged in encouraging the misdirected norms and values that have made having these procedures seem necessary.
Physicians actively engaged in the field of cosmetic surgery are faced with a difficult task in determining what their responsibility should be regarding performing certain surgical procedures. Such physicians must balance their relationship with the patient with their collateral responsibility to society in general. Unfortunately, at the present time there appear to be too many physicians involved in the field of cosmetic surgery who are profiting greatly by actively promoting the suspect values and norms that place too high a value on one's appearance and too few physicians practicing who help their patients by exploring other options and speaking out about the pressures women feel to conform to the Barbie doll look. These are the important options available to the profession and the options that must be addressed in order to protect the ethical integrity of the profession.
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