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

• Pages: 432-450
• DOI: 10.10520/EJC145905
• Published date: 01 January 2013
• Date: 01 January 2013

432

Cosmetic surgery and responsible patient

selection – does a legal duty to screen

patients exist?

Hanneke Verwey

LLB LLM

Academic Associate, Department of Private Law, University of Pretoria

Pieter Carstens

BLC LLB LLD

Professor and Head of the Department of Public Law, University of Pretoria

OPSOMMING

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