Aesthetics and Ethics: The Implications of Cosmetic Surgery

AESTHETICS AND ETHICS: THE IMPLICATIONS OF COSMETIC SURGERY DAVID A. HYMAN* God hath given you one face and you make yourselves another.—[1] The creed of a cosmetic surgeon: "Ifyou're happy, I'm happy."—[2, p. 110] I The pursuit of physical beauty is as old as human history. Mankind has always admired the youthful and the comely. Human beings recognize the beautiful in their own creations and in nature, but most of all each individual sees it (or its lack) in himself. The "health and beauty aids" industry reflects this absorption. We are bombarded with advertisements for pills, creams, lotions, and other devices that will smooth our wrinkles, shrink our bulges, and cure our lassitude. Until recently, though, the only way to get close to beauty was to be born beautiful or to marry someone who was. Current events have revealed a new choice— buy it. A new surgical specialty (called variously cosmetic, plastic, or aesthetic) has sprung up to fill an unprecedented but still growing demand . The common perception is that beautiful people get ahead—in life, love, and business. To look old is unacceptable. Our mortality weighs heavily enough without a reminder of our physical deterioration. The "puritanical attitude" that preoccupation with physical beauty was a sign of vanity and self-indulgence has lapsed [3, p. ix]. Supported in part by National Institute of Mental Health grant 17552-03 and the Pew Program in Medicine, Arts, and the Social Sciences at the University of Chicago. This essay received honorable mention in the 1988 Dwight J. Ingle Memorial Award for young authors. *Fellow in the Pew Program in Medicine, Arts, and the Social Sciences, Pritzker School of Medicine and the University of Chicago Law School.© 1990 by The University of Chicago. All rights reserved. 003 1 -5982/90/3302-066 1$0 1 .00 190 I David Hyman ¦ Cosmetic Surgery Implications Questions about the appropriate limits of such self-absorption are rarely raised. "If it makes me feel better, what harm can it do?" is the rallying cry of those lining up for consultation. The proponents also tout the miracle of "organopsychic therapy" where the alteration of the body "cures" the afflictions of the soul [4]. The popular media fuel expectations of miraculous results: "It can make them look better than any vitamin on the market. It's cheaper than psychoanalysis and people don't even have to work through their problems to get results. ? can do in two hours what therapy can do in five years,' says Dr. C------, a Manhattan plastic surgeon" [5, p. 44]. The trend is clear: surgical alteration of the body for the sake of beauty is accepted if not expected in many social circles. However, the rush to embrace such "youth-restoring" techniques has obscured the implications of such technology. These medical miracles have little to do with disease or sickness. They simply serve the wishes of the patient—a powerful incentive when combined with the pocketbook. That private desires might not deserve fulfillment may strike some as old-fashioned— the matter, after all, is between the doctor and his patients. Yet, it is precisely because the matter involves doctors and patients (and notjust consenting adults) that it demands closer scrutiny. Cosmetic surgery calls into question our most fundamental ideas about health, physicians, patients , and the practice of medicine. Moreover, it underlines the increasing preoccupation of our society with physical appearance. The problem is made more complex by the distinctions between different procedures performed for "cosmetic" reasons. It seems best to start with some concrete examples. 1 . Mike was born with a cleft lip and palate. Failure to repair the cleft will result in frequent ear infections and difficulty in speaking and eating . Psychological problems are common in parents and siblings. Surgery to repair the cleft requires general anesthesia and a lengthy operation. 2.Harry is a 7V2-year-old boy with ears that stick out. He is constantly teased at school. He has started to wet his bed and is getting poor marks in class. Surgical correction can be done under local anesthesia. 3.Janice is a 29-year-old, married mother of two small children. She is self-conscious...