1. Ethical and Policy Questions re Ideals of Beauty, Cosmetic Surgery, and Obesity Martin T Donohoe

2. Ethical and Policy Questions What roles do culture, the media, sexism, and racism play in individual and public perceptions of beauty? Individual and collective perceptions of ideal body weight? The response of society to outliers and development of pathological behaviors? The desire for cosmetic surgery? What roles do culture, the media, sexism, and racism play in individual and public perceptions of beauty? Individual and collective perceptions of ideal body weight? The response of society to outliers and development of pathological behaviors? The desire for cosmetic surgery?

3. Ethical and Policy Questions Is aging defined as a physical and/or mental illness? If so, is the substitution of happiness for health an appropriate goal for cosmetic enhancement? Does this enhancement constitute medical treatment? Or is cosmetic surgery simply a business service provided to those who desire it, can pay for it, and are willing to accept the risks involved? Is aging defined as a physical and/or mental illness? If so, is the substitution of happiness for health an appropriate goal for cosmetic enhancement? Does this enhancement constitute medical treatment? Or is cosmetic surgery simply a business service provided to those who desire it, can pay for it, and are willing to accept the risks involved?

4. Ethical and Policy Questions How do providers and insurers define medical necessity as it relates to cosmetic surgery? How do providers and insurers define medical necessity as it relates to cosmetic surgery?

5. Ethical and Policy Questions A sizable minority of physicians admits to "gaming the system" by manipulating reimbursement rules so their patients can receive treatments or undergo procedures the physician deems necessary. How often do cosmetic surgeons "shade the truth" in attempting to obtain coverage for services they perceive to be necessary for their patients? A sizable minority of physicians admits to "gaming the system" by manipulating reimbursement rules so their patients can receive treatments or undergo procedures the physician deems necessary. How often do cosmetic surgeons "shade the truth" in attempting to obtain coverage for services they perceive to be necessary for their patients?

6. Ethical and Policy Questions How much revenue-generating cosmetic surgery is too much for underfunded, university dermatology (or plastic surgery) departments? What are appropriate arrangements for using such revenue to cross-subsidize indigent care? How much revenue-generating cosmetic surgery is too much for underfunded, university dermatology (or plastic surgery) departments? What are appropriate arrangements for using such revenue to cross-subsidize indigent care?

7. Ethical and Policy Questions To augment lagging revenues and offset budget deficits, states have begun taxing cosmetic procedures; New Jersey's levy is 6%. Should cosmetic surgery be subjected to the same sort of consumption taxes as cigarettes and gasoline? To augment lagging revenues and offset budget deficits, states have begun taxing cosmetic procedures; New Jersey's levy is 6%. Should cosmetic surgery be subjected to the same sort of consumption taxes as cigarettes and gasoline?

8. Ethical and Policy Questions Many endocrinologists treat short- statured, non-growth hormone- deficient children with growth hormone. Is it appropriate for parents to consent to such "treatment" and for physicians to offer it? Many endocrinologists treat short- statured, non-growth hormone- deficient children with growth hormone. Is it appropriate for parents to consent to such "treatment" and for physicians to offer it?

9. Human Growth Hormone Provision of growth hormone may augment height and enhance social acceptability (and ability to make the basketball team), but can carry potential long-term side effects such as diabetes and hypertension Provision of growth hormone may augment height and enhance social acceptability (and ability to make the basketball team), but can carry potential long-term side effects such as diabetes and hypertension Treatment requires six injections per week for 4-5 years at a cost of $20,000/yr Treatment requires six injections per week for 4-5 years at a cost of $20,000/yr

10. Ethical and Policy Questions Should surgeons correct the physiognomy of children with Trisomy 21, giving them a "normal" appearance while leaving their underlying neurologic defects and distorted voices unchanged? How will such surgery affect their emotional development and integration into society? Should surgeons correct the physiognomy of children with Trisomy 21, giving them a "normal" appearance while leaving their underlying neurologic defects and distorted voices unchanged? How will such surgery affect their emotional development and integration into society?

11. Ethical and Policy Questions What cosmetic procedures are acceptable in consenting adolescents? What cosmetic procedures are acceptable in consenting adolescents?

12. Ethical and Policy Questions Should cosmetic surgery be used to transform racial characteristics, by (as one author put it) "transforming a Black nose into an aquiline nose better befitting a British butler," or by rounding off the eyelids of Asians? Should cosmetic surgery be used to transform racial characteristics, by (as one author put it) "transforming a Black nose into an aquiline nose better befitting a British butler," or by rounding off the eyelids of Asians? Most surgeons would say no. However, some surgeons still refer to reconstruction of the Jewish nose, a moniker implying a physical deformity. Most surgeons would say no. However, some surgeons still refer to reconstruction of the Jewish nose, a moniker implying a physical deformity. Asian eye surgery common in Taiwan, Japan, and Korea Asian eye surgery common in Taiwan, Japan, and Korea Sometimes performed on children Sometimes performed on children

13. Ethical and Policy Questions How should professional societies regulate the evolving field of genetic aesthetic enhancement? What, if any, differences exist between eugenics and genetic aesthetic enhancement? How should professional societies regulate the evolving field of genetic aesthetic enhancement? What, if any, differences exist between eugenics and genetic aesthetic enhancement?

14. Ethical and Policy Questions What are the appropriate actions of health professionals, lawyers, teachers, ethicists and governments in responding to ideals of beauty and body weight, and to unhealthy behaviors and unsafe and/or unethical cosmetic surgical practices? What are the appropriate actions of health professionals, lawyers, teachers, ethicists and governments in responding to ideals of beauty and body weight, and to unhealthy behaviors and unsafe and/or unethical cosmetic surgical practices?

15. Covered in Other Slide Shows Ideals of beauty and body modification Ideals of beauty and body modification Female genital cutting Female genital cutting Body weight and the obesity epidemic Body weight and the obesity epidemic Ethical and policy issues Ethical and policy issues

16. References Donohoe MT. Beauty and body modification. Medscape Ob/Gyn and Womens Health 2006;11(1): posted 4/19/06. Available at Donohoe MT. Beauty and body modification. Medscape Ob/Gyn and Womens Health 2006;11(1): posted 4/19/06. Available at http://www.medscape.com/viewarticle/529442 http://www.medscape.com/viewarticle/529442 http://www.medscape.com/viewarticle/529442 Donohoe MT. Cosmetic surgery past, present, and future: scope, ethics and policy. Medscape Ob/Gyn and Womens Health 2006;11(2): posted 8/28/06. Available at http://www.medscape.com/viewarticle/542448 Donohoe MT. Cosmetic surgery past, present, and future: scope, ethics and policy. Medscape Ob/Gyn and Womens Health 2006;11(2): posted 8/28/06. Available at http://www.medscape.com/viewarticle/542448 http://www.medscape.com/viewarticle/542448

17. References Donohoe MT. Female genital cutting: epidemiology, consequences, and female empowerment as a means of cultural change. Medscape Ob/Gyn and Womens Health 2006;11(2): posted 11/06/06. Available at http://www.medscape.com/viewarticle/546497 Donohoe MT. Female genital cutting: epidemiology, consequences, and female empowerment as a means of cultural change. Medscape Ob/Gyn and Womens Health 2006;11(2): posted 11/06/06. Available at http://www.medscape.com/viewarticle/546497 http://www.medscape.com/viewarticle/546497 Donohoe MT. Weighty matters: public health aspects of the obesity epidemic. Parts I-V. Medscape Ob/Gyn and Womens Health 2007 and 2008 (see http://phsj.org/?page_id=10 ) Donohoe MT. Weighty matters: public health aspects of the obesity epidemic. Parts I-V. Medscape Ob/Gyn and Womens Health 2007 and 2008 (see http://phsj.org/?page_id=10 ) http://phsj.org/?page_id=10

18. Contact Information Public Health and Social Justice Website http://www.phsj.org martindonohoe@phsj.org