Cosmetic surgery and responsible patient selection - does a legal duty to screen patients exist?

Published date01 January 2013
Date01 January 2013
Cosmetic surgery and responsible patient
selection – does a legal duty to screen
patients exist?
Hanneke Verwey
Academic Associate, Department of Private Law, University of Pretoria
Pieter Carstens
Professor and Head of the Department of Public Law, University of Pretoria
Kosmetiese Chirurgie en Verantwoordelike Pasiëntkeuse – Bestaan daar ’n
Regsplig om Pasiënte te Evalueer?
Daar is sekere unieke uitdagings wat pasiëntkeuse vir kosmetiese chirurgie
betref. Die uitdaging wat kosmetiese chirurge in die gesig staar is hoe om
reeds voor chirurgiese ingryping pasiënte te identifiseer wat ’n swak
resultaat in terme van sielkundige aanpassing en psigososiale
funksionering sal hê, ten spyte van ’n tegnies aanvaarbare resultaat.
Aangesien sielkundige faktore onderliggend is aan die meeste versoeke vir
kosmetiese chirurgie, word daar aan die hand gedoen dat kosmetiese
chirurge ’n regsplig het om bewus te wees van algemeen erkende
psigiatriese toestande en simptome . Kosmetiese chirurge, meer so as die
meeste ander spesialiste, moet aandagtige luisteraars wees met kliniese
vernuf wat strek buite die tipiese grense van medisyne en siekte. Die
deliktuele, strafregtelike en kontraktuele aanspreeklikheid van ’n
kosmetiese chirurg wat opereer op ’n sielkundig onstabiele pasiënt word
in besonderhede bespreek. Die bespreking vind plaas aan die hand van ’n
Amerikaanse saak, die enigste saak van sy soort ter wêreld, waar die
vraag of ’n pasiënt wat ly aan liggaamsdismorfiese versteuring geldige
toestemming tot kosmetiese chirurgie kan gee, aangespreek is.
1 Introduction
Medical techniques and technology are increasingly being used for
purposes that seemingly deviate from the traditional goals of medicine.
Medical techniques and technology are often implemented, not to
prevent or cure illness, but to fulfil a patient’s personal, individual and
ostensibly non-medical wishes.1 These wishes are often aimed at
improving certain human characteristics beyond their normal healthy
state.2 A prime example of wish-fulfilling medicine is cosmetic surgery.
The pursuit of beauty by means of cosmetic surgery is big business in
modern societies and South Africa is catching up very fast in this
1Buyx “Be Careful What You Wish For? Theoretical and Ethical Aspects of
Wish-Fulfilling Medicine” 2008 Medicine, Healthcare and Philosophy 134.
2 Bordo “Material girl: the Effacements of Postmodern Culture” 1990 Mich
Qly R 657; Gimlin “Cosmetic Surgery: Beauty as Commodity” 2000
Qualitative Sociology 80.
Cosmetic surgery and responsible patient selection 433
particular area. With the rise of cosmetic surgery, the contemporary
body, instead of being a dysfunctional object requiring medical
interventions, has become a primary symbol of identity and a
commodity, not unlike “a car, a refrigerator, a house, which can be
continuously upgraded and modified in accordance with new interests
and greater resources”.3 Cosmetic surgery has in fact become a “modern
body custom”.4 As exciting as this might be to some, certain legal and
ethical issues must not be overlooked. The fact remains that cosmetic
surgery involves the performance of very invasive surgical operations on
otherwise healthy individuals for the sake of improving appearance.
Miller et al describe cosmetic surgery as “a most unusual medical
practice” and state5 that:
[i]nvasive surgical operations performed on healthy bodies for the sake of
improving appearance lie far outside the core domain of medicine as a
profession dedicated to saving lives, healing, and promoting health.
Due to the ethically ambiguous nature of cosmetic surgery, it is
submitted that certain safeguards must be put in place in order to
prevent ethical abuses. In the everyday practice of a cosmetic surgeon,
at least some of these safeguards need to address the process of
informed consent and patient selection.
2 Why the Relationship between Cosmetic
Surgeons and their Patients Differs from the
Conventional Doctor-Patient Relationship
The performance of cosmetic surgery necessitates a degree of ethical
conduct on the part of the cosmetic surgeon that surpasses the level of
ethical conduct normally required between a physician and patient as the
relationship between a cosmetic surgeon and a patient differs from the
traditional physician-patient relationship.6 This is essentially due to the
distinction, albeit tenuous, between elective and non-elective forms of
medical treatment. Distinguishing between elective and non-elective
medical treatments is difficult, but cosmetic surgery is usually elective in
the sense that cosmetic surgery is opted for by a patient more freely and
less for reasons of medical necessity in the narrow sense of the word.7
3Finkelstein The Fashioned Self (1991) 87; Gimlin 2000 Qualitative Sociology
80; Adams “Motivational Narratives and Assessments of the Body after
Cosmetic Surgery” 2010 Qualitative Health Research 757.
4 Sullivan Cosmetic Surgery, the Cutting Edge of Commercial Medicine in America
(2000) 10.
5 Miller et al “Cosmetic Surgery and the Internal Morality of Medicine” 2000
Camb Qly Healthcare Ethics 353.
6Atiyeh et al “Aesthetic/Cosmetic Surgery and Ethical Challenges” 2008 J
Aesthetic and Plastic Surgery 830.
7 Healy “Duties of Disclosure and the Elective Patient: a Case for Informed
Consent” 1998 Medico-Legal J Ire 26; Nugent “Cosmetic surgery on Patients
with Body Dysmorphic Disorder: the Medical, Legal and Ethical

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