The Hippocratic Oath can be summed up in a single statement—to abstain from intent of harm and wrong-doing. It’s popularly known as “do no harm,” even though the original text doesn’t make any exact mention of it.
It’s a promise that isn’t too difficult to understand or uphold. Yet, stories of doctors breaking it are in no short supply, including a TikTok-er losing her medical license after livestreaming her surgeries on the platform.
According to a medical inquiry in charge of hearing the case, three of her plastic surgery patients suffered from post-op complications.
Abstention from doing harm extends beyond the operating room, especially in cosmetic surgery. Practitioners have an obligation to inform their patients what they’re signing up for, whether for a breast implant or a major facelift. Failure to do so constitutes medical negligence, nothing short of a serious crime in many countries.
Patient autonomy and consent
Patient autonomy, the right to make your own healthcare decisions, is a protected right. Any individual over 18 years of age is entitled to choose to undergo a procedure or treatment. If they’re under 18, the decision falls on their legal guardian. Age of maturity is often associated with competence to make choices, hence the legally given right to patient autonomy.
Doctors must respect a patient’s choice, even if it goes against medical convention or evidence. Given the invasive or experimental nature of certain treatments, it makes sense for the person to evaluate their doctor’s recommendation further. While experts in their field, in the end, doctors are still human and prone to err from time to time.
Despite being legally protected, patient autonomy isn’t absolute. One exception is life-and-death situations, where doctors can temporarily override such rights to save the patient’s life.
Patient autonomy only occurs under informed consent. Suppose a client is to decide whether to get breast implants; she must be informed of crucial details like the risk of breast implant illness and post-operative care. To quote a law expert, ‘Consent without necessary information is no consent at all.’
Elements of informed consent
Whether for cosmetic surgery or procedures in other fields, informed consent requires five key elements. The hospital or clinic’s records system must note that the patient:
· Is sufficiently competent to make decisions
· Obtains full disclosure of the proposal
· Understand the disclosure
· Comes to a voluntary conclusion
· Concurs with the proposal
Although medical guidelines use “competence,” the idea emphasizes “capability” in practice. The law assumes that a person is capable of sound decision-making upon reaching the age of maturity, so doctors test patients based on basic abilities like comprehension. Otherwise, the responsibility falls on their legal guardian, regardless of age.
More important is the need for full disclosure of the doctor’s plan. With the client’s well-being at stake, there’s no room for professionals to lie about the procedure and expectations before and after it. For cosmetic procedures, the surgeon must divulge:
· Pre-existing conditions that might affect the surgery
· Information about the proposed cosmetic procedure
· Available alternatives to the surgeon’s plan of action
· Risk of complications and other adverse side effects
· Overall prospects of the procedure succeeding or failing
The cosmetic surgery industry is poised to expand by 6.34% over the next five years. However, to sustain this growth, organizations need to be more transparent with their clients and provide a conducive environment for performing procedures. Lack of adequate oversight remains an issue with unauthorized establishments and individuals continuing to offer cosmetic surgery.
Meeting expectations
So far, the discussion has focused on patient autonomy and informed consent relative to surgery in general. If you haven’t noticed, this piece has referred to people undergoing cosmetic surgery as ‘clients’ instead of ‘patients.’ A world of difference exists between the two terms.
According to Sander Gilman, an American literary historian who’s written a book on the history of cosmetic surgery, cosmetic surgery clients are rarely referred to as ‘patients’ because they’re in good health when they undergo a procedure. Surgeons are even reluctant to proceed with one if there’s evidence of a pre-existing health condition in the client due to fear of complications. While they can be medical in some cases, such as weight loss surgery, cosmetic procedures are mostly elective or voluntary.
How does all this influence the significance of informed choice? As with elective procedures, the success of any cosmetic procedure lies in meeting client expectations instead of the effective remedy of an illness. Because of this, even if the surgery went without incident, it can still be considered a failure if the client doesn’t get the results they expect.
Sadly, many people base their beauty standards on before-and-after content from celebrities and other personalities on social media. Pre- and post-op photos tend to paint an incomplete picture, leaving consumers with a dangerous knowledge gap.
The surgeon is, thus, obligated to advise their clients to maintain realistic expectations about the outcome. Informed consent should prompt people to answer the hard questions, namely:
· Why do you want to undergo cosmetic surgery?
· Are you prepared for its physical and emotional effects?
· Do you have a plan if the results go unexpectedly wrong?
· Can you afford it without causing long-term financial strain?
These questions give important information for making a smart decision. It prevents people from taking cosmetic surgery decisions lightly while protecting practitioners from liabilities fueled by unrealistic expectations.
Conclusion
Doctors are under oath to avoid bringing harm to their patients. Those in the medical field have a straightforward idea of how to uphold it as they treat people with illnesses. But the same can’t be said for cosmetic surgeons, given that their clients are mainly in good health. Not to mention that undergoing a cosmetic procedure presents the risk of post-op complications.
In this case, people deserve to be informed of the potential weight of their decisions. Patient autonomy is protected under the law, but it can’t happen without proof of a person’s competence or capacity and expert insights from their cosmetic surgeon. The lack of either is insufficient consent, and the lack of both is a lack of consent.
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