Bioethical aspects of aesthetic and reconstructive surgery

21 June 2012


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In the first part of the document, the NBC reflects on the limits of the legitimacy of requests for cosmetic surgery, and especially on the physician-patient relationship, in the context of the discussion on the many ethical, social and cultural factors that affect the change of attitude towards the body and an expansion of the concept of health in the subjective sense.
Since it is not a strictly therapeutic intervention, the NBC reiterates application of the ethical standards that govern medical practice, sometimes disregarded - in this particular area - in favour of an accommodating compliance with the request expressed by the individual; it emphasises the unacceptability of disproportionate intervention, as it is excessively invasive or unnecessarily risky and inappropriate in relation to the possible benefits required by the patient. The Committee also believes that the balancing of risks and benefits should be commensurate with the psycho-physical condition of the patient, the functionality of the organs affected must take precedence over the aesthetic result and patient information must be complete, with adequate guidance including psychological counselling.
As regards intervention on minors and those lacking the capacity to consent, the NBC believes that there must be limits to lawfulness, except when the intervention is in their exclusive and objective interest in terms of health, particularly in view of the period of adolescence. There should also be guaranteed protection of minors by banning forms of advertising and television broadcasting which cause them to reject their appearance. In particular, the NBC does not consider aesthetic surgery on children with Down syndrome to be legitimate, when its aim is conformity to the social canons of 'normality', especially if it is invasive and painful.
Lastly, the Committee believes that there should be adequate social information and education regarding the risks and benefits of aesthetic surgery and it calls for greater rigour in the formation and professionalism of plastic surgeons, also aimed at including an understanding of the psychological and ethical issues related to these specific medical procedures.
The second part of the document tackles the emerging bioethical issues in reconstructive surgery. The NBC believes that these operations, although not essential for the survival of the patient and despite still being therapeutically-experimental, nevertheless, they are ethically justifiable, subject to careful assessment of the risks and benefits, in relation to general considerations of the quality of life improvement of the patient. Appropriate counselling is required in advance of the surgery, and for a prolonged period (extended even to the family), due to the complex issues that affect the risks and benefits, accompanied by constant psychological monitoring of the recipient. Patients must be informed accurately and comprehensively of the risks and severity of the anti-rejection therapies for their health and the fact that in any event it will lead to a dependency on these drugs (with possible negative outcomes) that could even last a lifetime.
The NBC encourages public awareness campaigns for the donation of external organs and tissues, as normally takes place for the donation of internal ones. It also calls for, in this context, the possibility of integrating the legislation providing for "partial" consent or dissent to external organ donation.

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