An ethics analysis of the rationale for publicly funded plastic surgery

Abstract

Background Healthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations. The aim of this article is to normatively analyze different suggestions regarding how publicly financed plastic surgery should be delineated in order to identify a well-considered, normative rationale. The scope of the article is to discuss general principles and not define specific conditions or domains of plastic surgery that should be treated within the publicly financed system. Methods This analysis uses a reflective equilibrium approach, according to which considered normative judgements in one area should be logically and argumentatively coherent with considered normative judgements and background theories at large within a system. Results and conclusions In exploring functional versus non-function conditions, we argue that it is difficult to find a principled reason for an absolute priority of functional conditions over non-functional conditions. Nevertheless, functional conditions are relatively easier to establish objectively, and surgical intervention has a clear causal effect on treating a functional condition. Considering non-functional conditions that require plastic surgery [i.e., those related to appearance or symptomatic conditions (not affecting function)], we argue that the patient needs to experience some degree of suffering (and not only a preference for plastic surgery), which must be ‘validated’ in some form by the healthcare system. This validation is required for both functional and non-functional conditions. Functional conditions are validated by distinguishing between statistically normal and abnormal functioning. Similarly, for non-functional conditions, statistical normality represents a potential method for distinguishing between what should and should not be publicly funded. However, we acknowledge that such a concept requires further development.

Retrospective comparative cohort study of neovagina creation by modified Vecchietti-laparoendoscopic single-site surgery for Mayer-Rokitansky-Küster-Hauser syndrome

“…Huebner et al ( 24 ) also suggested psychological counseling as part of the treatment plan for patients with MRKHS. Most patients with congenital absence of the vagina are mentally distressed due to the physical defect ( 25 ). MVLESS conceals the surgical incision in or around the umbilicus with little to no scarring.…”

A systematic review and meta-analysis of risks and benefits with breast reduction in the public healthcare system: priorities for further research

“…However, such effect can also be seen when a breast reduction is performed for aesthetic purposes [ 14 , 15 , 54 ]. In this context, it is unclear how such patient-reported outcomes improvement should be valued, and how patients suffering due to appearance related factors should be differentiated from patients with a mere preference for plastic surgery [ 16 , 55 ]. Moreover, little is known about the long-term effect of plastic surgery on HRQoL, depression and anxiety [ 56 ].…”

“…A breast reduction (reduction mammaplasty) is considered effective at reducing physical and psychosocial symptoms and improving HRQoL [ 12 , 13 ]; however, similar effects are also achieved when a breast reduction is performed for cosmetic reasons and therefore it is difficult to distinguish which patients should be operated in the publicly funded healthcare system [ 14 , 15 ]. Moreover, there is no standardisation regarding the assessment and prioritising of functional problems, such as back pain, compared to non-functional problems, for example suffering due to appearance [ 16 ].…”

A systematic review of direct preference measurements in health states treated with plastic surgery

“…However, the outcome of preference studies might also play an essential role in deciding which plastic surgery procedures should be considered for public funding or rationed within the system, implying out-of-pocket spending. For example, if conditions or complications from interventions result in preferences in line with preferences for statistically normal conditions not receiving treatment, it might not warrant public funding [52].…”