Surgically Shaping Children

Surgically Shaping Children contains 16 essays divided in four parts and held together by one overarching theme: the tension between two parental obligations toward children with non-normal appearances. The essays are written by philosophers, bioethicists, psychologists, surgeons, pediatricians, legal scholars, and social scientists as well as by individuals with a non-normal appearance. The first part contains four essays from a first-person perspective describing what it is like to have, or to be a parent of someone who has, a non-normal body; the second part offers general philosophical reflections on having such a body and the use of surgery to reshape it; in the third part, medical professionals reflect on their practices and report some results from their empirical research; and, finally, the fourth and most practical part is devoted to different aspects of decision making. It closes with a kind of open letter, wonderfully written by Alice Dreger, who gives thoughtful, encouraging, and deliberately undramatic practical advice to parents of children with non-normal looking bodies.

Despite the fact that the essays are all focused on the same topic, they are neither conspicuously overlapping nor repetitive; rather they display a rich and fruitful diversity of perspectives, opinions and styles, ranging from the detached academic to the poignant and personal. If you have a strong formalistic bent, you may object that, when taken together, these essays are not wholly consistent, but if you are more interested in the subject matter than in formalities, you will find that they faithfully reflect our ambivalent attitudes about whatever deviates from a norm. As Cassandra Aspinall, who was born with a cleft lip, writes in her contribution about living with a non-normal appearance: "If this seems confusing it's because it is: welcome to my world" (p. 20). As a result, Surgically Shaping Children is a versatile, thought-provoking, even somewhat unsettling collection of essays—and that, of course, is meant as a compliment.

In his introduction, Eric Parens sums up the only two conclusions all the contributors could agree on. The first one is that children with non-normal appearances must, whenever possible—and it is possible from a much younger age than is commonly supposed—be included in the decisions about surgically changing their bodies. Nothing is more detrimental to the relationship between parent and child than secrecy and the breach of trust it implies. Secondly, children must be assured of their caretaker's unconditional love. What, then, does unconditional parental love require? What it requires in actual practice remains to be seen, but what it is ideally supposed to require can be gathered from Dreger's ironic description: "Now, American parents like you find themselves the subject of two daily dicta. The first is that you should do everything you can for your children—braces, tutors, antibiotic soap, organized soccer and baseball, cushy car seats with juice box holders in behemoth SUVs. The second is that even when (especially when) the world rejects your children, you should accept them just as they are—nerdy, gay, dreamy, homely" (p. 254). In other words, it requires parents to shape their children and to let them be, and that brings us to the overarching theme of the book: the tension between letting children unfold according to their own capacities—to let them be—and secondly, promoting their flourishing—to shape them.

If the goal of medicine is to alleviate suffering, the goal of shaping children surgically should be to alleviate their psychosocial suffering by minimizing the stigmata of their deformity. But several authors also mention another less obvious aspect of this kind of surgery: by normalizing non-normal appearances, surgery transforms bodies and thereby identities. So the question arises whether parents should use surgery as a means to change appearances when that might involve changing children's identities as well. Aren't they in danger of giving their children more than they have bargained for: a better life at the price of becoming inauthentic? Aristotle, for one, was convinced that that would be too high a price to pay for a good life: "Being is a good thing for the good person...