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Ban Cosmetic Surgery in Children?

The Queensland Government, in Australia, has announced it will ban cosmetic surgery in people under 18 years of age. Other states, such as New South Wales, have stated they will also consider restricting access by teenagers to cosmetic enhancement.

This is problematic in a number of ways.

Some people under the age of 18 are competent, that is have the maturity and mental abilities, to give valid consent on their own to medical procedures. In England, such children are described as Gillick-competent after the judge who first said a child of under the age of 16 could, if competent, consent to the use of contraception without the consent of her parents.

This principle has been extended in other legal decisions (Marion’s case) and sex reassignment has even been commenced in childhood:

Savulescu, J. and M. Spriggs. (2006) ‘The Ethics of Surgically Assigning Sex for Intersex Infants’, in (D. Benatar, Editor) Cutting to the Core: Exploring The Ethics of Contested Surgeries (Rowman & Littlefield Publishers, Inc.). Available on Amazon

If children can even commence sex reassignment in adolescence, why is cosmetic enhancement different? Indeed, cosmetic surgery has routinely been performed on children for decades: "bat ears" can be surgically corrected early in life to make the child conform to societal norms and expectations, and reduce teasing. There is no doubt that how we look influences our lives and people’s responses to us. In some cases, it may be best to psychologically adapt to what nature has dished out; but in other cases, it may be preferable to use technology, including surgery to modify ourselves to increase our opportunities.

Circumcision is another example of a surgical procedure which is performed mostly for non-medical reasons.

Perhaps the strongest objection to all these interventions in children is that it is preferable to wait until the child is older and can make a more mature, balanced and perhaps more fully autonomous decision. This point ignores two relevant considerations.

Firstly, some children are competent prior to 18 to make their own decisions and indeed autonomy is fostered by taking control of one’s own life, in the way one sees as best.

Secondly, some enhancements cannot be delayed without significant costs. One cannot always undo the effects of teasing, humiliation, ostracism, low self-esteem and other psychological damage once it has occurred. Sometimes it will indeed be best to wait until a child can make his or her own decision. But sometimes, parents and doctors may even have to make a judgement call before the child is competent.

Each case will be different. Wise judgement, between people willing to consider the child’s own best interests, including most of all the child, which is sensitive to the particularities of the situation is preferable to blunt, blunderbus legislation which can never cover the nuances of the human condition.

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2 Comment on this post

  1. I believe the distinction between cosmetic surgery and the conditions described in this post are similar to the distinction between harm and lack of benefit.

    Failing to provide surgery for “bat ears” will indeed harm a child in the sense that it will bring teasing. Yet, failing to provide breast implants surely will not provide a similar harm. Rather, it seems best described as a lack of a benefit to a child.

    Hence, if one believes there is a moral distinction between refraining from avoiding a harm and refraining from providing benefit, then one can allow the surgeries currently used (such as ones for “bat ears”) yet disallow cosmetic surgery for children.

    I realize that this does not address the first argument that “some children are competent prior to 18 to make their own decisions”. However, I felt that it was at least important to address the first point.

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