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Friday, June 16, 2006

Enhancement Gone Awry

The NYT has yet another story on plastic surgery in its Thursday Styles section, focusing on the new "microprocedures" of liposuctioning knees and ankles.  Ana Bartow has already cuttingly commented on the Times' obsession with modish means of body modification.  I just want to juxtapose a few provocative quotes.

First, to their credit, the Times notes that

some sociologists and medical ethicists say that using liposuction — which can cause complications ranging from infection to death — for such tweaks raises profound questions about the increasing risks cosmetic doctors and patients are willing to take in the name of perfection. They say these microprocedures may signal a shift in beauty standards in which people come to regard the body the way they do their cars or kitchens: as an object able to withstand never-ending renewal and modification.

But it's back to so-called "journalistic objectivity" by the end of the piece, with a "bioethicist" commenting that "'Humans have always been willing to invest time, energy and risk in looking attractive, so I don't see smaller liposuction procedures as a sign of doom, gloom and the downfall of our culture.'"

Which brings me to the legal question.  Some of the procedures mentioned in the article were so "micro" that almost no one could notice what had occurred.  Query: what if a patient just asked a doctor to perform surgery, with absolutely no effect on their appearance?  Would it be legally permitted for the doctor simply to take the money, make the incision, take out, say, a gram of fat? Is this purely a matter of contract?  Or should legal standards prohibit such a transaction?

A final point: many libertarian bioethicists love to point out that the line between "therapy" (curing disease) and "enhancement" (making someone "better than well") is very difficult to draw.  I think that's only true to the extent we take it to be true.  As Victoria Pitts comments in the article, "The goal posts are changing so rapidly that what was once considered cosmetically unnecessary is now considered helpful . . . . [As more of the body] become zones of perfectibility, we will feel more and more pressure to get involved in projects that improve them."  Query: is that type of pressure at all socially useful?  Or, rather, does it betoken an infectious vanity that leaves everyone worse off?

Posted by Frank3 on June 16, 2006 at 08:00 AM in Culture, Current Affairs, Odd World | Permalink


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I guess name-calling is fair for both sides, though I must say that I saw little that looked like an arguemnt in your remarks, and of course was explicite in saying that I was doing no more than suggesting an argument, not making one. I know a pretty fair amount about the arguments relating to abortion (having taught them at Penn several times) and don't see much evidence of understanding them in your case. Maybe you _do_ understand them, but we'd never know from your "funny" or "playfull" comments. (Maybe you should ask some people if they seem funny or playful, or just obnoxious?) And please, whether one is an "outspoken woman" or not has nothing to do with my reaction to them. If you think you can find any evidence to suggest otherwise I suggest you bring it forward, but if not I'd ask that you stop suggesting otherwise. Obviously you know nothing about me on this or other scores. And I've not played tetris for probably 15 years.

Posted by: Matt | Jun 19, 2006 12:28:12 PM

Matt: are you the kind of guy who, in response to “how are you,” starts a saga on how he is? Look, this is a blog comment. The point of a blog comment is to be brief, clever, funny, playful, provocative, engaging – anything other than your preferred dull-1L style of chewing every obvious idea to death. I actually have quite a lot to say about the equivalence of elective abortions and facelifts (both being medically unnecessary body alterations, conducted for the sole purpose of retarding a perfectly normal physiological process that doesn’t fit a woman’s lifestyle), but I can’t play this out in the comments without prompts from a decent side-kick. If you get off your high horse, you might notice that my two prior comments contain fairly sophisticated compact versions of this argument waiting for the “on the other hand” replies – complete with a reference to a six-months-old fetus, which largely preempts the point about reductions in physical burdens that Trevor made later on. You, on the other hand, with all the talk about being on-point, failed to produce any coherent argument to explain why exactly abortions are different from facelifts. Just announcing them to be obviously different is not enough. (Hint: burdens of parenthood is not a helpful argument. Thousands of hopefuls will happily relieve a woman of parenthood by adopting her newborn).

By the way, if you continue having uncontrollable urges to teach outspoken women some good manners, you might be better off crawling back under your rock for the umpteenth round of Tetris.

Posted by: Kate Litvak | Jun 19, 2006 12:20:18 AM

Another response to Kate would be to note that in addition to the autonomy/personal choice theme, abortion law also reflects a concern for bodily integrity. This concern isn't so much about the nature of the choice at issue as about the impact on the person's body of prohibiting the procedure in question. The consequence of prohibiting certain cosmetic surgeries is that the person has to make do with his/her body in its unaltered form. The consequence of prohibiting abortion is that the woman has to go through all the profound physical changes entailed in nine months of pregnancy, followed by childbirth. Surely it's not irrational for the law to acknowledge the greater physical burdens entailed in the latter.

To be sure, abortion involves other competing interests (viz., the potential life of the fetus) that are not implicated in cosmetic surgery. So the stakes are much higher on both sides of the ledger. I concede all that. My only point here is that, contra Kate, whether to permit or prohibit elective abortion is not simply about whether to permit a certain lifestyle choice. It's also about whether to force the woman to undergo profound physical changes and burdens that have no equivalent in the vast majority of cosmetic surgeries.

Posted by: Trevor Morrison | Jun 17, 2006 11:20:59 AM

What I'm saying, Kate, is that certain choices are generally seen to be more fundamental to personal liberty, freedom, or dignity than others, and that as such they deserve more protection and freedom from outside control. Which choices these are can be debated but most people who have thought of the issue put the choice to be a parent or not on the very important side, while most would, I hope, put the choice to have less back fat or larger breasts on the less important side. Of course this doesn't, by itself, imply that "moralizing busybodies" should be allowed to but in to one's relationship with one's plastic surgeon (I hope one wouldn't go to a cosmetologist for a boob job, since that's a person who works with make-up!). But, if there are somehow significant social costs connected with less fundamental choices it's reasonable to restrict these choices in a way that it would not be reasonable to restrict more fundamental choices. A clear example is laws requiring people to use safety belts in cars or wear helmets. From the standpoint of dignity or freedom this is a trivial choice, but it has potentially great social impact. Therefore it makes sense to restrict choice here in a way that would not make sense if the freedom or dignity side were more greatly impacted.

So here you have an argument. It's only a sketch, of course, and even a fuller version would not be convincing to everyone, but note how it tries to engage with the issue, give reasons, and the like rather than just asserting a position or implying that everyone else is stupid. That's because it's an attempt to improve understanding, while your remark (most of your remarks, actually) was merely trolling.

Posted by: Matt | Jun 17, 2006 8:28:11 AM

Matt: an elective abortion, like a boob job, is simply a lifestyle-enhancing procedure. The sole purpose of both is to allow people to maintain a particular lifestyle. So, you are saying that it is more appropriate for the government to regulate the trivial and reversible lifestyle-enhancing procedure that affects only consenting adults (boob job) than to regulate the irreversible lifestyle-enhancing procedure that affect a non-consenting third party (fetus in abortion)? And moralizing busybodies should stay out of my relationship with an OB-GYN, but not out of my relationship with a cosmetologist? And this logic is supposed to be the opposite of “poorly grounded” or whatever else you accused me of doing?

Posted by: Kate Litvak | Jun 17, 2006 1:06:44 AM

Also, perhaps we ought to pressure the bio-ethicists and the AMA to speak out in favor of common sense and public safety. It is amazing that the AMA has thrown its weight behind "personal choice" matters such as anti-smoking laws, healthy diet, car seat belts and motorcycle helmets but cannot bring itself to issue widespread and easy to understand public disclosure statements about the attendant risks of elective cosmetic surgery . One has to wonder if the reticence may have something to do with the effect that might have on the thickness of some of its members' wallets.

Posted by: Ruchira Paul | Jun 16, 2006 9:29:34 PM

Kate, can you really not see how the choice to not be a parent might be more important than the choice to not have back fat, and so how if (we suppose) the direct risk from and larger social costs of the opperations were the same it might make sense to allow the first but not the second? Like Ruchira I'd not be eager to see these operations become illegal, but you might consider actually engaging with someone now and then rather than always acting smug. This is especially likely to be helpful in areas where you seem to be poorly grounded.

Posted by: Matt | Jun 16, 2006 7:51:28 PM

I don't think any of these surgeries should be illegal - abortion included. What would be beneficial is if we better educate ourselves and our children to be a little more confident and mature to avoid either procedure except in case of major personal pain or catastrophe.

Just as it is advisable to prescribe sensible sex education for our children so they do not casually get pregnant and choose abortion with capricious glee, it may be worthwhile to impress upon them at a tender age that the pursuit of market driven ideas of beauty and social success may not be in their best interest either. How about calling it "safe sex and safe self image" education?

Most people, when fully informed without glamorous hype, will recognize the cost to benefit ratio in risking a surgical or chemical procedure for correcting severe, debilitating physical defects caused at birth or by accident versus those which merely make us more "attractive" in an often artificially defined cultural milieu. The world is never going to be free of pre-conceptions of beauty, success and the advantage of having a leg up over one's competitor. But most of us don't like extreme cheating either. That is why the Olympics ban performance enhancing drugs and we wish to put an asterisk against Barry Bonds' home run record.

Apart from the physical hazards associated with surgical / chemical enhancements, there is the pernicious cultural effect of marketing ever unattainable markers of "beauty " so much so that what is "normal" becomes undesirable. What is "functional" is deemed embarrassing in favor of the merely "decorative". That explains why we have no problem ogling at oversized, surgically sculpted, pneumatic breasts of near naked fashion models and movie stars in shop windows and on magazine covers but are annoyed and queasy when a mother breast feeds her infant (even decorously) in a public place. Or why dark skinned Asian men unselfconsciously demand "fair" brides.

I don't want to sound like a "back to nature" earth mother who wants to throw away her razor, bra and her nail clipper. We are for the most part able to weigh the "harmless" enhancements via perfume, lipstick, mascara and well fitting clothes against drastic steps such as liposuction, breast enhancement and toxic complexion creams.

The pressure on women is especially alarming. While I believe that a majority of women operate within the limits of reality, there is no doubt that more women than men will go to dangerous lengths to become "beautiful." Ironically, when it comes to what constitutes "attainable" limits of male beauty, both women and men seem to agree!

Posted by: Ruchira Paul | Jun 16, 2006 7:09:36 PM

If it's legally permitted that I have a surgery to kill a fetus at six months of gestation, for the sole reason of changing my mind about parenthood, why should it not be legally permitted that I have a surgery whose point is to produce no result whatsoever? How can I be trusted to act in my own best interests in the former case, but not in the latter? How can one say that the former surgery is "socially beneficial", but the latter isn't?

The world is becoming very confusing these days.

Posted by: Kate Litvak | Jun 16, 2006 4:08:44 PM

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