Plastic Surgery and Ethical Considerations

I heard someone say once that plastic surgeons walk a thin line between the doctor’s oath of “doing no harm” and treating the patient like a customer and giving her what she wants. Whether true or not, there are definite ethical challenges for those involved in this field–and especially those who accept the extra responsibilities of performing labiaplasty and vaginoplasty operations.

Clearly, the plastic surgeon must put the safety and health of her patient first in deciding if she should honor the patient’s request for a procedure. Ethics demand that she not do any procedure without the patient’s written consent. She also must not perform an operation on a minor without her parent’s or guardian’s consent.

These, though, are areas of law more so than ethics. Other issues are definite ethics issues, and cover gray areas. For instance, there is the ethically-sticky question of “how much risk constitutes too much?”

Other gray areas arise when considering whether or not to use newer techniques–ones which haven’t been completely tested. And along those lines, how much does the doctor disclose to the patient concerning a new piece of equipment or a new technique that she is using?

Even more complex are ethical issues involving a patient’s emotional and mental state of mind. If a patient displays certain signs of cosmetic surgery addiction, where is the cut-off point? That is, how does the surgeon know when to tell the patient,, “No more!”?

Similarly, if a patient has shown symptoms of Body Dysmorphic Disorder (a disorder wherein the patient feels she has flaws which aren’t really there, and yet wants them to be immediately corrected), how does the surgeon respond?

The answer to many of these questions lies in good screening. It is paramount that the surgeon make a habit of thoroughly evaluating and screening a patient before she agrees to operate on a new (or old) patient. The doctor must ask questions which help her to correctly determine the patient’s expectations as well as her present emotional state. Is the patient under the delusion that this surgery will magically turn her into a supermodel? Does the somehow think that larger breasts will make her husband fall in love with her again? Does a 50-something woman think that a labiaplasty or vaginoplasty will make all the 20-something males swoon at her presence?

Gray areas go beyond just the patient’s emotional and mental state, too. It goes into the area of subjective tastes. Remember that beauty is a subjective, not objective, fact. What pleases the eye of the surgeon might not necessarily please the patient to the same extent. This is why good communication is absolutely essential.

Where, then, does the doctor draw the line? What is she to do when a patient asks her to perform a procedure that the surgeon thinks in not in her best interest, either from an emotional perspective for aesthetic reasons?

It comes down to a judgment call. The surgeon relies upon her own training, experience and judgment to determine when to operate, when to refuse to operate, and when she should refer this patient to speak to another professional–such as a psychiatrist.