A good plastic surgeon walks a fine line between the Hippocratic ideal of “doing no harm” and giving the patient what he or she asks for. Obviously, the surgeon should put the health and safety of the patient first in deciding whether or not to accommodate a patient’s request for a particular procedure. Ethics dictate that he or she would not perform any procedure with the written consent of the patient. Nor would the surgeon perform surgery on a minor without the consent of his or her legal guardian(s).
Ethical Gray Areas
The former are more than matters of ethics, they are matters of law. There are ethical gray areas, though, like answering the question, “How much risk is too much risk?” More gray areas emerge when it comes to using newer, less tested (or untested) surgical techniques. One line that seems to be blurred a bit too frequently is that of the ideal of full disclosure to patients regarding the scope of the surgeon’s experience with a new technique or piece of surgical equipment.
The issues of ethics become even more complex where mental and emotional state of the patient is concerned, and there is a good deal of psychology involved. How does the surgeon determine when “enough is enough”, in the case of a person who displays signs of plastic surgery addiction? How does the surgeon deal with a patient displaying signs of body dysmorphic disorder---a condition in which the patient perceives flaws that are not really there, and wants them corrected…NOW!?
A surgeon also needs to do a good deal of evaluative screening before agreeing to operate on a patient. He or she needs to ask questions that help him or her to accurately ascertain both the emotional state and the expectations of the patient. Does the patient fantasize that surgery will magically turn him into a Brad Pitt look-alike? Does the patient hope that larger breasts will save her marriage? Or is he / she envisioning a full-body liposuction procedure that will erase 50 lbs of cheeseburger-induced blubber?
The Eye of the Beholder
The gray areas don’t stop at a patient's mental and emotional state. Beauty is subjective, and what is aesthetically pleasing to the surgeon may differ from what the patient imagines as an ideal result. Good communication is the key here.
So, where does a surgeon draw the line? How tight is too tight for a face lift? What should a surgeon do when asked to perform a surgery he or she believes is not in the best interest of the patient in an aesthetic sense? (i.e., it will make the patient look worse instead of better---Michael Jackson’s nose comes to mind)
A Judgment Call
Ultimately, it is up to each surgeon to call upon his or her experience, training, and judgment to make the decision of when to operate, when not to operate, and when to refer the patient to another medical professional, such as a qualified psychiatrist.