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

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.

First, she assumes that the procedure would be relatively safe from a medical point of view. The doctor she has in mind would refuse because the reasons for the request conflicted with his own values. She groups the objection under four headings and dismisses all of them:

The intervention violates the goals of medicine. This means that the doctor is imposing his own view of what constitutes good medicine upon the patient, even though the patient believes that he will benefit from the procedure. This violates the patient's autonomy.

The benefits do not outweigh the risks. The doctor is imposing his own understanding of benefits upon the patient, who understands better than the doctor what is in his best interest.

The surgery promotes opposing moral values. But, as in the often-discussed cases of abortion and euthanasia, doctors are not entitled to impose their moral views upon patients. Minerva cites the hypothetical case of a feminist who wants to subvert conventional norms of beauty by "uglifying" herself. The doctor would be wrong to refuse.

The intervention would benefit the patient, but not society. What about surgery to make Asians look more Caucasian? This reinforces stereotypes of Western beauty and constitutes denigration of a racial group. Minerva is sympathetic to this line of argument, but rejects it. It is up to the government to determine what is or is not beneficial to society. Unless a procedure is illegal, the doctor would be wrong to refuse. "If we conclude that we have no good reason to prohibit such kind of treatment, then doctors would not have a good reason to refuse to perform them on patients who require them."

Like other bioethicists, Minerva appears to conclude that there is no place for legitimate conscientious objection in modern medicine – even for implanting ears on forearms. "According to the basic principle of respect for autonomy, patients are entitled to decide if undergoing a certain treatment is in their best interest. And what constitutes one's best interest is, at least in large part, based on one's own assessment." If a request is legal, an ethical doctor must comply. 

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