GESTIÓN EN SALUD PÚBLICA: BioEdge: Is it ethical to refuse a patient surgery for body art?

sábado, 4 de marzo de 2017

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

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

by Michael Cook | 4 Mar 2017 |

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.

Parramatta is just 20 minutes west of the BioEdge office. It’s not a city which has made a huge mark on the world, although not long ago an ISIS-inspired teenager shot dead a police employee and ended up dead himself. It has a lot of historic buildings from the colonial era, surrounded by high rise office buildings, drab shops and a huge park.

A few weeks ago the park hosted Tropfest, billed as the world’s largest short film festival. The crowds watched the films on huge screens as they picnicked on the grass. I was amazed that the winner was a 7-minute film about euthanasia, “The Mother Situation”. With excellent acting and snappy dialogue, it is a brilliant black comedy. Three adult children are delighted to hear that their mother wants to be euthanised – but then she changes her mind.

The director, Matt Day, says that it is not an anti-euthanasia film, but I haven’t seen anything which illustrates more vividly the danger of elder abuse. Sure, it’s absurd and a bit unrealistic but it sends a powerful message. Check it out.