Tongue splitting, bodily harm, and human dignity

BioEdge

Xavier Symons

Contemporary cosmetic surgery has become a tool for realising bizarre personal fantasies. Sometimes it also leads to significant bodily harm. “Tongue-splitting” is an operation whereby a person’s tongue is split from the tip to as far back as the underside base. The operation has become a common alteration for body-modification enthusiasts, who say it heightens their sense of taste and touch.

Some jurisdictions, however, have enacted a ban on the procedure. The operation can be painful, and can temporarily impede one’s capacity for speech.

In a recent post on the blog Practical Ethics, UK lawyer Charles Foster considers the legality and ethics of the procedure.

Foster discusses the case of R v BM, where a Wolverhampton tattooist was found guilty of inflicting grievous bodily harm on a patient after splitting their tongue. Even though the customer consented, the court found that consent was not a defence against having inflicted grievous bodily harm.

Foster argues that the ruling represents a defence of basic human dignity, which transcends the ambit of personal autonomy:

[The ruling] is a salutary reminder that there are limits to the law’s protection of personal autonomy. Factors other than autonomy are in play in the criminal law. I have argued elsewhere that the primary factor (and the foundational factor in the criminal law – in which all other factors, including autonomy, are rooted) is human dignity.

Indeed, Foster argues that in harming another, one does violence to one’s own human dignity:

One might say that X causing injury to Y is doubly culpable because in doing so X outrages not only Y’s dignity but also his own (X’s) dignity…dignity is ‘Janus-faced’.


This article is published by Xavier Symons and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must contact BioEdge for permission and fees.

You’re a surgeon. A patient wants to look like a lizard. What do you do?

As medical treatments advance, the need to accommodate conscientious objection in healthcare is more pressing

The Guardian
Reproduced with permission

David S. Oderberg*

Imagine that you are a cosmetic surgeon and a patient asks you to make them look like a lizard. Would you have ethical qualms? Or perhaps you are a neurosurgeon approached by someone wanting a brain implant – not to cure a disability but to make them smarter via cognitive enhancement. Would this go against your code of professional ethics? With the rapid advance of medical technology, problems of conscience threaten to become commonplace. Perhaps explicit legal protection for conscientious objection in healthcare is the solution.

There is limited statutory protection for those performing abortion, and there is some shelter for IVF practitioners. Passive euthanasia (withdrawal of life support with intent to hasten death) is also part of the debate over doctors’ conscience rights. That’s about it as far as UK law is concerned – though freedom of conscience is enshrined in numerous conventions and treaties to which we are party. Abortion, artificial reproductive technologies (involving embryo research and storage) and passive euthanasia are the flashpoints of current and historic controversy in medical ethics. The debate over freedom of conscience in healthcare goes to the heart of what it means to be a medical practitioner.

Curing, healing, not harming: these are the guiding principles of the medical and nursing professions. But what if there is reasonable and persistent disagreement over whether a treatment is in the patient’s best interests? What if a practitioner believes that treating their patient in a particular way is not good for them? What if carrying out the treatment would be a violation of the healthcare worker’s ethical and/or religious beliefs? Should they be coerced into acting contrary to their conscience?

Such coercion, whether it involve threats of dismissal, denial of job opportunities or of promotion, or shaming for not being a team player, is a real issue. Yet in what is supposed to be a liberal, pluralistic and tolerant society, compelling people to violate their deeply held ethical beliefs – making them do what they think is wrong – should strike one as objectionable.

Freedom of conscience is not only about performing an act but about assisting with it. There are some people who ask doctors to amputate healthy limbs. If you were a surgeon, my guess is that you would refuse. But what about being asked to help out? Would you hand over the instruments to a willing surgeon? Or supervise a trainee surgeon to make sure they did the amputation correctly? If conscientious objection is to have any substance in law, it must also cover these acts of assistance.

This country has a long and honourable tradition of accommodating conscientious objectors in wartime – those who decline to fight or to assist or facilitate the fighting by, say, making munitions. They can be assigned to other duties that may support the war effort yet are so remote a form of cooperation as not to trouble their consciences. In any war, the objectors are a tiny fraction of the combat-eligible population. Yet when it comes to one’s rights, do numbers matter? Has their existence ever prevented a war from being carried out to the utmost? I fail to see, then, why we are tolerant enough to make adjustments for conscientious objectors in the midst of a national emergency, yet in peacetime would be reluctant to afford similar adjustments to members of one of the most esteemed professions.

Do we think medical practitioners should be no more than state functionaries, dispensing whatever is legal no matter how much it is in conflict with personal conscience and professional integrity – lest they be hounded out of the profession? Some academics think expulsion is not good enough. Or should healthcare workers be valets, providing whatever service their patients demand? Perhaps when practitioners find themselves faced with demands for the sorts of treatment I’ve mentioned – or perhaps gene editing treatments or compulsory sterilisation, society will act. Or maybe by then it will be too little, too late.

David S Oderberg is professor of philosophy at the University of Reading, and author of Declaration in support of conscientious protection in medicine

 

 

No case to answer in UK’s odd female genital mutilation imbroglio

BioEdge

Michael Cook

An unusual criminal investigation in London of high-profile doctors for female genital mutilation (FGM) has collapsed. FGM is usually carried out in secret amongst communities from the Middle East and Africa. However, this procedure was described in a medical journal and involved leading British physicians.

In 2011 a surgeon, Professor Joe Daniels, and a psychiatrist, Professor David Veale, published an article in The Archives of Sexual Behaviour about a clitoris removal operation on a 33-year-old Western patient. She had already had labia reduction surgery but still thought her genitals were “ugly” and “hated the look of them”. So Veale gave his approval as a psychiatrist and Daniels did the operation.

Upon reading the article, another academic, Professor Susan Bewley, was outraged and urged the Crown Prosecution Service to investigate because it appeared to breach the UK’s law banning FGM. However, surgery of this kind is permitted for medical or psychological reasons and eventually the police declared that there was no case to answer.

Professor Veale told the Evening Standard that he was utterly opposed to FGM.

“FGM and cosmetic surgery are completely different. To me it’s completely clear. FGM is an abhorrent practice conducted on girls against their consent motivated by a desire to control female sexuality, but [cosmetic genital surgery] is provided for adult women with capacity to consent and motivated by a desire to improve their appearance and sexuality. It’s no different to any other cosmetic surgery…

“I don’t like the procedure. But the bottom line for me is freedom of choice. You have a freedom of choice if you have capacity for consent to do what you wish with your own body.”

Professor Bewley was disappointed, fearing that it might be impossible to prosecute over FGM:

“It makes a mockery of the law. It’s extraordinary. Despite the police having spent three years investigating, it’s puzzling that the CPS has decided against pressing charges. Does this mean all female cosmetic genital surgery, maybe even on minors, is exempt? The CPS decision-making looks inconsistent. Inevitably doctors are left confused and patient safety is unclear.”


 

This article is published by Michael Cook and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must contact BioEdge for permission and fees.

Is it ethical to refuse a patient surgery for body art?

BioEdge

Michael Cook

The “bioartist” Stelarc has an ear surgically implanted on his forearm. Like him, a number of other people have hacked their own bodies with implants and prostheses. With growing interest in transhumanism, more and more people are likely to request enhancements to turn them into cyborgs.

Many doctors are unwilling to modify bodies for artistic, political or whimsical reasons. Stelarc complains that it took him ten years to find a willing surgeon. Is it ethical for a doctor to refuse? This is the question tackled by Francesca Minerva in the Journal of Medical Ethics. . . . [Full Text]

Cosmetic surgery and conscientious objection

Francesca Minerva

Abstract

In this paper, I analyse the issue of conscientious objection in relation to cosmetic surgery. I consider cases of doctors who might refuse to perform a cosmetic treatment because: (1) the treatment aims at achieving a goal which is not in the traditional scope of cosmetic surgery; (2) the motivation of the patient to undergo the surgery is considered trivial; (3) the patient wants to use the surgery to promote moral or political values that conflict with the doctor’s ones; (4) the patient requires an intervention that would benefit himself/herself, but could damage society at large.


Minerva F. Cosmetic surgery and conscientious objection. Journal of Medical Ethics. Published Online First: 02 March 2017. doi:10.1136/medethics-2016-103804

 

Increasing medical alteration of disabled children

Surgical and pharmaceutical treatment to limit the growth of disabled children is becoming more frequent.  A British newspaper has identified a dozen families involved in them.  Such procedures first came to public notice about five years ago, when a severely disabled nine year old girl living near Seattle was subjected to a series of medical procedures to prevent her from growing further.  [The Guardian]