Nip & Tuck: A Parable

Author: 
Hans Madueme, MD

Incredibly perhaps, there are people out there who are still ethically nervous or worried about cosmetic surgery. We live in a modern world that is trying to democratize beauty with the assistance of the scalpel. We lust after the holy grail of ageless youth. Those unschooled in this brave and beautiful new world find it all strange, even morally noxious.

But why is that? Cosmetic surgery for many elicits an unbidden, irresistible reaction of repugnance. The growing reality of nose jobs, breast and pectoral implants, buttock lifts, and liposuctions – it appalls and disturbs. In a different context, Leon Kass popularized the notion of the ‘wisdom of repugnance.’ This negative response or ‘yuck factor’ is a strong intuition that something is wrong or morally amiss. Folks who worry about Botox rituals discern the stink of ethical death in the cultural air. Their repugnance is an ethical gatekeeper, a barometer of all things pernicious to genuine human flourishing: This far you can go, and no further.

It is worth asking, however, whether this custodial ethical wisdom has anything going for it. To many the issue seems simple enough – we do not need the nuance of philosophers to realize that cosmetic surgery goes against the grain of what nature and her God have granted us. Few will chastise parents who warn their children against the surgical woes of the recently deceased pop star Michael Jackson. This seems obviously wrong. Likewise, the antics of a Jocelyn Wildenstein can be easily dismissed, her face a shocking specter of multiple surgeries. Yes, something has obviously gone awry.

And yet, none of this establishes a case against cosmetic surgery itself. We have hunches and intuitions, even extreme examples, but is there more? Well, suppose we say that cosmetic surgery falls beyond the pale of ethical orthodoxy. Suppose our reasoning tells us that it is unnatural. What then shall we say, for instance, of tweezing eyebrows? Are there any plausible differences between these two cultural practices? Or what shall we say about that (almost) universal Western practice of using antiperspirant? These choices are all, in a way, going against nature and her God—they are ‘unnatural.’

Not so fast, you say. There is a significant difference between tweezing eyebrows and cosmetic surgery. Tweezing eyebrows is temporary; cosmetic surgery is permanent. In the one, nothing irreversible is done, a negligible price paid for aesthetic effect. In the other, desperate measures have been deployed; cosmetic surgery permanently changes the hand we have been dealt. Nature has been cheated. The moral logic here seems to be that the ethical difference between cosmetic surgery and tweezing eyebrows turns on duration of effect. Temporary is good, permanent is bad. But then, what are we to say about children post-appendectomy, or men with hip replacements, or women minus their wisdom teeth? Do they deserve ethical condemnation? Surely not.

So then, is the original reaction of repugnance to cosmetic surgery so much ethical smoke and mirrors? Must we all simply fess up and admit there is really no legitimate criticism after all? In response, we might make a distinction between treatment and enhancement. The thought goes roughly like this. There needs to be more ethical clarity on the legitimate boundaries of modern medicine. Since medicine is becoming much more technologically powerful, we need to specify carefully what medicine ought and ought not to be doing. Therefore, whenever medicine is involved in the treatment of disease, its use is ethical; but whenever it is involved in enhancement, its use is ethically suspect. Plastic surgery for the reconstruction of a burn victim’s limb is okay (treatment), but cosmetic surgery for a chin tuck is wrong (enhancement).

If only things were so easy. But the world is bursting with ethical and moral complexity—you cannot escape real life indefinitely! The distinction between treatment and enhancement, it turns out, is not always clearcut. There are countless things we do every day that are ‘enhancements,’ and yet we typically do not consider them morally objectionable. And so, the argument goes, it is difficult to inveigh against cosmetic surgery while endorsing something as commonplace as, say, makeup or perfume. The question is whether finding fault with cosmetic surgery is merely an instance of special pleading. Such observations do not ultimately render the treatment vs. enhancement distinction worthless, but it may need assistance from elsewhere.

There is another dimension to all this, however, drawing from virtue ethics in the Christian tradition. In short, ‘nip & tuck’ culture can serve as an old-fashioned moral parable. Cosmetic surgery is a relatively new technology, one that allows us to gratify old desires in new, more effective ways. The moral narrative here is certainly about beauty and covetousness, vanity and denial. But it is perhaps broader and deeper than that. It is about men and women, about us. You and I are frail creatures, wearied by the relentless punishments of life, dissatisfied with our lot, restless and often inconsolable, searching after something beyond us. There is an insatiable longing in our hearts, a yearning for meaning, for transcendence, for fulfillment. What are we after? What do we want? What are we willing to do to get it? Like the practiced fingers of a surgeon, these questions peel away our polished masks, revealing our true selves, our real identities. From wearing makeup to choosing friends, from buying a house to considering liposuction, life in its ordinariness, life in its spiritually charged imperfections and sufferings, reveals the kinds of people we are and are becoming. Botox culture vividly reminds us, if we are listening, that we are men and women with longings, loves, and lords. We are in fact in the full swing of a theological drama: our lives are irreducibly religious, and it is the living God of Jesus Christ with whom we have to do (cf. Acts 17:28). We will worship something – God or paltry idol. Cosmetic surgery is just the tip of the iceberg. Look deeper and you will find our vices and virtues, our hearts and our gods.

Given the growing culture of cosmetic surgery and gnawing worries about what it portends, a typical reaction to surgical beauty junkies might be, ‘You’re all going to hell!’—or variations on that theme. Such an outlook is fair game as a theological judgment, though its scope is unduly restricted. Since cosmetic surgery and other enhancement technologies tend pedagogically to illuminate our universal ethical condition, our present moral predicament, it should suggest more democratically that all of us are going to hell. That prospect of weeping and gnashing of teeth is sobering indeed, terrifying and anxiety ridden, unless someone saves us from ourselves.

This essay originally appeared in Dignitas 17(1): 2009, a quarterly publication of CBHD.

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