Case 7 Cosmetic Surgery (15-17 Feb)
Make a distinction between a procedure for restoration/therapy vs. cosmetic/enhancement and argue about what should happen in this case. Answer the questions at the end of the case, and then imagine some other medical case involving genetics --- do you feel the same way if the "enhancement" comes from genetic engineering? (We'll talk about this in a week or two...this is just a preview that there are similar issues. Don't assume that just because cosmetic surgery is rather familiar to us that it is morally appropriate. Likewise, don't assume just because genetic engineering is not familiar to us, that it is morally inappropriate).
The difference between CS for restoration/therapy and cosmetic/enhancement is basically medicine vs business. If a physician is practicing for cosmetic reasons with no medical benefit then it is strictly business. Yes, the provider is a physician doing a procedure, but it is more of a skill of art than medicine. The same can be said about reconstruction or therapy in respect to art, however it is typically due to a condition out of the patients control ie: cancer or an accident.
ReplyDelete1) I do believe it is ethically acceptable for the physician to perform surgery for cosmetic reasons, however playing into the hands of insecure or easily manipulated women can be tetoring on immoral.
2) Just like using sex to sell anything else, showing what the outcome of treatment can do for you is an acceptable and effective was of marketing. However, targeting underage girls is not ethically right.
3)I believe medicine is seen as a profession that is held to a higher moral standard. Physicians and other medical professionals are known for being trustworthy and caring for the most part.
As far as profession or business I think it should be a profession but it is ran too much like a business. Hospitals care too much about the bottom line and that always seem to be the driving force of what hospitals stress.
Deleteagreed!
DeleteAgree, I feel that is were the focus is from higher ups. The business side controls everything. Even with patient satisfaction, ultimately it is because that is how we are reimbursed. What happened to just being good people for the principle.
DeleteI think that there is a lot of issues with this. I think that there is a discount at some places such as Hooters that gives you a discount to get breast implants to make you "fit" their requirements or they make you wear different bras and give you insecurity about your body. It is all about marketing and people do just strive for patient satisfaction. However I do know a lot of good cosmetic surgeons that will refuse to make breast implants bigger than they see fit and if the patient doesn't like it they go somewhere else. I think that it is a fine line between immoral and moral, it is more about patient satisfaction and if thats what the patient wants that what the patient gets.
DeleteI do agree though targeting teenage girls is not good but we target everyone with a lot more things than cosmetic surgery like alcohol and smoking. Its everywhere.
Restorative surgery is a medical procedure whose primary function is to restore the form or the function of a part of the human body. Reconstructive surgeries include but are not limited to: Cleft lip/palate repair, frenectomy, Post-mastectomy breast reconstruction, Insertion of testicular prosthesis, removal of cancerous or pre-cancerous lesions, removal of vascular birth marks, removal of port wine stains, removal of warts and Pectus repairs. These procedures help patients to function normally either physiologically (as in enabling an infant to eat normally by repairing their cleft lip/ palate) or psychologically (by returning a body to normal form with a breast or testicular prosthesis after they have been altered by a medical condition). Restorative surgery is ethical, it is moral, it supports beneficence, non-maleficence, autonomy and justice. Cosmetic surgery for enhancement is a business to put money into the pockets of very-talented surgeons who prey upon human insecurity.
ReplyDeleteIn the case of the “Shape up for summer” advertising, the ads should be pulled.
1). While this has become an accepted norm in our society, it is not ethically acceptable for physicians to provide services that employ their medical skills for ends other than treating medical illness, dysfunction or other diagnosable condition. Medicine is to have proper goals, such as: prevention of disease and promotion of health maintenance and relief of pain and suffering. It is also held to role-specific duties like refraining from the misrepresentation of medicine, as well as unspecified clinical virtues (Miller et al, 2000). Cosmetic surgery for enhancement and an ad campaign to prey on potential “patients” does not meet these qualities.
2). It is not ethically acceptable for physicians to stimulate demand for cosmetic enhancement services with attention-grabbing ads taking advantage of people’s insecurities, especially teens. The distinction between medicine and business calls for more specialized ethical constraints in advertising, stating ads create a “demand for services not medically indicated” (Dr. Catherine Sherron, personal communication, February 13, 2016/ lecture notes September 10, 2007). People may often see this ad as physician endorsement making this procedure a legitimate, warranted procedure.
3). Medicine is not a business, it should be seen as a profession with stricter moral norms than a business would have. I’ll refer to The Hippocratic Oath to answer this. When someone becomes a physician, they take an oath to: “…come for the benefit of the sick, remaining free of all intentional injustice…” (DeGrazia et al, p.79). Very often by creating this need for surgery, in the name of business, they create illness with medical complications (infections, rejection of implants, etc.) and an enhanced mental need for one to continue to try to perfect themselves, much like creating a mental illness.
Brand-Ballard, J., Degrazia, D., Mappes, T. (2011). Biomedical Ethics 7th ed. New York, NY. MCGraw Hill.
http://www.merriam-webster.com/medical/reconstructive%20surgery
Miller, F., Howard, B. & Chung, K. (2000). Cosmetic Surgery and Internal Morality of Medicine. Cambridge Quarterly of Healthcare Ethics 9: 353-364.
The only thing I disagree with is that you could never prove that they are targeting underage girls because women and men of all ages have insecurities not just young women. Also our hospital ran and ad of a young mother playing soccer getting a total knee replacement which is completely false picture of what these patients are really like the majority of them are over 50 and obese.
DeleteThat's interesting, Alex. I never saw that ad. That would seem to be false advertisement for certain. I wonder how ethical that is if it isn't a real patient, real scenario for us? I'm guessing a pic of an older person, with a huge, bruised knee, working with therapy at a rehab hospital wouldn't be as appealing....
DeleteI agree that the main difference between restorative surgery and cosmetic surgery seems to be more the difference between a medical 'need' and a choice to 'enhance' your looks. A woman who chooses to have a breast enhancement will have to pay for it out of pocket. A woman who has had to undergo a double mastectomy due to cancer and desires to have full breast augmentation is just restoring her normal womanly body. This type of surgery is covered and does not fall under the same category. She may choose to increase her new breast size over what she previously had, that's her choice. Then the surgery could be considered cosmetic. Either way, it's a person's choice to make.
DeleteI do not agree with the "enhancement" from genetic engineering. I do not agree with genetic engineering period. I think genetic engineering violates many of the ethical codes we have studies.
DeleteI like what you said regarding the norms of society. It is! But as you dig deeper into these issues that are the norm, its ironic how many ethical dilemmas they create.
DeleteThank you, Ashley. It is amazing. I think it's less what someone else is doing to make themselves feel better, but it is then projected upon others that they have to meet these criteria as well, and they feel pressured and start to question themselves. It's almost like tearing people down versus building them up. We have to learn to love our flaws and the little things that make us different.
DeleteRestoration vs. cosmetic in some regards I view them as the same in some cases only for example in the OR when we have a patient getting a double mastectomy we implant tissue expanders which are little different then implants and then they eventually go back and get breast implants. The reason women like this because they would like to keep their feminine figure and cancer took away what God gave them. I don't believe that is any different than a female wanting bigger breasts because she would like to look more feminine. After you get a mastectomy there is no reason that you need to get implants it is a restoration procedure but it is because patients want to remain cosmetically pleasing to them or others.
ReplyDeleteI do believe it is ethically acceptable for doctors preforming cosmetic procedures and not treating medical illnesses. My main reasoning for this is because some patients may not be happy with the way they look and if it helps that person feel better or more confident I think it is a good thing for that patient. Using ads preying on the insecurities of patients and using bikini models I think is perfectly fine because I don't think it would breed confidence if the doctor used people that are unattractive that is the whole point of cosmetic surgery is to make yourself look more attractive. Also our hospital does unrealistic advertising as well. We ran an ad of a mom in her late 30's early 40's and she was playing soccer with her kids after she had a total knee replacement. This is very unrealistic advertising in reality she is not getting a total knee replacement and then playing soccer after she recovers the majority of our patients are over 50 and obese. So I feel that it is ethical for doctors to advertise in that manner. I think when it comes down to it medicine is a business although it should be a profession. Everything is driven by cost and reimbursement which is important because with out that hospitals and health care systems couldn't survive with out income although I feel that hospitals focus on this piece too much. As far as genetic engineering I don't believe we should be doing this because I believe that God has created us in his image and I know you could say that about cosmetic surgery but I don't think we should be choosing what someone else looks like before they are born. Once you are an adult I believe you have your own free will to change your body. Also we don't know what you might screw up and give a unborn child a life long handicap because you were messing with the genetics of a child just so they might have blonde hair and blue eyes.
Very interesting view point related to the advertisement question. While I do agree, the ads would probably work; I don’t think “ethically” using ads that intentionally prey on others insecurities are acceptable just as the soccer mom knee replacement add you mentioned. A more appropriate advertisement might include some realistic before and after photos. But then again, it is a business trying to succeed so whatever works I guess.
DeleteVery interesting view point related to the advertisement question. While I do agree, the ads would probably work; I don’t think “ethically” using ads that intentionally prey on others insecurities are acceptable just as the soccer mom knee replacement add you mentioned. A more appropriate advertisement might include some realistic before and after photos. But then again, it is a business trying to succeed so whatever works I guess.
DeleteI do agree that unfortunately hospitals have become a business. Many people that run them have no medical background, just business. While this seems wrong, in order for us to afford the fancy technology we use to treat our patients we need money, and a lot of it. So the better the "business" the cooler tools we get to have.
Deleteinteresting point Jocelyn! puts things into perspective.
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DeleteVery good, Alex. Interesting viewpoints with strong reasoning. I would think that the business aspect and profitability of cosmetic surgery would violate Kant's Ethics. Actions are right if they are done purely from goodwill (based on duty not consequences), not to make us feel good or bring about good consequences. The right thing should be done regardless of what profit, praise or promotion caregivers think they might receive.
DeleteOne question I have is about your comment "After you get a mastectomy there is no reason that you need to get implants it is a restoration procedure but it is because patients want to remain cosmetically pleasing to them or others.". If they are not getting larger breasts, they are wanting to just get the breasts they had restored you still think it is unnecessary? Breasts are not an added feature of a woman, they are a feature they were created by God having. They were created as a utilitarian tool to feed their babies. It's a hallmark of a woman. Often, this might be to help salvage the ability to breastfeed again (the reconstruction of the functionality of the nipple/ areola in cases it did not have to be completely severed). Out of curiosity, I would wonder if you would support testicular prosthetics in the event a male had to have his testicles removed.
The difference between a procedure for restoration/therapy vs. cosmetic/enhancement is a thin one. Although the procedure may be the same, the reasoning for those procedures are the main difference. Reconstructive plastic surgery is done to correct ravages of disease and injuries as well as gross physical abnormalities constitutes a core medical practice (Degrazia et. al., 2011). Cosmetic and enhancement surgery is typically performed on healthy bodies for the sake of improving appearance and are not medically indicated for a diagnosable medical condition (Degrazia et. al., 2001). So take for instance a nose job. One person may have the procedure to correct a deviated septum that makes it increasingly difficult to breathe and has trouble sleeping due to this condition. The patient next door is also having a nose job because she wants to look more like Barbie. I believe that although the first reason is perfectly acceptable, the second patient may have severe body dysmorphic disorder and makes it difficult to function in everyday life and is also acceptable.
ReplyDelete1. Is it ethically acceptable for physicians to provide services that employ their medical skills for ends other than treating a medical illness, dysfunction, or other diagnosable condition? It is acceptable if it ends in improvement of the health, whether it is physically or mentally beneficial to the patient. Advancements in medicine have come a long way and if it results in helping people in ways we have never been able to before and it does not break any laws or causes undo harm, then it should be acceptable. Doctors provide contraception and sterilization which do not heal, or promote health, but it is deemed medically acceptable (Degrazia et. al., 2011).
2. Is it ethically acceptable for physicians to stimulate demand for such services with attention-grabbing advertisements that may take advantage of some people’s insecurities? Physicians should not be marketing their services in a way that may thrive on someone’s self-image insecurities. They see that skinny, sexy model with large breast and no cellulite and think that is what they should look like. Young girls may see those advertisements and feel like that is what the mainstream look should be. If it is really that much of a problem a patient should actively seek out a physician. Even though the Federal Trade Commission was able to reverse the Medical Association’s ban on physician advertising in 1978, an ad that simply states that they are a plastic surgeon should be sufficient (Degrazia et. al., 2011). During the consultation the patient and doctor can review the concerns and a plan of care and surgical options may be addressed.
3. Is medicine best understood as a business or as a profession with stricter moral norms than those governing business? Medicine is most definitely a profession whose governing bodies hold us to stricter moral norms. Medicine is not just a commodity to be bought, sold or given away. The professional integrity of physicians is constituted by loyalty and adherence to an internal morality framework (Degrazia et. al., 2011). Business is not held to such high standards nor does it have stringent ethical constraints like medicine does. Cosmetic surgery may be the closest thing in medicine that works along the same lines as business. They both work in a market economy and thrive on consumer demand, but those physicians are still held to the same internal morality framework.
Brand-Ballard, J., Degrazia, D., Mappes, T., (2011). Biomedical Ethics 7th ed. New York, NY.
I had the exact same thoughts about the difference between the two. I feel like the procedures themselves are usually the same just being performed for different reasons. I struggled with the third question, so your answer did help to clarify it for me. Very well said!
DeleteI feel like the main difference between the procedures is really just the reasoning behind them. In a restoration/therapy type case such as a cleft lip or reconstruction on a burn victim is always done because of an unplanned tragedy or circumstance, whereas cosmetic or enhancement procedures are typically done for personal reasons or insecurities.
ReplyDeleteI do feel like it’s ethically acceptable for a physician to provide services other than treating illness and other medical conditions. They are qualified surgeons that are capable of performing these surgeries if they so choose to do so. These are skills that the general population cannot. Ethically, I feel if they do a thorough assessment of their patient and can determine them to be mentally capable of making a decision to alter their body, then there is no ethical dilemma. I do not however, find it ethically acceptable for physicians to advertise and the key phrase in this question “take advantage of” patient’s insecurities. There will always be a demand to look and feel better about oneself, and those individuals willing to consider plastic surgery will seek these physicians out. I don’t really know how to answer the third question, I would hope that medicine has stricter moral norms than a governing business; however, I don’t feel like I know enough about the politics of medicine to answer this appropriately.
Genetic engineering is a topic I have never really given too much thought. It is very fascinating to think that humans could be genetically engineered to possess certain traits and characteristics. I suppose I could see the pros and cons related to this subject. If “enhancement” is coming from genetic engineering, I suppose it would be very similar and could see myself supporting it. What I wouldn’t agree with would be altering genetics in the unborn to satisfy parent’s desires such as having a girl with blue eyes and blond hair. I feel like that is way too much interference with life. But if it’s a consenting adult who has decided to “enhance” her bust line with some type of genetic engineering, I feel like that’s a different situation.
Good viewpoints, Erin. As for genetic engineering, it's always made me cringe thinking of dialing in the traits and characteristics of future humans. I'm even saddened by cosmetic surgeries that take away special genetic traits (like certain nationality traits: noses, shapes of eyes, etc.). I would be curious as to what types of "enhancement" would you support from genetic engineering?
DeleteErin, I think that your comment on making sure patients are mentally capable of making a body altercation is a very good one. Just like bariatric surgery, they must undergo some form of mental evaluation. I think it would be a good idea to do the same thing for elective cosmetic surgery patients.
DeleteCosmetic surgery is largely an elective surgery that the individual chooses on the basis of vanity, no medical reasoning applies. That is why insurance does not pay for it. To answer the questions.
ReplyDelete1. socially acceptable - yes. ethically acceptable ?- that's debatable. I actually feel that its ok as long as that's what the doctor is trained and licensed to do; and the patient wants the surgery. I guess I've been ingrained in societal norms as well. I know people who have had their bags under their eyes lifted, or other minor face lift surgeries. It seems harmless, yet to go to more extremes, as you see in Hollywood, the stars undergoing countless major changes, it seems a bit excessive. This is where I feel ambiguous. When I think of a physician employing their medical skills in this way. It makes me think of the paper we did on the virtuous physician.
2. I do not believe that it is right to advertise for this type of surgery in this way, especially in the way it is done to target a specific audience as this. Young girls' self images are battered enough in leafing through a magazine.
3. Yes, I believe medicine as a profession should adhere to stricter moral norms - It's not just like any other big business.
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DeleteGood examples, Gloria. I'm going to support your stance with the application of Consequentialism. Consequentialism is based upon the ultimate values of happiness or pleasure for humans; things are to be maximized and can be instrumental or intrinsic goods. The actions are permissible as long as they maximize. In this case the maximization could be for both the surgeons and the patients. The patients will get the results, the body, the face they have wanted and feel they need to give them the confidence they need. It also benefits the surgeon financially, and I'm sure he feels good about his actions of making another feel good about themselves
Delete1. I think this goes back to the virtuous physician. The physician should be virtuous in practice. However, in today's society, the bottom line is the almighty dollar. Of course the physician is going to use his talents to make money even if it isn't to serve the sick, lame or deformed. Not ethical, but it is socially accepted.
ReplyDelete2. The old saying "sex sells" works. He is going to boost his "clientele" by sporting the sexy models. Not ethical again, but socially accepted.
3. Medicine, unfortunately has become a business. There are few morals left that are followed. Sadly, it has become all about money.
We see the almighty dollar even in the acute care hospital. I will never understand putting knee replacements in the morbid obese who will never use them. I think it may also be encouraged by the facilities to help their bottom lines. I saw that many times in for-profit hospitals.
Delete1) Yes, I do believe it is ethically acceptable for physicians to provide their medical skills for things other than medical necessity. Just because some may feel uncomfortable regarding unnecessary cosmetic enhancement surgery and is not a person choice they would make, does not necessarily mean it is not ethical. Using the Principles of Biomedical Ethics, as long as the 4 principles of Autonomy, Beneficence, non-maleficence, and Justice are respected, they person has right to have cosmetic surgery as so does the physician to provide a service of expertise. With the cosmetic surgery it may not be medically necessary, however, to that patient it is more of an emotional struggle. Not getting into some of the psychological aspects of certain cases, in general these surgeries enhance the individual’s self. If the physician is able to provide this service while respecting these principles, I do not see any ethical dilemma.
ReplyDelete2) I do not think it is ethically acceptable for physicians to stimulate demand for such procedures through 'attention grabbing advertisements'. Doing the service is one thing but flooding society with ads about how "your not perfect, so lets fix you" is not ethical as you prey on other's insecurities to gain for yourself.
3) I think that medicine is viewed as a profession with higher moral norms than those governing business. I do believe healthcare in general is a business. We are in the business of helping and saving people. As healthcare providers practicing medicine, we tend to be more compassionate and hold higher moral tendencies.
I think most of us are in agreement to this issue. Physicians should not be creating an environment were people feel bad about how they outwardly appear. It's one thing for someone to come to them for help, its another to make individuals feel inferior.
DeleteI have friends that work at St. Elizabeth that have had restoration surgery due to cleft palate and breast cancer. I understand this is a body image nursing diagnoses. I agree fully with the surgeries that they have had. I do have a harder time with those who seek treatment or surgery for what they see are inequalities.
ReplyDelete1. Who are we to judge what surgeries are necessary for those among us. I personally do not believe in cosmetic surgery for myself. Those who choose may have had something happen in their life and it affects them mentally. I know women that have gotten breast augmentation due to the fact that they were teased their whole child and teenage years for being small breasted. There is nothing wrong with the physician helping these people. We are not to judge those who choose these procedures. Most of us in the medical field now that behaviors are dictated by their peers and families. Not everyone has a good childhood and even adulthood.
2. I find it despicable that physicians would lay the ground work for their patients to feel inadequate. To place ads in the papers showing college females with big breasts is wrong. I think the MD is not following his oath that he or she took. They are putting their patients in harms way. Every surgical procedure is a risk for the patient. I saw many female patients die in Atlanta due to plastic surgery. The worst one being a butt implant that the surgeon cut through the artery and the patient bled out in the ED. The surgeon should face criminal charges and have his license revoked.
3. God may prophets and healers, Both should hold themselves to the highest standard. We all know that there are enough ill patients for the physicians to take care of. We do not need to drum up any more business. We are a profession that should be proud of what we do. We need to leave the profiteers out of the medical profession.
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