HealthLawProf Blog

Editor: Katharine Van Tassel
Concordia University School of Law

Wednesday, May 18, 2011

Questioning Body Modification

[I've decided to put the whole post beneath the fold, since the topic reminds me of Leontius's Tale, and I don't want anyone to accidentally click through to something they don't want to see.]

Recently one of Rupert Murdoch’s properties carried news of the “164XXX” chest of a woman named Chelsea Charms. At a conference on Transhumanism & Design in New York a few days ago, participants talked about a person who has forked his tongue and implanted bumps on his head to look more like a reptile. Yesterday, the “Botox Mom” lost custody of her daughter for injecting her with beauty aids.

These are all extreme and freakish phenomena, but they speak to larger social dilemmas. What are the limits of personal and parental autonomy when it comes to body modification? At least two thoughtful law review articles have addressed the topic.

Botox Mom

Alicia R. Ouellette’s article “Shaping Parental Authority over Children’s Bodies” addressed a number of dilemmas:

In the health-care setting, parental decisions to size, shape, sculpt, and mine children’s bodies through the use of nontherapeutic medical and surgical interventions are a matter of parental choice except in extraordinary cases involving grievous harm. This Article questions the assumption of parental rights that frames the current paradigm for medical decision making for children. . . . I argue that by allowing parents to subordinate their children’s interests to their own, the current paradigm distorts the parent-child relationship and objectifies children in violation of the moral principle, deeply embedded in American legal tradition, that no person, even a parent, may subordinate the life, liberty, or body of another for his or her own purposes.

Ouellette discusses a number of issues, such as the Westernization of Asian eyes, the “3979 cases of liposuction on patients between the ages of thirteen and nineteen in 2008,” and the stunting of a mentally disabled girl. Taking a bioethical perspective, the article “develop[s] a trust-based construct of the parent-child relationship, in which the parents are assigned trustee-like powers and responsibilities over a child’s welfare and future interests and are charged with fiduciary-like duties to the child.” It attempts to “construct in the health-care setting separates medical decisions that belong to parents from decisions that belong to children and those that should be made by a neutral third party.” I think it safe to say that it would be very difficult to defend the Botox mom’s purely cosmetic interventions to affect her daughter’s appearance within Ouellette’s ethical framework.

Extreme Self-Alteration

Does maturity give persons the right to do whatever they want with their bodies? Annemarie Bridy confronted this issue in Confounding Extremities: Surgery At The Medico-Ethical Limits Of Self-Modification. Her description of the following scenario reminded me of the role of the medical profession in the self-modification of Ms. Charms:

Controversy swept the U.K. in January of 2000 over public disclosure of the fact that a Scottish surgeon . . . had amputated the limbs of two able-bodied individuals who reportedly suffered from a condition known as apotemnophilia. The patients, both of whom had sought and consented to the surgery, claimed they had desperately desired for years to live as amputees and had been unable, despite considerable efforts, to reconcile themselves psychologically to living with the bodies with which they were born. Both surgeries were successful, and both patients, who had undergone psychiatric evaluation prior to the amputations, subsequently reported having no regrets. In the wake of a wave of sensationalistic stories in the media, the hospital at which the surgeries had been performed, the Falkirk and District Royal Infirmary, banned any future surgeries of the kind. Outraged local politicians promptly announced their intention to pass laws banning the procedure outright. One member of Scottish Parliament declared the surgery “obscene” and asserted that “the whole thing is repugnant and legislation needs to be brought in now to outlaw this” . . . .

[T]he automaticity of the politician’s response suggests, even as it implicitly denies, the need to examine the cultural dimensions of the paradox and to understand what is at stake for apotemnophiles and for society at large in the proscription of amputations performed on physically healthy individuals. Although apotemnophilia is by no means common, its effects can be quite devastating for those who count themselves among its victims. Consider the case of Philip Bondy, an apotemnophile who died from gangrene in 1998 in a San Diego motel room within days of a “back alley” amputation in Tijuana.

Though apotemnophilia may be rare, compulsive self-alteration is becoming more common, given both advances in cosmetic surgery and fickle and restrictive concepts of beauty and uniqueness. Bridy “consider[s] the legality of elective amputation in light of laws prohibiting mayhem and in the context of the regime of self-regulation that operates within the medical profession.” Psychiatry also promises a way around the paradoxes of self-determination via self-mutilation, via the diagnosis of “Factitious Disability Disorder” (FDD):

Under the factitious disability model, the apotemnophile seeks amputation not as a means of expressing a psychologically “authentic” self, but as a way of artificially manipulating the behavior of others to compensate for a perceived emotional lack. Not surprisingly, surgery does not emerge as a therapeutic option under the FDD model. Presumably this is because accepting apotemnophiles’ desire for amputation would be tantamount to authorizing their delusion that they are irremediably unlovable in their able-bodied state and, conversely, that they will become spontaneously lovable (and therefore loved) if they become disabled.

Roberto Unger once stated that “The closest equivalent to love in the outer coldness of social life is the practical organization of responsibility to care for others, nourished by the patient development of the ability to imagine other people’s experience.” Pleas for extreme self-modification deserve exactly this type of empathy. Those responding to such pleas must first imagine exactly what drives lie behind them, before any technological “quick fix” is offered. Unger, like Dante, is a great theorist of “love misdirected,” and the modern vanity industry’s most extreme excrudescences are its prototypical forms.

Fortunately, the “coils of polypropylene” that Ms. Charms uses are now illegal. But given the dizzying range of potentially self-harming body modifications now on offer, the German approach of discouraging or even banning their promotion might be a necessary additional step to protect the vulnerable.  [FP]

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