Jessica Laimann wonders whether we should prohibit breast
implants (1). She proceeds to argue that we shouldn’t prohibit breast implant
surgery but then suggests we might compensate individuals who decide not to
have such surgery. She seems to be uneasy with the idea that breast implant
surgery could be a legitimate aim of medicine, I agree with Laimann that we
shouldn’t prohibit breast surgery and would and suggest that the skills of
medical practitioners might be better employed elsewhere. However, there is a
difference between what could be a legitimate aim of medicine and what we
should prohibit. Let us assume that in the future medical practitioners can
satisfy all the now commonly accepted aims of medicine, in these circumstances
could breast implant surgery become a legitimate aim of medicine? In these
circumstances could human enhancement become a legitimate aim of medicine? In
this posting I want to examine these questions.
In order to examine these questions, I must first examine
what the aims of medicine should be. The aims I am concerned with a list of
aims, such as repairing heart valves, treating cancer and so on but with aims
common to all medical procedures. It might be suggested that aim of all
medicine is obvious, to make people better. But what do we mean by better? William
Mayo expressed the traditionally held view that “the aim of medicine is to
prevent disease and prolong life, the ideal of medicine is to eliminate the
need of a physician.” Mayo’s definition might be extended to include the
treatment of injury and disability. According to the traditional view medicine
makes us better by the treatment of disease, injury, disability and the
prolongation of life. If we accept this definition then cosmetic surgery,
assisted reproduction and any enhancement, with the possible exception of life
extension, wouldn’t be things that make us better. A slightly different
definition of the aims of medicine is given by Silver.
“The proper ends of medicine are to use medical skills and
training to maintain or improve the position of the person involved, subject to
her autonomous consent.” (2)
If we accept Silver’s definition then cosmetic surgery and some
forms of enhancement might be considered as making us better. How can we decide
which of the above definitions to accept? Let us accept that medicine is a caring
profession. Let us also accept that medical practitioners should exercise their
skills to serve those interests of patients which can only be served by medical
means.
Unfortunately accepting the above doesn’t automatically
help us in deciding which of these different aims of medicine to accept.
Firstly, what is better for a patient might simply be defined as her medical interests
as defined by her doctors. Secondly, what is better for her might be partly defined by what she sees to be her interests, her subjective interests. Let us accept that
doctors should respect a patient’s autonomy. I have previously argued that a
purely Millian account of autonomy is an incomplete account, see autonomy and beneficence revisited
. I argued that a more complete account means that respecting someone’s
autonomy requires that one must sometimes act beneficently towards her by
attempting to satisfy her desires provided so doing does not harm her on
balance and does not cause me significant inconvenience. Autonomy and some
forms of beneficence are linked. If the above argument is accepted, then
it seems to me that we should accept that a patient’s interests must include
her subjective interests provided her general health interests can be easily
satisfied. Such satisfaction is difficult now but might be more easily achieved
in the future. If we accept the above it might be concluded that we should
accept Silver’s definition, such a conclusion would be premature.
Let us assume that breast implants might be in the
subjective interests of some individuals. However, it does not automatically
follow that breast implantation surgery should be a legitimate aim of medicine.
Breast implantation might damage society by sending a damaging picture of what
it means to be a woman to both to some men and vulnerable young women. In this
situation should we give greater weight to the interests of individual women or
to the interests of society? I now want to argue that the above is a false
dichotomy and that by respecting individual rights we benefit rather than
damage society. Let us accept that breast implantation does some damage to society
by projecting a damaged picture of what it means to be a woman. I now want to
argue that a ban on breast implantation surgery would cause even greater damage
to society. If we fail to respect the right of individuals to make their own
decisions, then we fail to see them as the kind of people who can make their
own decisions. This failure has two bad consequences, first we fail to truly
respect those individuals and secondly we might be accused of moral arrogance.
Even more importantly in this failure is the implicit belief that society
should shape its members’ decisions. I believe such a belief is dangerous
because it is too simplistic. Let us accept that when individual members of a
society make decisions that those decisions are partly shaped by the society
they live in. However, society both shapes and is shaped by the decisions of
its individual members. A flourishing society resembles a living entity that
evolves and changes over time. This change is in part shaped by the decisions
of its individual members. In order for this shaping to take place such a
society must be prepared to accept these decisions. Mill makes much the same
point when he suggests that the human race is damaged by silencing the
expression of an opinion.
What conclusions can be drawn from the above? Firstly, that
Silver is right and that the aim of medicine should be to use medical skills
are both to maintain or improve the position of the person involved, subject to
her autonomous consent. Let us also accept that in achieving this aim
precedence should be maintaining rather than improving the position of the
person involved if resources are scarce. Secondly provided resources aren’t
scarce then cosmetic surgery and assisted reproduction can and should be a
legitimate aim of medical practice. Lastly the above suggests that we have some
reason to accept that other forms of enhancement, of those who autonomously
desire enhancement, should be a legitimate aim of medical practice unless
compelling reasons can be advanced as to why such enhancement causes greater
damage to society than the satisfaction these autonomous desires.
- Jessica Laimann, 2015, Should we Prohibit
Breast Implants? Journal of
Practical Ethics 3(2)
- Silver M, 2003, Lethal injection,
autonomy and the proper ends of medicine, Bioethics 17(2).
