Children's Bodies, Parents' Choices
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Children's Bodies, Parents' Choices

Last October, the state of Queensland in Australia made it illegal for teenagers under eighteen to have cosmetic surgery. Other governments may soon follow. Germany is drafting a similar law, and advocates in the Netherlands are calling for one there.

The trend reflects the tremendous growth in the number of minors having these procedures—and in the number of parents who are consenting to them, paying for them, and sometimes seeking them out. In the United States, 205,119 teenagers aged eighteen and younger had cosmetic interventions in 2007, up from 145,094 in 2000, according to the American Society for Aesthetic Plastic Surgery. In Germany, about 100,000 teenagers under eighteen have cosmetic surgery each year.

Earlier generations of children and teenagers had surgery to correct abnormalities such as cleft palates and protruding ears. Nose jobs arguably fell into this category, too. Today, things are different. The goal in many cases isn't to look normal; it's to look better than normal. The bar that justifies permanently altering a child's physical nature may have reached an all-time low.

In 2007, more than nine thousand Americans eighteen years and younger had liposuction to remove body fat. Nearly eight thousand girls in this age group had breast augmentation. "Breast implants and liposuction are now bestowed by parents as graduation or birthday gifts," said an article in the Washington Post. Millions of American adults had Botox injections and soft tissue fillers to make their faces as wrinkle-free as a teenager's; one can only guess why more than eleven thousand teenagers went under the syringe.

Often it is the teenagers who want enhancing procedures. If they are underage, they must convince their parents to give consent and, even if they are not underage, to give financial assistance. But sometimes it is the other way around, with parents wanting an intervention that they think is in the child's best interest. Regardless, the decision depends on the parents.

The essays that follow look at procedures that are testing the limits of parental choices over children's bodies. Alicia Ouellette discusses "Asian eye surgery" performed on Asian children to make their eyes more like typical Western eyes. Parents who seek this surgery consider wide, round eyes to be a sign of beauty and even to confer a competitive advantage—"like having a great degree from a better school," as one woman quoted in the essay put it. Ouellette argues that it is problematic because it forever alters a feature that signifies a person's identity.

A different aspect of personal identity is the subject of Alice Dreger's essay. She presents the dilemma facing parents of young children with gender identity disorder, mainly boys who identify as girls. The options include psychological therapy to change the child's gender identity, medical intervention to change the child's sex, and in some cultures, letting the child's development take its own course.

Three of the essays revisit the terrain charted by Ashley, the most controversial case of cosmetic surgery in a child. Ashley, who has profound cognitive disabilities, underwent medical and surgical treatment a few years ago to prevent puberty, remove her sex organs, and stunt her growth because her parents wanted to keep her small enough to care for easily at home, rather than in an institution. Two of the doctors involved in the Ashley case, [End Page 14] Douglas Opel and Benjamin Wilfond, discuss other reallife examples of cosmetic surgery in cognitively impaired children. They argue that it is all too easy—and wrong—to dismiss such procedures if the psychological benefit to the parents is clearer than the benefit to the child. "[E]xploring parental motivations and clarifying parental values may be precisely what is needed before performing cosmetic surgery on children with profound cognitive impairments," they write.

Erik Parens offers some advice to parents of children with profound cognitive impairments who are considering cosmetic surgery. The insights come from children with physical disabilities who have considered cosmetic surgery and their reasons for either going with it or refusing it. Parens, a senior research scholar at The Hastings Center, led...