Ethical and Policy Questions re Ideals of Beauty, Cosmetic ...

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Ethical and Policy Questions re Ideals of Beauty, Cosmetic ...

  1. 1. Ethical and Policy Questions reEthical and Policy Questions re Ideals of Beauty, CosmeticIdeals of Beauty, Cosmetic Surgery, and ObesitySurgery, and Obesity Martin T DonohoeMartin T Donohoe
  2. 2. Ethical and Policy QuestionsEthical and Policy Questions  What roles do culture, the media, sexism, andWhat roles do culture, the media, sexism, and racism play in individual and public perceptionsracism play in individual and public perceptions of beauty? Individual and collective perceptionsof beauty? Individual and collective perceptions of ideal body weight? The response of society toof ideal body weight? The response of society to outliers and development of pathologicaloutliers and development of pathological behaviors? The desire for cosmetic surgery?behaviors? The desire for cosmetic surgery?
  3. 3. Ethical and Policy QuestionsEthical and Policy Questions  Is aging defined as a physical and/or mentalIs aging defined as a physical and/or mental illness? If so, is the substitution of happiness forillness? If so, is the substitution of happiness for health an appropriate goal for cosmetichealth an appropriate goal for cosmetic enhancement? Does this enhancementenhancement? Does this enhancement constitute medical treatment? Or is cosmeticconstitute medical treatment? Or is cosmetic surgery simply a business service provided tosurgery simply a business service provided to those who desire it, can pay for it, and arethose who desire it, can pay for it, and are willing to accept the risks involved?willing to accept the risks involved?
  4. 4. Ethical and Policy QuestionsEthical and Policy Questions  How do providers and insurers defineHow do providers and insurers define medical necessity as it relates tomedical necessity as it relates to cosmetic surgery?cosmetic surgery?
  5. 5. Ethical and Policy QuestionsEthical and Policy Questions  A sizable minority of physicians admits toA sizable minority of physicians admits to "gaming the system" by manipulating"gaming the system" by manipulating reimbursement rules so their patients can receivereimbursement rules so their patients can receive treatments or undergo procedures the physiciantreatments or undergo procedures the physician deems necessary. How often do cosmeticdeems necessary. How often do cosmetic surgeons "shade the truth" in attempting tosurgeons "shade the truth" in attempting to obtain coverage for services they perceive to beobtain coverage for services they perceive to be necessary for their patients?necessary for their patients?
  6. 6. Ethical and Policy QuestionsEthical and Policy Questions  How much revenue-generatingHow much revenue-generating cosmetic surgery is too much forcosmetic surgery is too much for underfunded, university dermatologyunderfunded, university dermatology (or plastic surgery) departments? What(or plastic surgery) departments? What are appropriate arrangements for usingare appropriate arrangements for using such revenue to cross-subsidizesuch revenue to cross-subsidize indigent care?indigent care?
  7. 7. Ethical and Policy QuestionsEthical and Policy Questions  To augment lagging revenues and offsetTo augment lagging revenues and offset budget deficits, states have begun taxingbudget deficits, states have begun taxing cosmetic procedures; New Jersey's levy iscosmetic procedures; New Jersey's levy is 6%. Should cosmetic surgery be subjected6%. Should cosmetic surgery be subjected to the same sort of consumption taxes asto the same sort of consumption taxes as cigarettes and gasoline?cigarettes and gasoline?
  8. 8. Ethical and Policy QuestionsEthical and Policy Questions  Many endocrinologists treat short-Many endocrinologists treat short- statured, non-growth hormone-statured, non-growth hormone- deficient children with growthdeficient children with growth hormone. Is it appropriate for parentshormone. Is it appropriate for parents to consent to such "treatment" and forto consent to such "treatment" and for physicians to offer it?physicians to offer it?
  9. 9. Human Growth HormoneHuman Growth Hormone  Provision of growth hormone mayProvision of growth hormone may augment height and enhance socialaugment height and enhance social acceptability (and ability to make theacceptability (and ability to make the basketball team), but can carry potentialbasketball team), but can carry potential long-term side effects such as diabetes andlong-term side effects such as diabetes and hypertensionhypertension  ““Treatment” requires six injections perTreatment” requires six injections per week for 4-5 years at a cost of $20,000/yrweek for 4-5 years at a cost of $20,000/yr
  10. 10. Ethical and Policy QuestionsEthical and Policy Questions  Should surgeons correct the physiognomy ofShould surgeons correct the physiognomy of children with Trisomy 21, giving them achildren with Trisomy 21, giving them a "normal" appearance while leaving their"normal" appearance while leaving their underlying neurologic defects and distortedunderlying neurologic defects and distorted voices unchanged? How will such surgery affectvoices unchanged? How will such surgery affect their emotional development and integrationtheir emotional development and integration into society?into society?
  11. 11. Ethical and Policy QuestionsEthical and Policy Questions  What cosmetic procedures areWhat cosmetic procedures are acceptable in consenting adolescents?acceptable in consenting adolescents?
  12. 12. Ethical and Policy QuestionsEthical and Policy Questions  Should cosmetic surgery be used to transform racialShould cosmetic surgery be used to transform racial characteristics, by (as one author put it) "transforming acharacteristics, by (as one author put it) "transforming a Black nose into an aquiline nose better befitting aBlack nose into an aquiline nose better befitting a British butler," or by rounding off the eyelids ofBritish butler," or by rounding off the eyelids of Asians?Asians?  Most surgeons would say no. However, someMost surgeons would say no. However, some surgeons still refer to reconstruction of the “Jewishsurgeons still refer to reconstruction of the “Jewish nose,” a moniker implying a physical deformity.nose,” a moniker implying a physical deformity.  ““Asian eye surgery” common in Taiwan, Japan, andAsian eye surgery” common in Taiwan, Japan, and KoreaKorea  Sometimes performed on childrenSometimes performed on children
  13. 13. Ethical and Policy QuestionsEthical and Policy Questions  How should professional societies regulateHow should professional societies regulate the evolving field of genetic aestheticthe evolving field of genetic aesthetic enhancement? What, if any, differencesenhancement? What, if any, differences exist between eugenics and geneticexist between eugenics and genetic aesthetic enhancement?aesthetic enhancement?
  14. 14. Ethical and Policy QuestionsEthical and Policy Questions • What are the appropriate actions of healthWhat are the appropriate actions of health professionals, lawyers, teachers, ethicistsprofessionals, lawyers, teachers, ethicists and governments in responding to ideals ofand governments in responding to ideals of beauty and body weight, and to unhealthybeauty and body weight, and to unhealthy behaviors and unsafe and/or unethicalbehaviors and unsafe and/or unethical cosmetic surgical practices?cosmetic surgical practices?
  15. 15. Covered in Other Slide ShowsCovered in Other Slide Shows  Ideals of beauty and body modificationIdeals of beauty and body modification  Female genital cuttingFemale genital cutting  Body weight and the obesity epidemicBody weight and the obesity epidemic  Ethical and policy issuesEthical and policy issues
  16. 16. ReferencesReferences  Donohoe MT. Beauty and body modification.Donohoe MT. Beauty and body modification. Medscape Ob/Gyn and Women’s HealthMedscape Ob/Gyn and Women’s Health 2006;11(1): posted 4/19/06. Available at2006;11(1): posted 4/19/06. Available at  http://www.medscape.com/viewarticle/529442http://www.medscape.com/viewarticle/529442  Donohoe MT. Cosmetic surgery past, present,Donohoe MT. Cosmetic surgery past, present, and future: scope, ethics and policy. Medscapeand future: scope, ethics and policy. Medscape Ob/Gyn and Women’s Health 2006;11(2):Ob/Gyn and Women’s Health 2006;11(2): posted 8/28/06. Available atposted 8/28/06. Available at http://www.medscape.com/viewarticle/542448http://www.medscape.com/viewarticle/542448
  17. 17. ReferencesReferences  Donohoe MT. Female genital cutting: epidemiology,Donohoe MT. Female genital cutting: epidemiology, consequences, and female empowerment as a means ofconsequences, and female empowerment as a means of cultural change. Medscape Ob/Gyn and Women’scultural change. Medscape Ob/Gyn and Women’s Health 2006;11(2): posted 11/06/06. Available atHealth 2006;11(2): posted 11/06/06. Available at http://www.medscape.com/viewarticle/546497http://www.medscape.com/viewarticle/546497  Donohoe MT. Weighty matters: public health aspectsDonohoe MT. Weighty matters: public health aspects of the obesity epidemic. Parts I-V. Medscape Ob/Gynof the obesity epidemic. Parts I-V. Medscape Ob/Gyn and Women’s Health 2007 and 2008 (seeand Women’s Health 2007 and 2008 (see http://phsj.org/?page_id=10http://phsj.org/?page_id=10))
  18. 18. Contact InformationContact Information Public Health and Social Justice WebsitePublic Health and Social Justice Website http://www.phsj.orghttp://www.phsj.org martindonohoe@phsj.orgmartindonohoe@phsj.org

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