- Serap Sahinglu Pelin, MD (Research Assistant and Doctoral Student) and
Yaman Ors MD, D.Phil. (Professor);
Unit of Medical Ethics, Ankara Medical Faculty, Sihhiya, 06100 Ankara, TURKEY
Medical Esthetics is apparently not a sufficiently known (and appreciated) topic in medical and other academic/professional circles. Nor do we know of any academic unit or subunit in higher educational institutions devoted to the study of esthetic issues in medicine. To the extent that one can judge by the related literature, there appear to be few academic people, medical or other, who have shown a real interest in the esthetic aspects of medical activity. In certain clinical branches, notably plastic and reconstructive surgery, and surgical specialties in general, esthetic problems have certainly played a vitally central role; and evidently one can also mention psychiatry in this context, although its role here appears to be, in principle, an indirect one. But medical esthetics, or esthetics in medicine to reword the expression, seems to be far from being an academic let alone professional discipline.
It should be justifiable to regard medical esthetics as a differentiated extension of general or philosophical esthetics into the medical domain, above all, into the clinical area. Seen from such a broad methodological perspective, esthetics in philosophy and in medicine have the same kind of relationship that exists between general or philosophical ethics and medical ethics. This is basically a set-subset relationship in which the latter has a lesser scope but also shows certain characteristics not existing in the former. This, therefore, is why the subset is of a differentiated nature.
Using the term in a rather broad sense as we do, the subject matter of medical esthetics may be grouped under three headings: (a) the esthetic problems created in medical practice, which comprise those situations ordinarily meant by the term; (b) those arising in the course of the patient-physician relationship, which may be seen as part of what we could call behavioural esthetics; and (c) the esthetic issues which may be discerned when examining critically the places (the inner and outer architectural characteristics of health institutions) in which the medical practice and the patient-physician relationship take place; and this may perhaps be called, in turn, spatial esthetics (in medicine) (1). It must be noted that such a broad understanding of esthetics in medicine had already been developed by a philosophically minded physician in the middle of this century (see ref. 2), with an admirable emphasis on the need of its further development.
Esthetic issues in medicine also have ethical implications, in both concrete terms or at the case level from the perspective of philosophical methodology (1). Cosmetic interventions are a characteristic subset (1,3). From a medical point of view, what is the status of those individuals seeking clinical "correction" for their "esthetic" problems? What diagnostic "label" might they have? Are they "patients"? Should we not consider surgical and anesthesiological risks involved in the related interventions? And we need to ask to what extent it would be morally justifiable, on the part of the surgeon, to make those individuals "more beautiful" or "more attractive".
We have been considering the relationship between ethics and esthetics in medicine for several years, and Dr Pelin is under the advice of the other author here, writing her thesis with the title, "Visual Esthetics in Medical Evolution with its philosophical, scientific and applied aspects", for a doctoral degree in Deontology and Medical History. Academically, this is related basically to medical history, the second component of the "mixed" academic discipline in our country at the graduate level. The thesis necessarily involves theoretical as well as practical aspects. We hope that the soon-to-be completed work will be of interest both philosophically and in the medical context, and would welcome comments from readers.
Apart from "purely cosmetic" applications or interventions, an esthetic approach to medical practice is never independent from the functionally orientated aim of the physician, organically and psychologically; the correction of the hare-lip is a typical example in this regard. In the broader social context, on the other hand, the association of the concepts of health and beauty with the idea of eugenics (2) appears to be not infrequent. "eugenics" now carries largely pejorative connotations (4), however, people seem to be much more careful when mentioning that term. From a political standpoint, the crucial point in our context seems to be this. The therapeutic achievements of clinical medicine on the phenotype cannot justifiably be linked to racist expectations in any direct way, for the obvious reason that they would not affect the genotype. But we may perhaps imagine that the racist tendencies in a given social milieu would enhance the practice of cosmetic surgery" for its own sake.
(1) Pelin, S.S. (1994) "Problems of esthetics in medicine from the viewpoint of ethics", The Journal of The Faculty of Medicine University of Ankara 47: 65-74 (in Turkish, English summary).
(2) Knueker, A.W. (1949) Richtlinien einer Philosophie der Medizin (Vienna: Wilhelm Maudrich), pp. 93-6.
(3) Mayer, E. & Knorr, N.J. (1977) "Psychiatirc aspects of plastic surgery", Reconstructive Plastic Surgery 1: 549-564, ed. J.M. Converse (Philadelphia, Saunders).
(4) Motulsky, A.G. (1993) "Eugenics and past mistakes: can they now be forgotten?" Second Symposium of the Council of Europe on Bioethics, Strasbourg, 30 Nov. - 2 Dec., 1993.