Crossing the line on surgical fixes: When should a doctor say no?
How ethical is it for surgeons to perform extreme surgeries for reasons other than saving lives or improving health?columns Updated: May 14, 2017 10:59 IST
Rodrigo Alves, 33, is the man who wants to look like a plastic doll so desperately that he’s undergone 57 surgeries and more than a 100 cosmetic procedures since he was 17. He’s so plastic now that he can’t feel his face, but that’s not stopped him.
Alves was in Delhi for 10 days recently to get the colour of his eyes changed from brown to icy grey like his role model Ken, Barbie’s “fantastically fashionable” partner/boyfriend/playdate/accessory. Alves told British media that he wept on his flight home to London because his surgery was cancelled after tests showed his “eye chambers” were too small to hold the artificial lens.
Alves was in India not just because Indian doctors are the best, but also because a surgeon in Delhi agreed to consider doing a surgery fraught with risks for cosmetic reasons. “I could not get this procedure done in London for cosmetic reasons only,” he told HT.
Iris implants – where an artificial silicone iris is folded and inserted through a tiny incision in the cornea – are done to treat people who’s irises are absent from birth (condition called aniridia) or from an injury, iris atrophy, or conditions such as coloboma (hole in the iris, retina, choroid, or optic disc). The risk of surgical complications is higher in people who get the implants for cosmetic reasons. This is why many surgeons refuse to do it for non-medical reasons.
Womb for more
How ethical is it for surgeons to perform extreme surgeries for reasons other than saving lives or improving health? Since people who opt for such elective procedures often have body dysmorphic disorders that makes them obsess about perceived imperfections in their appearance, the onus is on the surgeon to determine whether the benefits from surgery outweigh the risk.
No medical procedure comes without side-effects, but while a person undergoing heart surgery or kidney transplantation is choosing between life and potential complications, while people going for elective procedures are choosing appearance over often irreparable risks to their health and appearance.
A surgeon in Delhi agreed to consider doing Alves’ surgery that is fraught with risks. (Hangingshoesfilm.com)
A Pune hospital recently announced it will do womb transplantations to help two women – one with an absent uterus and the other with a defective one – carry their own babies. In both cases, the donors are the recipients’ mothers. Is undergoing transplantation to bear a child worth the risks to health and the constant threat of organ rejection? Aren’t adoption or surrogacy good enough options? Medical literature shows some implanted wombs were rejected and only around a third of the recipients have delivered a baby.
The delivery is always by cesarean section, and that’s not the end of the surgeries. The implanted wombs are usually removed after the woman gives birth so that she can stop having immune-suppressing medicines to prevent organ rejection. And those who choose womb transplantation to experience carrying a baby are also disappointed -- nerves are not transplanted with the uterus, so the mother does not feel contractions or the baby kicking.
Which does make you wonder if the surgeons discuss the pros and cons with the patients thoroughly enough?
Another surgery being misused is the Ilizarov technique developed to treat deformities, such as those associated with polio. The technique involves breaking the bones in both legs (femur) and then fixing metal wires on a clunky frame around them to pull the bones as they heal to add three to four inches to height over four months. Apart from infection, people who undergo surgery risk deformity and osteoporosis at healing sites.
Perhaps the most misused surgery these days is bariatric surgery, which most recently made news when the world’s heaviest woman Eman Ahmed, 36, came to India and lost more than 300 kg in less than three months. She weighed 495 kg before surgery and needed it. Many who get it done don’t.
Many overweight people use it as a quick-fix weight-loss measure, oblivious to side-effects that range from the stomach pouch leaking and breaking to risk of osteoporosis, gastritis, heartburn, ulcers, gall bladder and kidney stones, and nutritional deficiencies.
Most elective surgeons plead that people who’ve made up their minds don’t stop till they find someone who will do the job for them. What they must keep in mind before sharpening their scalpel or blade is that their priority is patent safety, and unless the surgery meets the four principles of medical ethics-- autonomy, non-maleficence, beneficence, and justice – they cannot look their patient in the eye, irrespective of whether they are brown or icy grey.