At BioEdge, along with end-of-life issues, beginning of life issues, conscientious objection, organ transplants, the challenge of technology, we also try to cover cosmetic surgery. It is part of the larger project of human enhancement – escaping one’s natural endowment to create a better humanity.
For doctors, cosmetic surgery can be quite lucrative. However, it involves some serious ethical issues. The aim of aesthetic cosmetic surgery, such as liposuction or breast augmentation, is not to restore health. It only reshapes the body to make it conform to stereotypes of beauty.
Admittedly, there is an ever-growing demand for aesthetic cosmetic surgery. But is it a doctor’s job simply to acquiesce or to look after his patient’s welfare?
Feminist writer Naomi Wolf says savagely, “the Age of Surgery undoes [a woman’s] immense good fortune. It breaks down into defective components the gift of her sentient, vital body and the individuality of her face, teaching her to experience her lifelong blessing as a lifelong curse.”
Is most of aesthetic cosmetic surgery really medicine at all? It doesn’t treat patients in a holistic way and it often seems that the principal beneficiary is not the patient but the doctor’s bank account.
In the British magazine New Statesman, writer Michael Brooks writes this week that “Cosmetic surgery is nothing more than an industrial-scale scientific experiment”. After 50 years, it is time to question its validity. In the wake of the Poly Implant Prothèse breast implants scandal, he argues, we can see clearly that “Cosmetic breast implantation is a flawed and ethically corrupt psychological experiment, carried out for commercial profit on vulnerable women. And it should now be halted.”
What do you think? Is aesthetic cosmetic surgery medicine or just exploitation?
The biggest bioethics story this week is President Obama’s efforts to hose down anger over his Administration’s decision to force religious institutions to pay for insurance plans offering “free” contraception. The New York Times speaks for many when it argued that this is “a phony crisis over ‘religious liberty’ engendered by the right”. Churches have no right to deprive women of access to free birth control.
Let’s leave the place of religion in the public square to one side and look at the ethics of contraception. Mr Obama and his supporters assume that there are no rational reasons to oppose contraception (which includes the Pill, sterilizations, the abortion pill, and the morning-after pill) on ethical (or medical) grounds.
This is nonsense. Everyone, but everyone, from Planned Parenthood to the Pope, agrees that the Pill has been responsible for massive social changes which have imposed huge costs on the economy, including a rise in STDs, an increase in teen pregnancies, a decrease in marriage rates, a fall in the birth rate, promiscuity, etc etc etc.
The Obama Administration’s failure to recognise that there are legitimate ethical concerns about the range of contraceptive products covered by the Affordable Care Act shows that they are bioethically tone-deaf.
The bioethicist Peter Singer tweeted the other day that he had just co-authored an article in the New York Times about a morality pill. Assuming that behaviour is biochemically determined, he argued, surely drugs could help people to be kinder, more cooperative and more altruistic.
To my surprise, not many readers were sympathetic, to judge from the entertaining comments: “Give the morality pill to men; women, for the most part, don't need it… How big a pill do you think we'd need to swallow? …Would it work on Wall Street? … Too bad there was no morality pill around when Bush and Cheney were in office… The rich folks will never take it; it will cause them to lose their edge.”
However, this is not an altogether novel idea. Julian Savulescu, Peter Singer’s one-time student, is even more radical. He believes that “safe, effective moral enhancement [should] be compulsory” if it is ever developed.
With respect -- for Singer is said to be the most influential living philosopher and Savulescu is an Oxford don -- I am a bit sceptical. Public morality should have been boosted enormously in the 20th century with vast improvements in the standard of living and disposable income. No longer were workers sweating in unhealthy, congested slums. Yet the past hundred years have seen two world wars and appalling genocides. Would taking a morality pill with their morning orange juice really turn everyone into Mother Teresa?
And if it were feasible, the opposite might be attractive: a pill to make soldiers (or hedge fund analysts) pitiless and immoral. What do you think? Is Peter Singer on the money?
Our lead stories this week deal with donation after cardiac death. Frankly, I find this a bit perplexing, as there are several schools of thought on whether it is ethical to remove organs from someone after his heart has ceased to beat. Passions run high when lives are at stake. The donor’s life, first of all. Is he dying a natural death or is he being killed for his organs? And then all those thousands of people whose lives could be saved if they get kidney or a lung.
The premise of these debates is a fundamental principle, “the dead donor rule”. Surgeons agree that vital organs can only be taken from donors who are dead. Otherwise they would be murderers.
But no principle is so fundamental that bioethicists somewhere will not challenge it. Writing in the latest Journal of Medical Ethics, two Americans argue that the revered dead donor rule ought to be scrapped. They contend that “killing by itself is not morally wrong although it is still morally wrong to cause total disability”. Their point is that simply being alive is no big deal. If you are alive, but cannot move, speak, think, or feel, the notion of “life” is meaningless. So why not transfer your organs to someone who can make better use of them?
On the other hand, several doctors in Canada and the US argue that donation after cardiac death is so controversial that transplant surgeons ought to declare a moratorium until these ethical issues have been settled once and for all.
It’s a fascinating topic. I hope that you will take time to comment on the articles.
We are back from holidays. My apologies to a few new subscribers who received a polite automated note asking how they liked BioEdge – even though they still hadn’t received a single issue. One of the unhappy consequences of living in the southern hemisphere is that Australian holidays are perpetually out of synch with those enjoyed by most of our readership.
One of the threads in this week’s issue is the bioethics of intellectual disability. In the first story, a Massachusetts judge ordered a pregnant woman with schizophrenia to be aborted and to be sterilized – even though the woman clearly did not want this. I thought that the era of state-mandated sterilization ended decades ago. Some people fear that similar situations happen reasonably often.
In the second story, doctors at a Philadelphia hospital have denied a kidney transplant to a 3-year-old girl with significant intellectual and physical disabilities. It seems that the doctors reasoned that she didn’t have sufficient quality of life.
It’s a bit dangerous to pontificate without access to all the facts, not just what one gleans from newspapers. However, it does seem that people with intellectual disabilities are regard by some as having less dignity than the rest of us. It’s a dangerous idea.
We wish all of our readers a very Happy Christmas and send our best wishes for the New Year. I realise that many of you may not be Christian, but it is a time of great festivity and rejoicing for those of us who are, so I’d like to presume upon your good will and share it with you.
There will be no newsletter next week as that coincides with Christmas Eve and I have other commitments. We will resume production in late January, although if something momentous happens, I’ll try to post a news item.
Thanks for your support during the year, both financial and promotional. Lots more people seem to be commenting on the articles, as well, which may show that we are doing something right!
Thank God that journalism is not a trade that requires credentials or I would be out of a job. A little literary ability, a rat-like cunning, a willingness to steal other people’s ideas and an ability to betray, if not friends, at least friendly acquaintances is the basic tool kit, according to one journalist I read long ago. I score highly on these, I feel.
However, in the dim, dim past I did gain some rudimentary training on the sub-editors’ desk of the Sydney Morning Herald. One incident there has always stuck with me. As the experienced fellows were busy writing headlines and I was changing commas to semi-colons, someone asked, “what’s 42% of 96?”
Everyone looked puzzled. “No idea, mate.” “How should I know, I didn’t do maths.” “What do you want to know that for?” etc. Finally, someone had a bright idea: “Ring up Finance. They’ll have a calculator over there.” Problem solved.
Something similar happened this week in the UK. A major report from the Academy of Medical Royal Colleges found no link between mental health problems and abortion. This is a perpetually contentious issue which became even more inflamed after the September publication of an article by US academic Priscilla Coleman which found one.
There is no point becoming embroiled in this dispute, but one extremely obvious question arises for the media. The reason for 98% of English abortions is that continuing the pregnancy will cause mental health problems. However, the British medical establishment has just demonstrated that abortion has no effect upon the prevalence of mental health problems. Doesn’t this mean that 98% of abortions are technically illegal?
No doubt this is a complicated and terribly involved issue. But it seems like a very obvious question which no one in Fleet Street, apparently, had wits enough to ask. To me, it’s as simple as 2+2. But perhaps, like my friends on the subs’ desk, journalists still can’t do maths.
It may have escaped your notice, but today, December 3, is International Day of Persons with Disabilities. It has been overshadowed by World Aids Day, which was celebrated on December 1. No worries. You have a good excuse. There are thousands of newspaper articles about World Aids Day in Google News and only a handful about today’s event.
There’s something disproportionate about this, because 33 million people are infected with HIV, but according to The Lancet, one of the world’s leading medical journals, 1,000 million are said to be disabled in some way or other. Aids is a killer and therefore far more dramatic than workaday disabilities like dementia, paralysis, blindness, mental illness and so one. But don’t the maimed, and the halt, and the blind deserve a few kind words from the likes of Bono, Elton John and Carla Bruni-Sarkozy, too?
The Lancet devoted an editorial to the International Day of Persons with Disabilities. It points out that world disability is increasing as the world ages and chronic disease rates rise. People with disabilities are often doubly disabled because they often have poor health and must deal with discrimination.
Is one reason for the lack of attention paid to disability the increasing quest for gold star quality of life? Fine words in The Lancet about disability butter no parsnips for children with Down syndrome, for instance. More than 90% are aborted before birth with the connivance of the medical profession, even though these children normally live happy, fulfilled lives. This is sending an unambiguous message that disability is something to be feared and, if possible, eliminated.
The Lancet says that “Providing care with respect and dignity throughout is paramount” for the world’s disabled. However, I fear that we are not on the right path to achieving this. How do you think that our societies will cope with an avalanche of elderly and demented in 20 years’ time? With respect and dignity, or with grudging, tight-fisted indifference?
This week we visit familiar territory: anonymous sperm donation, exploitation in clinical trials, selective reduction, multiple parents on a birth certificate, and conscientious objection, among others. None of this is particularly surprising.
However, I was surprised by our brief report on an article in the journal Neuroethics. The author has done some surveys which indicate that moral liberals are more humane than moral conservatives. The latter tend to have the “dark and socially destructive” personality traits of machiavellianism, narcissism, and psychopathy.
I refused to be labelled either conservative or liberal, but dividing the world into Morlocks and Eloi seems to be a habit among neuroscientists. In 2009, a Cornell academic found that conservative ethics is motivated by disgust and is therefore irrational. In 2008, conservatives were said to have tidy rooms and square worldviews, while liberals were messy, but creative. Also in 2008 (an election year), geneticists claimed that voting patterns were genetically determined. In 2007 neuroscientists found that conservatives were dull plodders while liberals could handle "informational complexity, ambiguity and novelty".
I live in Australia where the culture wars are just a distant rumble. Would someone breathing the smoke and sweat of the front lines like to comment on whether or not this makes any sense?
I must admit that I have never been a fan of using human embryonic stem cells. I have serious ethical reservations and from what I understand of the science, they are incredibly hard to handle. So I wasn’t surprised at our lead story this week, the news that Geron, one of the few companies in the world working with these cells, had thrown in the towel.
What did surprise me was how small a splash it made. Amazingly, an article in New Scientist, ever an enthusiastic booster of embryo research, blandly declared, never mind, there has been amazing progress with adult stem cells.
“Treatments based on adult stem cells are undoubtedly in the lead, with some very encouraging results this year…So at the moment, adult cells are leading the way clinically? Absolutely. For instance, there are almost 200 trials under way globally using mesenchymal stem cells extracted from bone marrow. In terms of sheer numbers and commercial potential, they are way in front.”
Perhaps the journalist was too young to remember the fierce debates across the world six or seven years ago. Some scientists and journalists were ridiculed and ostracised for saying much the same thing. I wonder if journals like Science, Nature and New Scientist are drafting mea culpas. Somehow I doubt it.
There's more in this week's newsletter: Canada's euthanasia debate is getting warmer; a surprising celebrity surrogacy in the UK; the European Court of Human Rights upholds Austria's ban on sperm donation -- and more.
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