Botox and Bioethics

By: Natalie Pippin

In our Christianity and Culture class with Dr. Barnard, we read Gilbert Meilaender's book Bioethics: A Primer for Christians. In conjunction with our reading, Dr. Barnard assigned us a reflection essay in which we analyzed a current bioethical issue in light of our text. I found an article exploring the practice of performing minor cosmetic enhancements by OB-GYNs and General Practicioners. The article can be found here. Below is my paper reflecting on the article in light of Meilander's work:

Dermatologists and Cosmetic Surgeons across the country treat patients' undesirable signs of aging like crow’s feet, jowls, bags under the eyes, and thin lips. In Nashville, my aunt works in one such office giving injections and supplying skin care products only available through a physician. Before joining the Nashville practice, she honed her cosmetic skills alongside a local OB-GYN who added the services to her foray of medical procedures. Her professional experience is a microcosm of the transformed landscape of medical practice within a variety of specialties outside of dermatology and cosmetic surgery.

Cosmetic procedures are nearly ubiquitous among the inventory of services offered by OB-GYNs. General practitioners, too, have climbed aboard the enhancement express. The trend seems to indicate a general disregard for, or at least an ignorance of, the ethical implications of including cosmetic enhancement in the practice of a medical specialty. An article published by the Women’s Bioethics Project addresses the “deep ethical implications of the rapidly increasing trend.”

The article, “Your Cervix is Normal, Now Let’s Talk about Botox® for Those Frown Lines…” adequately enumerates most of the ethical issues that arise when OB-GYNs, and GPs couple cheek fillers with strep tests, pap smears, and insulin injections. The author begins by noting the conflict of interest created by adding lucrative cosmetic enhancement to a physician’s practice because the potential financial incentive compromises the requisite objectivity required in the physician-patient relationship. Board certification in the area of a physician’s specialty grants physicians credibility, and the cosmetic procedures fall outside of the scope of care for which a physician is Board certified. Ultimately, the author observes, this is an “exploitation of patient trust.” Moreover, this disturbing trend “demeans the practice of medicine,” relegating a physician to a “body technician,” and the medical practice to a “body shop.”

Overall, the article effectively argues many of the ethical issues inherent in the trend. However, the article overlooks the greatest ethical gaffe made by OB-GYNs and GPs who add cosmetic enhancements to their therapeutic lineup. In promoting physical agelessness, physicians contribute to a warped sense of wellness that they have a responsibility to subdue. In wishing to escape the physical signs of aging, patients wish to escape the reality of their finitude. Aging is a part of life, indeed it is a part of health. If true health is the body’s processes proceeding as they ought, then the signs of aging are symptomatic of a healthy individual. By displaying wrinkle-free fifty-year-olds in the waiting room pamphlets, physicians communicate a not-so-subtle message to their patients: “If your forehead is not this smooth, you are not well. And in this office you are free to fix that problem.” But, as Gilbert Meilaender points out, “The only freedom worth having… is a freedom that acknowledges its limits and does not seek to be godlike."

Certainly, aging brings its share of suffering. The skin of an elderly man seems as fragile as tissue paper. The bones of an elderly woman seem as porous as a sponge. For these maladies, physicians ought to offer adequate, compassionate care. However, in promoting unnatural youthfulness, physicians forget to embrace the good in suffering. Meilaender instructs physicians to understand both sides of suffering, seeing it “as an evil which can… have meaning and purpose.” Physicians charged with caring for the suffering of their patients step well beyond ethical boundaries when they include cosmetic enhancement as a standard in the care they offer.