The medical exception and cosmetic surgery: culpable doctors and harmful enhancement?

Whether we are talking about ill-advised cosmetic surgery or essential life-saving surgery, consent alone is not sufficient to render such surgery lawful. 1 We know, however, that there is an obvious imperative to permit beneficial medical interventions, giving rise to a ‘medical exception’ to the criminal law. Thus, as Margaret Brazier and Sara Fovargue explain, 2 ‘proper medical treatment’ or ‘reasonable surgical interference’ can be performed without fear of prosecution. 3 For this medical exception to the criminal law to be applicable, there must be a public policy justification rooted in medicine. 4 In this chapter we examine how such public policy justifications relate to non-therapeutic cosmetic surgery. Cosmetic surgery initially developed as a therapeutic specialism in medicine, and in many instances it remains exactly that. We do not dispute the therapeutic importance of treating patients requiring surgery in order to address physical and/or psychological issues; however, a distinction can be made between therapeutic or plastic surgery, which is medically necessary, and non-therapeutic cosmetic surgery. 5 The former is available on the National Health Service (NHS), albeit that availability is variable and accessing such treatment may require patience, whereas the latter is purely a private sector option which is consumer driven, subject to evolving societal attitudes, and, as we highlight, has become a highly lucrative industry.