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c h a p t e r f i f t e e n Appearance-Altering Surgery, Children’s Sense of Self, and Parental Love Adrienne Asch, Ph.D. I am finishing this chapter while on a group tour in another country. During dinner one evening, a member of our group turns to ask whether she is possibly breaching the etiquette of the country we are visiting. She does not expect to become a full- fledged member of the culture and will be returning to the United States in a few weeks, but she would like to make sure she does not needlessly give offense to others. Most observers of this transaction probably would believe that she is trying to be a good guest in a country but would not claim that she is “going native” or trying to “pass”; she is instead trying to learn enough of the rules to make others comfortable with her. Life in any family, group, or society requires ongoing negotiation, compromise , and at times the willingness to change in various ways to accommodate to others ’ preferences. Some changes or accommodations, however, raise disturbing questions that my traveling companion’s willing modifications of her behavior do not. In our project we have wrestled with how to assess whether parents and professionals should choose appearance-normalizing, perhaps better thought of as appearancealtering , surgery on behalf of children with atypical bodies. Here I consider many analogies and arguments that have emerged during our deliberations as I articulate my constantly evolving views about these surgeries. These surgeries are considered for people with conditions that often require nonappearance -related medical care. For people with such conditions as achondroplasia, should appearance-altering surgery be thought of as akin to other nonemergency therapeutic interventions that ameliorate the physiologic effects of impairment (e.g., surgery that might help LilyClaire “to avoid damaging misalignment and wear and tear on cartilage”)? (Hedley, this volume). Moving from interventions specific to peo- ple with impairments, is such surgery for children with atypical bodies analogous to what people with more-or-less typical bodies do when they use nonsurgical techniques (orthodonture, hair dyeing, acne medication) to make their appearance more acceptable to others? If adults can decide to undertake all sorts of medical and surgical interventions on behalf of their own appearance,is there any reason why parents should not make such decisions on behalf of their children’s futures? After all, Lindemann (this volume) reminds us that all parents directly and indirectly influence their children. Children’s lives are affected by their parents’jobs and friends,as well as by decisions made specifically on behalf of their children. If they have the financial and social resources, parents select neighborhoods, schools, or daycare options based on how they assess their children’s needs and also what they want for their children. Parents encourage some of their children’s friendships and discourage others. If parents choose surgeries as a means of helping their children with atypical bodies better fit into the world around them, are they doing anything different from what they do when they teach those same children to say “please” and “thank you,” to wear clothes that match, or to learn how to behave at meals? Having wavered,struggled,and searched my life and my soul throughout the years of this project, I can finally comment on these analogies and arguments and can offer professionals,parents,and their children something beyond ambivalence.In what follows , I question some of the assumptions leading well-intentioned people to believe that surgery for children with atypical bodies is a good solution to the difficulties children may face because of their atypicality. For many of the reasons offered in our project ’s statement on delaying surgery for children with intersex conditions (Frader et al. 2004), I urge delaying all appearance-altering surgery until children can participate in the deliberations. Parents and professionals should recognize that although they may find pleasing appearances desirable, they should not overestimate the relationship between good looks and a good life. They should also consider that routine surgery may exacerbate the societal values that make them propose changing the child’s body in the first place:an intolerance of what seems different,and an erroneous belief a child’s unusual features will render her different and inferior in all ways. No matter how many of the child’s physical features differ from what...

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