This month's Collier Column is written in support of the Journal of Aesthetic Nursing's newly launched campaign, ‘Ethics in aesthetics’. The campaign will give focus to the many ethical and moral dilemmas faced by healthcare professionals (doctors, dentists and registered nurses) who work in the field of aesthetic medicine.
Some important fundamental questions surrounding the field of aesthetic medicine need to be asked and answers established:
Aesthetic medicine is of course an important branch of modern-day healthcare and there must always be medical justification, be that physical or psychological, for carrying out a medical aesthetic procedure. As healthcare professionals, we must never stop medicalising the clinical decisions we make and never trivialise or belittle the importance of the work that we do. Healthcare is a moral undertaking. Unfortunately, in parts of the UK today, aesthetic medicine continues to be an anarchistic lawless community, absent of hierarchy and rules; is it any wonder that it sometimes entices those with a poor ethical and moral stance?
Healthcare professionals are considered to have a moral authority; they have trustworthy and respected characteristics to make decisions in the best interest of their patients' health and wellbeing. However, moral authority tends to be based around caring for the sick and diseased, and it would seem that for some healthcare professionals, their moral authority diminishes rapidly when treating healthy and disease-free individuals who seek medical aesthetic care.
The patient–practitioner relationship must have effacement of self-interest and self-gain. Ethics means acting beyond self-interest. Self-interest can heavily influence and motivate behaviour in healthcare professionals to the detriment of patient care. I believe there is a significant number of healthcare professionals (doctors, dentists and registered nurses) working in the field of aesthetic medicine who should hold their head in shame. Greed and self-gain is their true motivator, rather than helping their patients. Aesthetic medicine has yet to be given recognition as a medical specialism, and this may have influenced the ethical behaviour and actions of some. Further-more, failure to provide medical aesthetic care in a clinical environment conducive of good ethical behaviour may also reduce standards of conduct and practice.
Many argue that ageing itself should be considered a disease complex (Bulterijs et al, 2015; Zhavoronkov and Bhuller, 2015). Osteoporosis is a condition caused by an age-related decrease in the body's production of hormones. It is one of the most common age-related conditions that has now been given classification as a disease. The skin is a vital organ, and the largest of the human body. The structural and functional deterioration of the skin that occurs with age has multiple clinical presentations that can have a major impact on not only the physical aesthetic appearance of a person, but also on emotional and psychological wellbeing and quality of life. If skin ageing was recognised as a disease process, it would further medicalise the wonderful work that we do in the field of aesthetic medicine.
Ethics are not optional in medicine. They are an essential and integral part of all areas and every aspect of healthcare. The duties conferred on a healthcare professional require them to act responsibly and to be accountable for all actions and omissions. Practitioners must adhere to the four principles of healthcare ethics. The four-principle approach (Beauchamp and Childress, 1994) is one of the most widely used frameworks used in the clinical setting. The four principles are:
Healthcare professionals are bestowed an honour–they are privileged to care for others. Ethical behaviour is determined by multiple factors. What one person considers a sound ethical decision, another person may find unethical. However, the ethical and moral stance of healthcare professionals should not have such a broad variant. Healthcare professionals are bound by oaths, declarations and codes that serve as a source of moral authority. Codes of professional conduct are a necessary component to any profession in order to maintain standards. Healthcare professionals are regulated to protect the public. The facet of medical ethics is now recognised as an applied science and is finding its rightful place in healthcare.
Over the coming months the Journal of Aesthetic Nursing will endeavour to publish work that explores the vast subject of ethics in aesthetics. Examples of ethics in aesthetic medicine may include the following; however, the list in not exhaustive:
I would urge all doctors, dentists and registered nurses who work in the field of aesthetic medicine to invest much more in their own moral authority in order to protect an area of healthcare that is at serious risk of becoming completely eradicated as a discipline of medicine. Healthcare professionals should be entrenched in ethics and values, but unfortunately, some are not. It is our ethical stance that sets us apart from the non-medics, rogues and cowboys who have entered a field of medicine where they have no right or entitlement to be.