Cosmetic Surgery, Enhancement and the Aims of Medicine

  

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.

  

1. Jessica Laimann, 2015, Should we Prohibit Breast Implants? Journal of Practical Ethics 3(2)
2. Silver M, 2003, Lethal injection, autonomy and the proper ends of medicine, Bioethics 17(2).