Ethical questions about cosmetic surgery confront patients just as they do doctors. Patients have the ethical responsibility to make good decisions about their bodies, however "good" is defined, just as physicians are called to "First, do no harm," in the form of what J. Edward Hill, M.D., American Medical Association president, calls "a covenant." According to Dr. Hill, "First, the practice of medicine is, by nature, a moral endeavor that takes the form of a covenant" — a solemn agreement between physicians and their patients.
Just a few decades ago, patients had to combat the notion that undergoing cosmetic surgery might be personally demoralizing. In its most extreme form, the morality issue hinges on the question of whether or not it is wrong to surgically alter one's appearance beyond medical necessity. While society as a whole has become much more accepting, there may yet remain some resistance to the idea that surgically beautifying oneself is a reasonable action to take. This is a question that every potential cosmetic surgery patient must answer.
Nicholle, 32, Washington, says she never told a number of family members and friends about the cosmetic surgery procedures she underwent last year because she says the term "cosmetic surgery" would conjure in their minds "an image of a silicone Barbie-type woman sprawled out in a men's magazine." Nicholle had an abdominoplasty with muscle repair, liposuction to the hips and flanks, mastopexy and breast augmentation in July, 2005.She is one of six cosmetic surgery patients Cosmetic Surgery Times interviewed to explore ethical questions patients face. We explored patients' motivations, beliefs about beauty, views about appropriate doctor-patient relationships and we questioned why, overall, they feel that cosmetic surgery was the right decision for them.
Interestingly, when asked to describe a woman with a beautiful body, many of these women focused on inner qualities, someone with a "great personality or confidence" or a woman who is "well-proportioned" and not necessarily thin or with prescribed dimensions.
Christine, Deerfield, Ill., 26, had breast augmentation surgery in September, 2002. She considers how culture defines and re-defines beauty: "There are so many definitions of beauty. There's inner beauty, which to me is more important than the outer beauty. There is historical beauty — the voluptuous women in paintings with full figures, who were considered stunning and would now be considered overweight. And there is also the current standard of beauty, which I do feel is defined by popular culture: A woman in her early 20s, slender, with small hips and round perky breasts," she says.
Goals for surgery
All the women described goals that related in one way or another to identity — to the desire to feel comfortable with themselves.
Most of them described cosmetic surgery as one of several actions they understood was necessary to achieve their goals, such as proper diet and regular exercise. Furthermore, they had done careful and extensive research about their surgeries and described the realization that exercise had limitations as an impetus to pursue surgical procedures.
Carissa, 32, Ft. Lauderdale, Fla., had three cosmetic surgery procedures, including a bilateral mastopexy with breast implants in March, 2004, liposuction of the upper/lower abdomen, bilateral back, hips and flanks in December, 2005, and breast implant exchange surgery in June, 2005. She explains how weight fluctuations took a toll on her body, particularly her breast area: "By the time I was 28 years of age, my breasts looked like I had been pregnant and nursed several babies when, in fact, I had never been pregnant or breastfed."
Nicholle says her goal was to recover her "pre-baby" body. She describes working out regularly, which allowed her to be happy with her dress size but not with the shape of her body.