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The sum of my parts

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7248.1547 (Published 03 June 2000) Cite this as: BMJ 2000;320:1547
  1. Charles Weijer, bioethicist
  1. Dalhousie University, Canada

    Charles Weijer reviews the website www.medicineonline.com, where cosmetic surgeons bid for customers

    I worry of late that I am not as good looking as I used to be. I stopped exercising about a year ago after a move into the country. The bucolic setting disagrees with me. This week I turn 36 years old. But these aren't the bases for my complaint. The problem is that time has treated me more cruelly than similarly situated others. The rest of my birth cohort seems filled with vim and vigour. I, on the other hand, am fleshy, pallid, and prone to fits of profuse perspiration. This year I vow to do something about it.

    My first stop is my general practitioner, the best doctor I have ever had. “Stewart,” I say, “this is the year I do it; tell me where I should start.” He reminds me of visits around this date in the past three years, when he talked me out of trying Prozac (1997), Viagra (1998), and an all-protein diet (1999). “I am way beyond all that. This is about releasing a happier me from a corporeal prison. A more beautiful me. A…” I go on at some length. Stewart suggests diet and exercise. “Impossible,” I retort, “I am up for tenure in the fall.” He tells me that I'd have to gain a lot more weight before I am eligible to take a diet pill. I ponder this dilemma for some time. Then in a flash the answer comes to me—cosmetic surgery. Relief floods over me like warm butter.

    The website MedicineOnline.com reads as if it was written just for me. The “Bid for Surgery” section of the site describes itself as an “E-exchange for cosmetic surgery, dentistry, ophthalmology, and podiatry.” Inside is a virtual map to bodily enhancement. Three dozen procedures are offered to stretch or snip my parts on cosmetic surgery's procrustean bed. I am to select one or more procedures, fill out a form detailing medical information, and then wait for the bids to flow in from practitioners across the United States. Narrowing the field of procedures is going to be a problem.

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    I decide to ask my life partner to select for me. This is a mistake. I get a list of eight procedures: Botox injections for laughter lines (“Nothing's that funny,” my partner says); correction of enlarged male breasts; eyelid surgery; liposuction; nose surgery; scar revision (long story); laser surgery for myopia; and teeth whitening (too much coffee while writing snappy commentaries). Clearly we are going to need to set priorities. After a long heart to heart, we settle on four procedures—eyelid surgery, liposuction, laser surgery, and teeth whitening. Sharing a quality moment, we fill out the forms together and, on their completion, pause, warmed by the glow of my computer's new, flat screen monitor. We both sit transfixed by my image reflected by the digital surface. Somehow, I already seem slimmer, more beautiful. My partner's hand rests on mine as I click the left mouse key: “Submit—register and request a bid.” Yes, submit.

    The bidding among the various specialists lasts for seven days. Meanwhile, I ponder the ethics of all this—it is, after all, my day job. In short, it is perfectly acceptable to auction cosmetic surgery services. The clearest I can make it is to compare it to prostitution. My favourite political philosopher, Michael Walzer, argues that the distribution of a good (be it sex or health care) is determined by its meaning for a particular society: “People who believe that sexual intercourse is morally tied to love and marriage are likely to favor a ban on prostitution … Sex can only be sold when it is understood in terms of pleasure and not exclusively in terms of married love” (Spheres of Justice). If you believe that cosmetic procedures in particular, or medicine in general, are a commodity then you are committed to view free market forces on price, bidding, and unequal access based on wealth as wholly unproblematic. As Walzer says, “there is no such thing as a maldistribution of consumer goods. It just doesn't matter, from the standpoint of complex equality, that you have a yacht and I don't.” Nose jobs are the aesthetic equivalent of yachts, and cosmetic surgeons who ply their trade on the internet are the new captains of medical industry.

    After a week, I have four bids on two procedures. Next time I will have to say that I am willing to travel to California, the home of MedicineOnline.com. I ponder how to choose the right doctor—the most procedures per year, best patient ratings, fewest lawsuits, cheapest, or most expensive. I decide that the procedure I use for selecting sushi restaurants is most appropriate—pick the most expensive. Like raw fish, surgery should not be cheap. The cost for the new me? $6591. Of course, I have six more procedures to undergo. Sure, it's a lot of money, but if I'm not worth it who is? Of money—and he might have said the same of cosmetic surgery—the Bard said it is “That which makes the wappen'd widow wed again” (Timon of Athens


    • At the time of this publication, Charles Weijer's photo was still being retouched.

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