July 5, 2022

Cosmetic medicine is not medicine, says bioethicist

Can’t be justified by autonomy

Is cosmetic medicine really medicine? Writing in The Hastings Center’s Bioethics Forum, Alice D. Dreger gives a resounding No. Her epiphany came in Bloomingdale’s where she overheard a mother bragging about her daughter’s newly enhanced breasts. "If the great men and women of medicine could come back from the dead and watch television today, what would they make of the fact that a large percentage of the medicine that is represented is cosmetic?"

Dr Dreger is a bioethicist at Northwestern University who describes herself as an activist for children with intersex disorders. In this article, she asks why people are given treatments "which have almost no evidentiary claim to being necessary or effective".

Normally cosmetic medicine is defended as an expression of a patient’s autonomy. But she demurs:

"I know, these procedures are offered in the name of patient autonomy. But as any first-semester ethics student understands, real autonomous choice requires knowledge, and it does not appear that many patients who are literally sold the belief that these procedures will improve their lives have been told that what little evidence we do have suggests their hopes are false.

"Imagine if a patient came in and said ‘I think my cholesterol is probably high because I saw your advertisement and the actor looked like me, and so I want drug X because I want to feel better like the actor did,’ and the doctor simply said, ‘OK! You’re autonomous!’ and gave the prescription?"

She also objects to the intense commercialisation of cosmetic medicine. She recalls attending a seminar on cosmetic laser treatments. "Most of the doctors there were unlike any I had known; to be frank, they were openly greedy. They were loving the idea of ‘cash on the barrel’ as the salesperson put it. No insurance forms! No tricky diagnoses!"

Finally, she suggests that cosmetic surgery ought to be renamed: "Really, at best, ‘cosmetic medicine’ looks a lot more like hairdressing than health care. I’m not suggesting we let hairdressers do surgery and inject people with botulism toxin. But I am suggesting we stop gracing cosmetic procedures with the name ‘medicine’. Let’s just call these practices what they are: barber surgery." ~ Bioethics Forum, July 6