Is it ethical to refuse a patient surgery for body
BioEdge, 4 March, 2017
Reproduced under Creative Commons licence
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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