Eyes Wide Open: Surgery to Westernize the Eyes of an Asian Child

The speaker was a proud father.¹ To illustrate his comments about a piece of art that celebrated the wonders of modern medicine (and which he had just donated to a local hospital), he told a story about his adopted Asian daughter. He described her as a beautiful, happy child in whom he took much delight. Her life, he told the audience, had been improved dramatically by the miracle of modern medicine. When she joined her new Caucasian family, her eyes, like those of many people of Asian descent, lacked a fold in the upper eyelid, and that lack was problematic—in his view—because it made her eyes small and sleepy and caused them to shut completely when she smiled. A plastic surgeon himself, he knew she did not need to endure this hardship, so he arranged for her to have surgery to reshape her eyes. The procedure, he explained, was minimally invasive and maximally effective. His beautiful daughter now has big round eyes that stay open and shine even when she smiles.

The case may or may not be unusual in the United States. While surgery to widen the eyes of children, even newborns, is reportedly common in Taiwan, Japan, and Korea, no statistics are available on its use in children in the United States. The Web site of the American Academy of Facial Plastic and Reconstructive Surgery reports that "Asian eye surgery," or blepharoplasty, is the most common procedure elected by Asian Americans, and the American Society for Aesthetic Plastic Surgery reports that more than 230,000 such procedures were performed in 2005, but since no report breaks that number down by the patient's age and ethnicity or even mentions surgeries performed on children, blepharoplasty may be performed on children only rarely.

On the other hand, no specific legal barriers block the use of plastic surgery on children, and the American Academy of Facial Plastic and Reconstructive Surgery code of ethics says only that "a member must not perform a surgical operation that is not calculated to improve or benefit the patient." A nonscientific but reasonably thorough survey of Web sites advertising Asian eye surgery revealed just one group of physicians that expressly sets a minimum age of eighteen for the surgery,² and a search of chat rooms indicates that some families in the United States have obtained the surgery for their daughters. In an article in Salon in 2000, Christina Valhouli wrote of families traveling from the United States to Taiwan or Korea to obtain the surgery, but no hard data are available on how often that occurs.

Even if such cases are relatively rare, however, they merit consideration. The intervention is distinctive because its purpose is to shape the child solely for the sake of shaping the child, not to provide a medical or functional benefit. Because the surgery is triggered by a cosmetic preference, it raises stark questions about the limits of parental choice and the failure of the current model of medical decision-making to take into account the rights of the child. In the law's existing paradigm for parental decision-making, eye-shaping is a run-of-the-mill decision requiring deference to parental choice. The case stands as a clear example of the need to reconceptualize the legal role of parents in medical decision-making to better protect children from well-meaning but misguided parents.

The Law of Shaping

Current law affords parents broad, well-recognized rights to shape their children, whether the shaping is figurative (such as cultivating a love of music or reading through early exposure) or literal (such as cultivating a lean body through limited diet and enforced exercise). Indeed, the right of parents to shape their children's lives by deciding where they will live, how they will be educated, and what values they will be taught is so fundamental that it receives constitutional protection.³ To the extent that the law gives parents the right to shape their children, it treats children "like a special kind of 'property'"⁴ over which parents have exclusive control...