1.

Cosmetic Surgery: Stephen Coleman argues that cosmetic surgeries are generally
permissible with appeal to the right to exercise one’s autonomy. Margaret Little
defends a different perspective. She argues that suspect norms of appearance
influence the desires for cosmetic surgery and that individuals have obligations to
combat these norms to avoid complicity in the systems that uphold them. Given this
exchange of reasons, do you think that cosmetic surgery is generally permissible? If
so, under what conditions and if not, why not? Do individuals involved in such
surgeries, such as surgeons who conduct them or individuals paying for them, have
any special obligations in virtue of their involvement?

Beauty is a construct that is subject to the values of the people within the society.
Particularly these constructs change over time as different trends go in and out (ex. A Brazilian
Butt lift, heroin chic body, etc). These body types serve as a catalyst of fashion and great
admiration in the society. The benefits to adhering to the beauty standard can aid in job
placement and social status. Stephen Coleman supports cosmetic surgery in order to adhere to
this standard and are simply exercising their autonomy and are not under pressure to conform.
Contrastingly Margret Little argues that the beauty standard causes the values held within these
societies and must be questioned. Between these two authors autonomy is the biggest factor and
should always be considered when undergoing these procedures in order to ensure safety within
the society and mitigate discrimination.

Margaret Little describes cosmetic surgery as “medical enhancement” and defines it

within a surgery that is not necessary for health or restoration. However it is still motivated by
“deep and genuine suffering, in which surgery is pursued, not from a desire for beauty, but for a
desire to end a distressing source of alienation from some body part or incessant teasing.”(162).
In the previous quote Margaret demonstrates the meshing between societal beauty standards and
the cosmetic surgeries that are being addressed from the patient as correlative. Margret
establishes the first two premises of her argument as follows:

1. Cosmetic surgery is a form of medical enhancement and is not necessary for health or
restoration but can relieve the burden of alienation on the patient.
2. Cosmetic surgery is influenced by societal norms and beauty standards.

Little gives three case studies to support these two previous premises. The first study
centers on a society where double chins are seen as attractive. However, an individual is
unable to possess that attractive trait and it starts to wear at his mental health and causes
the individual to be miserable and want a surgical chin (164). This case study is a direct
link to the first two premises outlined above where the enhancement is not needed, but,
proves influence by societal norms. Fashion Fads and beauty standards are ever changing
attributes of society and does not implicate the society is acting immorally (Premise 1).
The second case study which a child is teased about his ears sticking straight out and
attempting to compensate with mental health, wants surgery to correct his ears. This
counteracts the previous point and highlights the pressure the society can put on the
individual to conform to the beauty ideals. The alleviation to the child’s alienation could
be to receive the surgery in order to ease his mental distress. Within the previous case
Little affirms that society shoulders the blame due to being “immoral in its enforcement
 of these (societal) norms”(165). Contained within the last moral case she labels as cruel
in the enforcement and blamed society for his suffering. Little describes the final moral
case as a black boy who wants white features in order to stop the bullying that happens to
him. This is a form of the long standing issues within the society due to colonization of
Africa. Furthermore, the implications of being black have been synonymous with apes
and a subhuman culture (167). The enforcement and dehumanization of black people and
pressure to conform to white beauty standards are unjust. Women are subject to
unrealistic beauty standards as well This highlights the reason why cosmetic surgeries
have to be questioned due to their moral backing. Continuation of these immoral
practices is complicity on the physicians part as they are a steak holder within this
argument. Complicity is defined as “To be complicitous is to bear some improper relation
to the evil of some practice or set of attitudes...Put in broadest brushstrokes, let me
suggest that
one is complicitous when one endorses, promotes, or unduly benefits from norms and
practices that are morally suspect” (170). This establishes another premises:

1. Cosmetic surgery is a form of medical enhancement and is not necessary for

health or restoration but can relieve the burden of alienation on the patient.
2. Cosmetic surgery is influenced by societal norms and beauty standards.
3. Some aesthetic enhancement requests reflect immoral social and beauty standards.
4. Physicians being complicit in these practices is what continues the reinforcement
of the harmful stereotypes.

Little further elaborates the way to mitigate the behavior of those benefiting from the unjust
system. Little asks physicians to question the system and ensure they are evaluating paitent goals
and values.

1. Cosmetic surgery is a form of medical enhancement and is not necessary for

health or restoration but can relieve the burden of alienation on the patient.
2. Cosmetic surgery is influenced by societal norms and beauty standards.
3. Some aesthetic enhancement requests reflect immoral social and beauty standards.
4. Physicians being complicit in these practices is what continues the reinforcement
of the harmful stereotypes.
5. Physicians should advocate for those who are subject to the immoral practices and
ensure patients are meeting personal goals and values.

Stephen Coleman identifies cosmetic surgery as “I will define cosmetic surgery as

surgery undertaken to alter a person's appearance (usually from its natural state) for
reasons other than a response to injury, disease, or genetic or other disorder” (171). He
elaborates further on this difference due to cosmetic reconstruction being covered by
the state (172). This further outlines the difference between treatment and enhancement
(173). The premises can be established as such:

1. Cosmetic surgery is undertaken to alter a person’s appearance.

2. Reconstructive surgery is covered by the state but cosmetic surgery is not.
 Coleman utilizes the case study of Public healthcare coverage within the Netherlands
which defines coverage by the following: functional disturbances, severe psychological
suffering and physical imperfections that cause a extreme variance in appearance (173).
Although it centered on the idea of autonomy is being enacted when engaging in the
practice of cosmetic surgery. The motivations to undertake plastic surgery he outlined in
three examples.

I. Actresses changing their appearance to maintain their careers. However

due to circumstances that surround their career because of ageism it does
not qualify under the first premise. (176)
II. Utilization of plastic surgery to ensure those were not discriminated
against due to predjusces in the society. “While the object of such
surgery is certainly to change the patient's appearance, and while we
might deplore the prejudices of a society that makes people feel that
such surgery is necessary, again it is clear that the object of the
surgery is to help these people avoid prejudice, rather than simply to
alter their appearance.”(177) This is also voided by the first premise.
III. Breast augmentation in the entertainment industry. Women with larger
breasts are booked more than those who have smaller breasts. Because of
the pressure not coming from a personal goal, it is not cosmetic surgery
because it is not intrinsically motivated. (177)

1. Cosmetic surgery is undertaken to alter a person’s appearance.

2. Reconstructive surgery is covered by the state but cosmetic surgery is not.
3. Cosmetic surgery has to be intrinsically motivated and not motivated by external factors
(ex. success at a career, mitigating discrimination, etc.)

Coleman defines autonomy as "being able to understand and act upon one's con-
sidered values and commitments."(178) He likens plastic surgery to receiving a tattoo. Both
forms of alteration are supplemented by their values and commitments. Individuals are
given autonomy to act in accordance with their own values so long as they’re practicing
beneficence.

1. Cosmetic surgery is undertaken to alter a person’s appearance.

2. Reconstructive surgery is covered by the state but cosmetic surgery is not.
3. Cosmetic surgery has to be intrinsically motivated and not motivated by external factors
(ex. success at a career, mitigating discrimination, etc.)
4. Tattooing is a form of body modification that is representative of ones values without
harming others.
5. Tattoos are permissible due to the lack of harm is causes anyone outside of the individual.
6. Both Tattoos and Cosmetic surgery only effect the individual and not harm to others.
7. Cosmetic surgery is permissible due to lack of significant difference between both
tattooing and cosmetic surgery.

Little reaches a conclusion that respects both the individual’s autonomy whilst still
questioning the moral backing. Cosmetic surgery through her lens of how autonomy and
cosmetic surgery meet. Both Coleman and Little come to the conclusion that these surgeries
 be of ones own personal will. However Little begs the question of how we mitigate the
society with its existing ills. Little advocates for the patient outside of just respecting the
wishes of the paitent to conform to society. Due to the position that these physicians hold,
they owe the public and ought to combat complicity within the system. Physicians
compliance aids in the enforcement of these impossible standards and need to keep the
paitent values and health in the primary focus.

However, gatekeeping autonomy due to the reasoning behind the surgery can limit ones
autonomy. Because autonomy is the central focus of the individual, bodily modifications should
not be subject to moral objections due to the beneficence of the action. Cosmetic surgery can aid
in the way an individual is seen and aid in the acquisition of better positions and self confidence.
Once societal pressures come into play however, cosmetic surgeries are not occurring very often
due to the commitment and possible danger to health. Limiting those who are able to get
cosmetic surgery can prove counter productive because limiting the choice to follow trends
threatens autonomy. As cultural influences are important in the society we live in does not negate
those wanting to get surgery is immoral or more immoral than tattoos.