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November 12, 2007
Blind ethicist takes hard look at reasons for cosmetic surgery

By carol clark

The parents of a little girl with Down syndrome decide to have cosmetic surgery done to the child to make her appear more "normal." Did these parents have the best interests of the child in mind? Or was the surgery more about the parents' dream of having a child who looks more socially acceptable?

Adrienne Asch posed such thorny questions during a recent campus lecture titled "Appearance Altering Surgery: Social Conformity or Self-Realization," sponsored by The John and Susan Wieland Center for Ethics. Asch is the Edward and Robin Milstein Professor of Bioethics at Yeshiva University and professor of epidemiology and population health at Albert Einstein College of Medicine.

"Maybe we shouldn't be working so hard to look the same," Asch said. "There are lots of ways to lead a rich, interesting life of relationships and activity and social contribution. Why do we assume that only some differences actually matter?"

The thesis of her talk covered all kinds of cosmetic surgery designed to approve appearance without improving physical health, including tummy tucks, face-lifts, nose jobs, limb lengthening, breast augmentation — even sex-change operations.

"I'm sometimes criticized for talking about these surgeries because, after all, I'm blind and I really don't know what people look like anyway," Asch said, addressing her obvious disability.

She explained that clichéd notions that the blind don't care about appearances are false. "Would I like to change my body to some ideal of what I'd like to look like? Sure. I have my images, too," Asch said. "But I think there's a very big problem that these surgeries of all sorts are trying to get us to escape — that, at rock bottom, we have to live with who we are."

She questioned the claims by some people that they need cosmetic surgery to make their "outsides" match who they are "inside."

"I'm interested in challenging notions of sameness and difference and normal," she said. "I'm also interested in challenging notions of 'inside' and 'outside' and how we want to think about them."

The issue of parents making decisions on behalf of their children to have cosmetic surgery is especially troubling, Asch said. While parents may want their child to fit in and not be teased or bullied, they are simultaneously transmitting a message that "your body isn't good enough as it is," she said. "What children need, more than a body that fits in, is parental love and acceptance of who they are for the things they cannot change. And if they have that, there's a lot of evidence that children can flourish."

The lecture attracted students and faculty from ethics, theology, public health and psychology. During the discussion following the talk, a public health student said that his brother grew up with Tourette’s syndrome, a neurological condition that causes facial tics and other socially embarrassing behavior. His brother is now married, has two children and a good job. He endured a painful childhood, however, full of cruel teasing and embarrassment. New medical techniques give an opportunity to lessen the symptoms of Tourette’s syndrome through deep-brain stimulation.

"If my parents would have been able to offer that to him, I would say they would have been willing to take that chance," the student said. He asked Asch how she could advocate that parents "simply provide love and strength" to children suffering from socially abhorrent facial morphologies when medicine offers other options.

"It may sound kind of hard-hearted for me to say I would like people not to do [medical interventions for social acceptance]," Asch said, adding that she knows what it's like to be teased.

She said that if a child is able to participate in an informed decision, then a child should be allowed to opt for such a procedure. But she believes it is important for people to fully realize why they are having such surgery. "Don't think that you're fixing yourself," she said. "You're fixing what other people don't like about you."

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