By: Summer Adams (University of Michigan) | February 5, 2025
With increasing suicide rates, it is important to prioritize mental health and well-being. Cosmetic surgery, though its intent may be controversial, has the potential to impact self-image and better mental health. With that in mind, this paper will begin by examining philosopher Eva Kittay’s view on the permissibility of aborting a fetus that tests positive for certain conditions, rejecting an expressivist claim that such actions convey or express harmful beliefs or attitudes about individuals with those conditions. I will then analyze Margaret Little’s position, which supports the expressivist claim that doctors performing cosmetic surgeries to alter their patients’ appearance in response to racist and sexist preferences endorse unjust attitudes unless they actively oppose them. Finally, I will explore the differences between these cases and yet aim to establish that one cannot reject the expressivist view on abortion without applying the same standard to certain cosmetic surgeries.
Eva Kittay brings a unique perspective to this debate, shaped by her experience with her daughter Sesha, who, at 27, lives with significant disabilities. Despite her familiarity with these challenges, Kittay opposes the expressivist argument, which questions whether choosing to abort a fetus with disabilities “signals the devaluation of the life of a person with disabilities” (Kittay 1998; 167). Kittay believes that the motivation behind these decisions is not to convey negative attitudes toward anyone. Instead, “they are based on the women’s perceptions and understandings, both of their circumstances and of the kind and extent of the disability” (177). Variables such as race, financial status, health risks, and lack of support or knowledge are all factors that keep individuals from following through with a typical pregnancy, which Kittay contends are similar in cases with a diagnosis of a disability and do not resemble expressivist conditions.
Yet, raising a kid with a disability requires extensive resources and support, which heightens the challenges for families. Kittay points out that “society does not provide the conditions that make raising and caring for a severely handicapped child [feasible],” leading her to conclude that it is “cruel to burden a couple with the responsibility for a severely handicapped child when prenatal testing can determine in advance the condition of the fetus” (Kittay 1998; 167-168). That, coupled with concerns over parental quality of life and dealing with societal stigma towards a disabled child, contributes to worry for the family’s future if the pregnancy were to continue. Moreover, Kittay’s son Leo suggests it may not serve the child’s interest, “to insist that parents have children they are not thrilled about” (194). Thus, Kittay argues that these decisions are motivated by familial and personal needs, not prejudice. This paper assumes that most consider this argument ethically permissible.
Little, on the other hand, acknowledges that “…requests for cosmetic surgery are often motivated by deep and genuine suffering,” aimed not at achieving beauty but at alleviating alienation or escaping “incessant teasing” (Little 2000; 162). However, she finds particular types of cosmetic surgery problematic, particularly those linked to “suspect norms of appearance” (163). Little distinguishes personal aesthetic preferences, like a preference for chin shape, from racial or sexual preferences, like desiring a kind of skin color. Critiquing the latter, Little describes that “norms of appearance occupy a moral suspect status” when they reinforce systems of injustice (167). To strengthen her view, she claims that “there’s something presumptively troubling about a practice that reaps profit from making society more white and women more like Barbie Dolls” (170). Thus, Little’s concern lies with the societal impact of certain cosmetic surgeries, not individual preferences.
The System Little challenges can have two alarming effects: patients may seek cosmetic surgery after internalizing the promoted norms and feel pressured to conform to them or suffer from society’s harsh judgment when they do not fit those standards. So, when considering whether medicine should treat such suffering, Little takes concern with doctor complicity, or, “when one endorses, promotes, or unduly benefits from norms and practices that are morally suspect” (Little 2000; 170). To avoid implicitly supporting these unjust practices, Little suggests that surgeons who perform these surgeries publicly reject and stand against the norms (173). Many argue that it is possible to hold an anti-expressivist stance in Kittay’s case of selective abortion while adopting a pro-expressivist stance on Little’s example of cosmetic surgery simultaneously because of the following distinctions. First, motivations differ. Kittay argues that decisions to abort a fetus with a specific condition are driven by financial, personal, and familial factors, aiming to secure the best possible outcomes for the family. In contrast, cosmetic surgery is aimed at alleviating distress, although the alteration of appearance can reinforce societal biases. Second, the social impact varies in the setting. The decision to have an abortion is typically a private, intimate, and unvoiced matter that cannot, therefore, invoke a misattribution. Cosmetic surgery, however, is sometimes publicly visible and can reinforce harmful societal ideas, impacting self-perception. Lastly, the responsibility to society is different.
Doctors vow to do no harm and must fully inform patients about the consequences of cosmetic procedures. Parents do not carry this responsibility, and must only worry about providing basic needs and a nurturing environment. These differences suggest that cosmetic surgery merits expressive evaluation, while selective abortion does not.
However, my argument denies that you can hold both views simultaneously, for some cosmetic surgeries are anti-expressivist and should be evaluated by such appraisals. I further propose that certain cosmetic surgeries, those aimed merely at promoting patient well-being, should be morally permissible, and Kittay’s arguments above should apply. These important exceptions happen in surgeries like those based on an anatomical deformation, for example, nose jobs or palatoplasty to correct cleft palates and gender-affirming procedures. Recall that Little might disagree here, as changing one’s physical features in those ways conforms to what society has deemed correct. For example, the changing of one’s nose can be reflective of a certain racial preference, such as, but not limited to, desiring an East Asian petite nasal figure, and gender-affirming surgeries tend to strive for gender-specific traits such as smaller shoulders, bigger lips, flat chests, and more. Many surgeries can be skewed in a way that claims they
promote unhealthy sexual or racial preferences when they are actually aiding individuals in establishing their true identity and overcoming mental or physical distress. It appears unjust to deny people some happiness for the possibility that their act will convey harm to society. I argue further that it is wrong to judge individuals who opt into these surgeries since they should not have to wait in anguish for society to change when it may never even happen. As Little’s opposers mentioned, “Why shouldn’t medicine provide a little pleasure…as long as the risks aren’t too high?” (Little 2000; 163). I argue further that those societal risks are not high enough to trump the importance of individual autonomy and patient well-being.
Now, I wish to discuss how these exceptional cases are of the same moral weight as Kittay’s permissibility of selective abortion concerning harm and intent. The harm of raising a fetus with a disability is taxing on the parents and the child, similar to how the harm of living with an undesirable trait is taxing on the individual who most likely struggles with mental health or body image. Secondly, the intent is comparable, as each situation aims at reducing harm. Whether that harm is to the individual or the fetus does not matter. If selective abortion does not have expressive undertones, similar reasoning should apply to some cosmetic surgeries. Some people might object to my view for the following two reasons. First, some may argue that the autonomy and mental health of one individual should not outweigh the risk of reinforcing unfair societal norms, as those may affect more than one individual. To that, I would say that it is unreasonable to ask someone to avoid the relief that cosmetic surgery could provide when the outcome of upholding society’s norms is vague and unspecified. Most cosmetic surgeries are private and not visible to society, for any noticeable changes will be seen by the patient’s close family or friends, who hopefully will support the decision, and not take it as an attack on them or society. That’s why I discussed a set of exceptions and did not try to argue that every cosmetic surgery is non-expressive. Second, some may criticize the slippery slope nature of my argument, claiming my reasoning, a motive for well-being, can apply to all cosmetic surgeries. I trust that doctors can use their expertise to make direct medical assessments of patients’ motivations for surgery and rule out excessive cosmetic practices to alleviate this worry. In conclusion, if cosmetic surgery can improve an individual’s mental well-being, even temporarily, that should be prioritized over the possibility of conveying a negative attitude through society. Therefore, both abortions of a fetus with certain conditions and some cosmetic surgeries do not deserve the judgment of reinforcing suspect norms of society, when both are ultimately a personal, intimate, and stress-reducing decision.
References
Kittay, E., & Kittay, L. (1998). Prenatal Testing and Disability Rights: On the Expressivity and
Ethics of Selective Abortion for Disability: Conversations with My Son. (pp. 165-195).
Essay. Georgetown University Press.
Little, M. (2000). Enhancing Human Traits: Ethical and Social Implications: Cosmetic Surgery,
Suspect Norms, and the Ethics of Complicity. (pp. 162-176). Essay. Georgetown
University Press.