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Dahlian Kirby says we don’t need cosmetic surgery.
If a person has something in their life they are uncomfortable with, and has the means to change it so that it suits them better, should anyone ever try to prevent them from doing so? Is it indeed anyone else’s business? If that thing is part of their physical self, isn’t it really up to them? I wish to consider the possibility that by noninterference we may be contributing towards damaging ourselves and possibly harming an already damaged person.
It is said that we all have some part of our bodies we are unhappy with, whether it be breasts that are too small or a nose that is too large. This is said often in fashion magazines, but nowhere else as far as I know. The magazines then help to change the parts we can change, or hide them, or draw attention to other parts of us, the parts which are apparently more attractive. What is attractive in one culture or era, may of course be repulsive in another. We learn quickly what is expected of us; most of it relates to amounts of flesh in the parts of the body with which our own particular society has an obsession.
Young people are particularly vulnerable to criticism; in adolescence we may fear our changing, emerging adult bodies, and if they don’t measure up, actually not like them. To dislike your own physical form cannot be good for you. There is no advantage in self-hatred. Yet in our particular culture it appears that we revel in it; perhaps in a sophisticated society there seems to be little else to conquer. For whatever reason, many individuals don’t love their bodies, and given the opportunity, would change some part of their physical selves.
If we have the money, we can have our bodies altered by plastic surgery, we can have our face rebuilt, our bodies reshaped. It has been said that this is the age of the designer body, that our bodies should be seen as another fashion accessory. If medical practitioners were prevented from carrying out these transformations could it be said that this was an attack on personal liberty? Should there be a right to alter your body in whatever way you wish? At present there is no such right; access to surgery depends on money. Should the rich be allowed to alter their form, or should they be protected from an act of self-hatred?
If a person suffers from disfigurement after an accident, restoring them as closely as possible to their original appearance could be seen as part of the medical treatment. This sort of treatment is performed in hospitals by qualified doctors. Although we could argue that this would be an unnecessary thing to do in a society which did not judge its members on physical appearance, most of us would prefer to look as we did, rather than as the accident made us. It can be said therefore, that plastic surgery is acceptable for people who have been physically damaged and feel uncomfortable with their resulting appearance.
If someone does not like the way they look as the result of a car crash, can it follow that someone else can just not like the way they look as a result of nature? They have not been given the opportunity to choose their body shape and features, and if they had, they would have chosen differently. Now that they are in a position where they can decide, why should they be prevented from doing so? I think that we should always remember that because something is possible, it does not follow that we should do it. Having the technology does not mean we must use it. We can choose not to do so, if we consider that the consequences would be bad.
If a person who is rich and successful decides that they do not like the way they look, there may be underlying reasons why they feel so negative about themselves, problems that will not be resolved by surgery. If that person is black, for example, and wishes to become white, is it a matter of beauty or a result of them having a negative attitude towards black skin, as a result of attitudes in society at large? If it was found that many black people felt low self-esteem, and considered that their blackness was a major contribution to that, would it be a good idea for them all to be dyed white? Would this not in fact reinforce the suggestion that white is superior? The situation for any individuals remaining black would be made more difficult: if white is right, what is wrong with those who choose to be inferior?
If a person who is black does not like their features, then that may be because they cannot accept their blackness. If they lived in a society where black people were treated as equals, or in a society which encouraged them to love their blackness, they might not feel the need to remove evidence of their racial origins. If we believe that racism is bad for those who are prejudiced against, and bad for society itself, then we must find ways in which to end it. Altering the features of those who do not look typically Aryan is not a way to end racial hatred.
To decide what is best for another is paternalistic, and if we believe that paternalism is always a bad thing, we should not consider interfering with the person who wishes to change their face. To be paternalistic is to imply that you know what is best for someone, that you believe that they are not able to make the correct decision themselves. So as individuals and a society we make decisions for the young, for the sick and for those we consider mentally unwell. We make decisions in order to protect them, even from themselves. The motivation may or may not be concerned with power, but it should be concerned with the best interests of the subject.
Those who are ‘vulnerable’ have little opportunity to protect themselves against paternalism, especially as practised by the State. By being unable to make decisions for themselves they lose some of their liberty. It may be considered acceptable to exchange loss of liberty for safety and protection. If however we agree with John Stuart Mill (On Liberty, 1859) that “His own good, either physical or moral isn’t sufficient warrant” [to exercise power over someone], we must reject paternalism.
Many of us feel uncomfortable with total rejection of paternalism, perhaps because we believe that we are not isolated individuals but part of a society. This implies that what is damaging to you may also damage me, so that I protect you in order to protect us all, even against your wishes. It may also be said that interference into the lives of others is a human reaction; we do not like to see others suffer and cannot help but interfere. Problems arise when we interfere and get it wrong, misjudging the situation because we do not really know what is best for that person. They know what their personal situation is, we can only guess.
There may however be times when that individual is not able to see their own situation clearly, and may therefore make a decision that it bad for them, possibly an irreversible decision. If for example, they have been inhaling lighter fluid they may wish to jump off the top of a high-rise car park. If I am able to prevent them, when their mind clears they will probably be very grateful. Alternatively they may wish they had jumped, and be annoyed that I interfered with their action. The person can then of course choose to jump when I am not there to stop them. But at least they have been given the opportunity to reconsider an irreversible decision.
If we know a person well, we may be better able to judge that they are temporarily unfit to make their own decisions and make suitable decisions for them. Their desire for a particular action may be an indication that all is not well in their lives, and that they may need help. A solution to the depression that leads many adolescents to become dependent on solvents (which then makes them feel important enough that they feel they can fly) could be to let them jump. They are no longer depressed and they are no longer a problem to society. If however we feel that we have a responsibility to them, that if they were mentally well they would not risk their lives, then perhaps we should help them to get into a situation where they can make a considered decision. To allow someone who is high on lighter fluid to do what, for that minute, they think is desirable, is not to give them liberty. In this instance paternalistic involvement cannot said to be freedom-restricting.
So back to the rich and successful black person who thinks he’s ugly and wants to be white. We may not, of course, consider Michael Jackson as an example. He has certainly used his wealth to have his features altered. He has also been accused of dying his skin, but it is now known that this was not the case. However, it is perfectly possible to imagine some other young, rich black man who feels that being black is an impediment to further success. He has not set up the situation of deciding who in his society is considered attractive and who is not, any more than the youth inhaling lighter fuel has created unemployment and homelessness. He certainly has not been instrumental in deciding that a certain colour of skin denotes inferiority. Yet he is unhappy with his appearance, and has the resources, in this case money, to alter his situation. He can choose the features that he believes he would have chosen, if that had been possible at birth or before. We know however that he is not choosing freely, he is making decisions based on what his particular culture, at that particular time, decides is right. And these decisions are not necessarily the ones all members of society would endorse; they are influenced mainly by a minority, the media. Many of the members of the medical profession agree with these decisions, because it is financially advantageous for them to do so. The high status of physicians gives the situation an air of respectability: we find it difficult to believe that doctors would exploit the mentally insecure for financial gain.
If this person was able to love himself totally, love his racial origins, and believe that the way he looks is as good as the way any other person looks, he might decide that he wanted to stay the way he is. If he didn’t have the resources to change his face he wouldn’t be able to. Should we allow him to have surgery to take away something of him that he cannot cope with, in the belief that it is his face and he knows what he wants? Is it a blow to liberty to ask him to confront the real issues? I suggest that the threat to liberty is in isolating individuals so that they feel that the problem is theirs and not ours. Paternalism can be a dangerous and destructive thing – but the alternative is rather more frightening. We can let people who don’t love themselves have unnecessary surgery, jump off buildings or starve themselves to death. All in the name of freedom.
© Dahlian Kirby 1993
Dahlian Kirby is a writer and teacher currently doing a PhD in philosophy at University of Wales College of Cardiff. She’d like to thank Maureen Ramsay for helping to change her mind about paternalism.