A prominent bioethics think tank in the UK, the Nuffield Council for Bioethics, has launched a public inquiry into cosmetic procedure industry and the ethical implications of its rapid growth and diversification. The Council hopes to gather information about a number of areas.
Definitions. What differentiates cosmetic from reconstructive or therapeutic procedures?
Risk: Many clients regard procedures as normal and are not sensitive to the risks involved. A 2013 government report found that “the public is consistently underestimating what is involved in having a cosmetic intervention.”
Normalisation: increasing demand means that some procedures are becoming routine, rather than exceptional. Experts are concerned that beauty is becoming stereotyped, increasing pressure on those whose appearance does not conform to these norms.
Popularity. Why has there been such explosive growth in this sector? The Council lists some possible explanations: “increasing affordability; technological change making more procedures available; the pervasiveness of celebrity culture; the development of digitally manipulated photographs (leading to ever-more unrealistic representations of beauty); the rise in the use of social media (including the trend of postings ‘selfies’ online) and self-monitoring apps; and easier access to pornography depicting unrealistic images of what is normal or desirable. In the context of the UK, these proposed explanations are also embedded in a society where body image is poor compared with other countries.”
Regulation. there is little government regulation of cosmetic enhancement and some unqualified doctors, nurses, dentists and beauty therapists are providing services. Discussion is also needed about demand for services. Should parents be able to authorise cosmetic procedures? Should people with a body dysmorphic disorder? Should advertising be regulated?
Which parts of the body? There are fashions in cosmetic surgery. In 2014, fewer women sought breast augmentation, but there was higher demand for more subtle effects like eyelid surgery, facelifts and fat transfers. There is growing interest in female genital cosmetic surgery and penis enlargements, for which the ethical, legal and psychological risks may be different. Other procedures are becoming more common such as limb-lengthening surgery, the removal of additional fingers or toes, and gender reassignment. Is special regulation required for some of these?
Professor Jeanette Edwards, Chair of the Council’s Working Party, said: “Concerns over the increasing use of Botox and fillers, as we have seen frequently discussed in the media, highlight some critical questions about the role and responsibilities of health professionals, the adequacy of current regulation, and the potential risks to users. We are also interested in exploring the various drivers for the increasing use of a wide range of surgical and non-surgical cosmetic procedures, including social and media pressures that influence people’s decisions to seek cosmetic procedures as a way of enhancing or ‘normalising’ their appearance.”
(If you would like to respond, contact Kate Harvey at firstname.lastname@example.org, with ‘Cosmetic procedures’ in the subject line.)
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