Research Proposal on "Teenage Breast Augmentation"

Research Proposal 18 pages (5573 words) Sources: 5 Style: MLA

[EXCERPT] . . . .

Teenage Breast Augmentation

This is a guideline and template. Please do not use as a final turn-in paper.

A Death Causes Debate

Stephanie Kuleba, 18, went in for a breast augmentation procedure in March, 2008. She died. Though many blamed the surgery itself for her death, it was later discovered that Stephanie had a rare genetic disorder brought on by anesthesia, and that is what killed her. That did not stop the issue from becoming a national debate about minors, which Stephanie wasn't, having such cosmetic surgery. That issue has developed into a discussion of whether or not minors should have any cosmetic surgery, or is it unnecessary and, in some cases, dangerous.

On the Other Hand

Jamie is now a happy, 26-year-old mother who, 10 years ago suffered emotionally with low self-esteem caused by the fact that she was "flat-chested." She counseled with her parents and her doctor for a year before going ahead with breast augmentation surgery.

"It just completely changed my life," she says now. "I went to college just feeling good about myself" (Clough).

About 50% of the augmentation procedures that were accomplished on women and girls under the age of 18 in 2007 were for purely cosmetic reasons. Overall, two percent of the 400,000 women who had breast augmentation procedures in that year were minors (Clough). That's 8000 "girls," or about 4000 who had the surgery for cosmetic reasons alone when you combine those statistics. it's not a huge number. However, if we look at the numbers of minor teenagers who had cosmetic surgery in 2006, including all types, that number expands significantly to just under 100,000 (Mann).

And, perhaps, the most shocking number is that several thousand teenage boys each year have breast reduction procedures -- most purely cosmetic (Duenwald F5).

The question is what are the legal and ethical guidelines, rules, and laws that control medical procedures on minors. We will focus on cosmetic surgery for minors and, more specifically, breast augmentation procedures on minor teenage girls, but many rules apply across the board and affect the rights of minors and parents regarding any medical procedure.

What Are the Issues?

There are a number of considerations when discussing medical procedures on minor children, even though they may be "mature minors" almost merging into adulthood. The issues we will spend the most time on are: parental rights and responsibilities, the minor patient's rights, physician responsibilities/ethics, the medical necessity for the procedure, and the subject of choice when it comes to medical care.

May "mature minors" consent to medical treatment? If a parent refuses a minor, a medical treatment, can a hospital treat the minor anyway? If a parent consents, can the child refuse the treatment? If a minor does not want their parents to know of their medical treatment, can the hospital tell them anyway? These are just a few of the questions we will address.

There are, of course, medical issues, legal considerations, and ethical and moral concerns to deal with when we discuss an issue such as medical treatments, and especially surgeries, for minors, whether "mature" or not. For purposes of our paper, we will spend the most time on legal and ethical concerns.

Focus Statement: Breast augmentation procedures for minors, whether for purposes of low self-esteem or purely cosmetic, are not healthy and should be stopped, or a "cooling off" period should be required prior to a minor receiving the surgery with permission of a parent.

Regarding cosmetic surgery for minors, Dr. Steven Shelov, chairman of pediatrics at Maimonides Medical Center in Brooklyn, says this: "In extreme situations where the size or shape of the nose or ears is really affecting a child's self-image, I believe surgery may be an appropriate thing to do. But with teenagers, in my mind, breast implants have no place whatsoever" (Duenwald).

Parental Legal and Ethical Rights and Responsibilities

U.S. Law does recognize the right of any "right-thinking" competent adult to make their own decisions about their health and any medical procedures or treatments performed on their own body. A child is not a "competent adult" and therefore it is not legal for a child to make such a decision. Modern day specialists in ethics would argue that younger children have the right to say yes to medical procedures, and teens must consent to them. However, laws and court proceedings clearly place the decision-making rights in the hands of the parents.

The law states that the competent parent or guardian is free, and is expected to, choose among whatever medical procedures or treatments are available and select the most appropriate one for the circumstances, and the one that is in the best interests of the child.

This can be both good and bad. It is inherent in the right of a parent to make choices for their minor children including medical procedures and so it is good that it is the parent who must make the decision. On the other hand, it is possible that a parent is making decisions that they feel are in their own best interests according to how they would like their child to look or behave.

In other words, parents can make decisions in favor of unneeded or cosmetic surgeries like correcting a facial feature or giving a boy breast reduction surgery, or a girl breast augmentation surgery just because they think it is best to do so. That is why, it is the responsibility of the parent to allow the teen to come to them first. The American Society of Plastic Surgeons recommends that the teenager initiate any such request. The support of parents is important, but it is the teen who must "own" it. It is something that the teen must have thought about over an extended period of time and strongly desire to do for the right reasons.

This broad authority for parents has been recognized by the U.S. Supreme Court and is deeply-rooted in the concept of family autonomy -- the family as a unit must retain control of decisions regarding the raising of a child. It gives the parents the right, and responsibility, to raise their children without government interference.

However, there are limits to this right. If the state finds that the child is not being raised "in his own best interests," then it can step in and abrogate the parental rights. The state can take children away that have been abused, and it can ensure that minors are vaccinated. It can also take control of a situation where the child is being used by his parents for his or her labor value.

It is becoming clear that, outside of healthcare, children's rights are being expounded, politicized and, to some extent, taken more seriously, particularly in the area of family law.

Legal experts can see the advance of a situation where, in some cases, the child' rights outweigh parents, and the children are beginning to be considered as "independents," instead of dependents.

However, when it comes to healthcare, the Supreme Court has firmly ruled that despite any circumstances, the parents must be the ones to make decisions concerning their child's medical care:

"Most children, even in adolescence, simply are not able to make sound judgments concerning many decisions, including their need for medical care or treatment. The child's wishes are essentially irrelevant. The fact that a child may balk at hospitalization or complain about a parental refusal to provide cosmetic surgery does not diminish the parents' authority to decide what is best for [a] child" (Parham v. J.R., 442 U.S. 584, 603, 604

(1979)).

There does exist precedent for the limiting of parental rights in this area of healthcare decision-making. Parents do not always have the right to refuse life-sustaining treatment for their child. Their right to say whether a minor child has an abortion is limited. There are some states that give minors the right to make decisions about contraception and drug treatment, and there are a few states who give full decision-making rights to those minors that have been legally freed of control by their parents or guardians (emancipated minors). And there are federal laws that prohibit parents making the final decision in any number of other medical situations.

The point of all this is that, yes, there is precedent, even in healthcare, for some liberalization of parental control and decision-making.

Although the FDA approved saline breast implants only for women ages 18 and older and silicone gel breast implants for women ages 22 and older, it is legal for doctors to perform breast augmentation using either type of implant for teens under 18, as an "off-label" (i.e., not approved) use with parental consent. It is FDA policy to approve medical products for specific uses for which they are proven safe and effective, and to allow physicians to determine if they want to use those products for other medical purposes (Zuckerman and Abraham 318-319).

Parental rights to control medical treatments for their minor children are clear and specific.

The responsibilities of the parent… READ MORE

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