UPDATE: Snopes, the urban legend and hoax website, now thinks that this is a scam. As I noted in the post, that would not be a surprise and in fact would be a relief. In such cases, I suggest that the post be read as a hypothetical, since the ethics issues raised by the three-breasted woman remain interesting, even if the story itself turns out to be fiction.
A 21-year-old woman being identified with the alias Jasmine Tridevil ( don’t over-think it) says she paid $20,000 to a plastic surgeon to give her a realistic third breast. She wants to become a TV reality show star. Jasmine has hired a camera crew to follow her around Tampa, Florida, documenting the challenges she faces as a three-breasted woman.
I know what you are thinking.
I HOPE this is a hoax.
“Jasmine” was rejected by more than 50 doctors who believed they would be violating professional ethical codes. Scot Glasberg, president-elect of the American Society of Plastic Surgeons, condemned the surgery as ‘worse than unethical’ and ‘harmful to society’. ‘This violates every ethical principle not just in surgery but in medicine as well. We look to enhance the norm. This is not the norm. Nothing speaks louder than the fact that the surgeon required the patient to sign a non-disclosure form.”
Really? That surgeon was responding to inevitable reactions by hypocrites like Glasberg. If an extra breast isn’t “enhancing the norm,” what is? What should be regarded as “enhancement,” for an individual ought to be the choice of the individual. Glasberg’s argument was once used to condemn surgeons who pioneered gender re-assignment surgery. Why were Joan Rivers’ face or Michael Jackson’s, not to mention Heidi Montag’s, well, everything, more “the norm” than Jasmine’s three boobs? What if her look catches on? In the 1920’s, Dolly Parton would have been looked upon as almost as much of a freak as Tridevil.
I fear I am beginning to tilt libertarian as the years crawl by. The last time I discussed this issue (in 2011), reacting to this…
If Kristin can eat, drink and breath with her mega-lips, and there is no risk that they might explode, killing everyone near her, the decision to do what she wants is probably ethical, at least by medical ethics standards. The fact that her Chap-Stick costs will be astronomical is not the doctor’s concern, however.Remember, though, that professional ethics standards are only the minimum level of required ethical conduct, not best practice. I think a plastic surgeon who assists a patient, especially one so young, in disfiguring herself to this extent is unethical. Autonomy is to be respected always, and beauty is in the eye of the beholder. Kristin’s lips are so far beyond reason that a plastic surgeon debases his profession by assisting in what can fairly be called self-mutilation.
I think I was overwhelmed by “ick” in the earlier post. Unless it can be determined that Jasmine is mentally ill (and seeking to vary from the “norm” is not sufficient proof of that), I don’t see why the same profession that botoxed Faye Dunaway and Cher into Mount Rushmore-style facial paralysis gets declare a three-breasted women too weird to be ethical. It’s her body, and if the “enhancement” isn’t going to harm her, and might make it easier for her to pay her rent, she should be able to buy it without the accommodating surgeon having to join the witness protection program.
Or is it that I am the biased one, and appreciate extra breasts more than giant lips?
_______________________
Pointer: Althouse
Graphic and Facts: Daily Mirror
Ethics Alarms 
Trivia: biologically speaking, that isn’t realistic. Mammals form breasts/mammary glands along two lines of predisposed tissue that, in humans, run from each of the usual two towards the groin. In the rare cases where humans (male or female) develop a third nipple, it is always further down one of these lines.
So you’re saying she should have gotten a fourth breast?
Those third nipples are more common than you might expect. Most men (they’re far more prevalent among men than women) won’t recognize them from the average wort or mole. Anyone reading this has a fair chance of having one.
Krusty the Clown has one!
Aside from the titillation factor there could be a number of reasons why such surgery should be regarded as ethically unsound. I agree that people should be able to access every technology they can afford to enhance their lives but this surgery mathematically increases the chance of breast cancer by 33% simply by adding the additional gland.
By her own admission such surgery will cause her harm. “Jasmine has hired a camera crew to follow her around Tampa, Florida, documenting the challenges she faces as a three-breasted woman.” Harm may not necessarily be related to the procedure but would we encourage or facilitate someone’s wish to incur additional challenges in life to gain fame. Why not just cut one of her legs off, or remove her corneas so she can deal with life’s challenges as a one legged blind woman. Would we wish as a society to permit those willing to sacrifice a limb simply to gain some modicum of fame – or infamy? I hope not, yet we seem to be heading done that path. My worry is that someone will try to upstage this by getting a doctor to do something even more radical.
To keep things edgy producers have created have naked dating and naked survival shows. For what purpose other than to attract voyeurs. Perhaps we should have naked house flipping shows with naked participants wielding power tools and hammers. Just like the audience that goes to the car race to see the potential crashes we can watch to see which participant accidently loses an dangling unprotected appendage to the table saw.
When the potential for harm outweighs any medical benefit then the procedure should not be performed. The examples of Joan Rivers and Michael Jackson should be enough of a reason for the medical community not to give in to the inane wishes of the fame seeker. If we are unwilling to allow doctors to provide the terminally ill unapproved therapeutic drugs or permit the off label use of approved drugs when no other treatment has worked then it is impossible to reconcile such surgical mutilations as ethical.
Since professional ethics across the board are slim to non-existent, this little gem of reconstructive surgery doesn’t surprise me. In fact, I now expect to see just about every whacked out concept from “Hitchhiker’s Guide To The Galaxy” played out in my lifetime… starting with the Triple Breasted Whore and proceeding on through a two headed president and ending only when a Vogon constructor fleet demolishes the planet. I’ll give the latter about twenty more years. We’ll all be yearning for it by then.
Just think what we males could have multiples of!
I knew there was a silver lining…
How soon will we see women with three buttocks?
Another Monty Python skit on the verge of being realized!
Monty Python inspired my comment.
But of course, what’s new and exciting will become old and dull too soon.
Think how far we’ve come! What would MP have to say today? Perhaps, “Now, for something completely different: A progressive who votes Republican”? Or “…: A global climate-change activist who flies on private planes all over the world and sips wine on the world’s biggest luxury yachts”? NO, no, no – forget those…”: A conservative for immigrant amnesty”? Or “…: A born-again Christian joining the Islamic State”?
Chuck Norris already has the patent on a third fist, so none of us get that benefit.
Oh…that’s not what you were referring to….
Sorry, Chuck has that patent also.
Steven:
You may be right In twenty years, we may be yearning for the Vogon constructor fleet to demolish the Earth to make way for an interstellar bypass, but I hope we don’t have to endure Vogon poetry. That I cannot abide.
jvb
Third worst poetry in the galaxy!
So, does she get minority preferences now? If the whole purpose of this is to show the world the challenges of being a three-breasted woman in a two-breasted woman-dominated world, her goal is to make herself an oppressed minority. She is the ultimate of all minorities, a minority of one. She needs her own national spokesperson the media can turn to on these matters. She needs to become an activist to push for special scholarships, housing assistance, loan programs, and government contract set-asides for her new minority. This can be the exciting start of a whole new set of underrepresented minority groups. I hope I am only joking about this.
First off, you were indeed correct that this was a hoax (see, for instance, http://blogs.miaminewtimes.com/riptide/2014/09/fake_third_breasted_woman_jasmine_tridevil_is_this_generations_greatest_fem.php ). You should never trust anything posted in the Daily Mail (which is very different from the Daily Mirror — and are those links to the Daily Mail’s Twitter feed and Facebook page _deliberate_?).
That said, I have to disagree with your analysis, Jack. Your argument rests on a combination of not really understanding medical ethics, a confusion of two separate ethical problems, and at least one rationalization from your own list.
To address the rationalization first, you argue by comparison to several other procedures (or, more accurately, the results of a number of procedures — Michael Jackson’s example involving God-only-knows-how-many). Their status as ethical or unethical, however, is irrelevant. More to the point, justifying the nonexistent Ms. Tridevil’s procedure as “no worse” is basically a form of what is literally the first rationalization on your list: the Golden Rationalization… although it can also be interpreted as a variant of #22 (the Comparative Virtue Excuse) or #44 (Unethical Precedent). When looked at from the standpoint of medical ethics, it can even be considered a form of #42 (If the patient doesn’t see a problem, why should we?).
At the same time, you confuse the ethics (and right/wrong) of the woman getting the procedure with the ethics of a doctor performing it.
The medical ethics issue, however, is a great deal more complex — and, frankly, I don’t have the time or energy to write an introduction to the subject as a blog comment. As such, I’ll stick to the simplest possible analysis and a very, very brief overview.
The best-known school of medical ethics is formally known as “principlism”, derived from the term “principle” and the suffix “-ism”. In brief, it attempts to treat medical ethics on the basis of several principles — four in the original formulation, although some texts involve more (or, in a few cases, fewer). Of these four principles, three — autonomy, benevolence, and nonmaleficence — are immediately relevant here (the fourth, justice, has to do with things like triage and the distribution of medical resources; I’m leaving it out for the sake of keeping length and complexity manageable).
The procedure passes — effortlessly — the test of autonomy (or respect for autonomy). If this operation were real, the surgeon was clearly respecting the hypothetical patient’s decision-making ability. She, in fact, would have sought out his assistance at great effort on her part. Obviously, there are other relevant obligations which apply (e.g. informed consent), but we see no evidence that they were left unfulfilled.
That, however, is the only such test that it would pass.
The principle of nonmaleficence is probably the best-known ethical principle in medicine, dating back to the very beginning of the Hippocratic Oath (“primum non nocere”). While colloquially stated as “do no harm”, this isn’t technically accurate in modern medical ethics: not only does the principle apply to risk, but risks and harms can actually be justified by benefit. Accordingly, a better phrasing of the concept of is that it is unethical for a doctor to perform, provide, or recommend an intervention which harms more than helps (or is clearly more harmful than alternatives).
The classic example of this is, ironically, surgery. Any surgical intervention involves substantial risk and harm — among other things, they, by definition, involve cutting the patient up… and even the most routine procedures involve not-insubstantial risk of serious complications up to and including fatality. Even if there aren’t complications, there’s a recovery period and a good bit of pain and discomfort involved.
While this is clearly justified sometimes (e.g. heart bypass surgery, extraction of precancerous tumors), there are other cases where it, well, isn’t, especially when the potential benefits are… less than tangible, shall we say? Subjecting someone to very real risk of death for a purely subjective benefit is, to put it mildly, questionable.
Because of this, the entire field of plastic/cosmetic surgery is on shaky ground at best, from the standpoint of ethics, and often derided on that basis. It doesn’t help that the field consumes medical resources and expertise for work that is almost universally without medical justification (and I’ll get back to that in a minute).
That enhancement bit you derided? That’s actually one of the dodges the field uses to try and escape this problem. In this case, we also have a pretty substantially-increased risk of buyer’s remorse… and this sort of thing is nowhere near easily reversible (see the mention of the not unsubstantial risk of morbidity above).
And, of course, the usual methods the field uses to try and escape this problem just don’t work in this (hypothetical) case.
Finally, we get into the principle of benevolence. As I’ve noted before, the benefits of this sort of operation are rather intangible (even if the breast in question has a good bit of heft to it) in comparison to the risks and harms. This is especially true when any woman who wants to turn off men has far, far simpler options available to her than acquiring a new breast (and, frankly, I’m not sure that the third breast strategy would be noticeably effective given some of the men out there).
But, more to the point, this is about medical benevolence, and medicine itself has a rather strict formal definition: It’s the art and science of the prevention and treatment of disease (with “disease” having a technical definition which is very much different from how the word is used colloquially: injuries and the like fall under its umbrella, for instance).
Or, to put it another way, there is no potential medical benefit whatsoever from this procedure. The same can be said about most cosmetic procedures, of course, but this is far more extensive and far more risky than almost any genuine cosmetic procedure I’ve heard of… including, notably, the examples you provided.
So… yeah. I have to disagree with your analysis. It’s 0 for 3 in even the most basic test… and so yes, a good bit of outrage is justified from a doctor who hears about it and thinks it’s genuine.
Anyway, sorry for the delay in getting this posted. It was worked on in my spare time, such as it is, over pretty much the entire time since you posted this.
Great post, and a Comment of the Day.
The crux of your point, I think, is this: “the entire field of plastic/cosmetic surgery is on shaky ground at best, from the standpoint of ethics.” The last time I wrote on this topic, regarding the women who got the cartoon lips, many of the comments compared the plastic surgeon to a tattoo artist. I think that’s a an apt comparison in this case. The question is whether human beings have a right to look like they want to, including like freaks, and whether the ethics of MEDICINE apply, or should apply. I think I accurately judged this plastic surgeon by his field’s own Code. I also wonder if the “harm” in the traditional medical field’s admonition is as clear as you seem to think. In law, the lawyer doesn’t substitute his or her assessment of what is right, as long as it is legal. Why is it unethical for a plastic surgeon to take the same approach? If a patient knows the risks, wants to have an udder and is willing to pay and accept the possible consequences, why is a profession unethical to permit her the autonomy to have what she wants?
Well, you’re certainly proving my points here regarding your analysis. Drawing analogies between legal and medical ethics simply doesn’t work, for the simple reason that legal and medical professionals have very different jobs, meaning that they take very, very different roles in regards to their clients/patients.
And yes, the risks and harm in this case is every bit as clear as I made it seem — more so, actually, as I was recently reminded when a mentor and dear friend failed to survive what should have been a routine operation. The hypothetical third breast would be anything but routine, and would actually involve a number of very substantial medical risks depending on the exact details of how the operation was carried out.
That said, you’re still confusing two very separate ethics issues. I have no problem, ethically speaking, with a woman getting such a procedure (at least in the abstract). I have issues with a doctor performing it. By analogy to legal ethics (which, as I mentioned, doesn’t fully work), this is akin to the difference between a person representing themselves in court and a lawyer suggesting that they do so.
But, well, autonomy trumps in law. It doesn’t in medicine. It can’t. Doctors override autonomy all the time. They have to. This ranges from the simple and clearly justified (e.g. vaccinating a child who doesn’t want a needle in the arm, triage in disaster situations) to the more controversial (the lack of a true standard for competence and capacity to give informed consent leads to many such cases, for instance, as do the numerous cases of psychiatric and psychological interventions surrounding suicide). In fact, one of the most influential medical ethics textbooks (Beauchamp & Childress’s Principles of Medical Ethics, which I’ve been paging through as I write this) contains a detailed discussion of when “interventions intended to mitigate harm to or to benefit a person, despite the fact that the person’s risky choices and actions are informed, voluntary, and autonomous” (p. 217 in the seventh edition) are justified.
A notable quote: “physicians do not have a moral obligation to carry out their patents’ wishes when they are incompatible with acceptable standards of medical practice or are against physicians’ conscience.” (Beauchamp & Childress, p. 226). This is a clear case of the former.
As for the ethics of medicine applying? Well… yes, they do. How and where they do is perhaps a matter of debate, but the anesthesiologist’s job is largely to keep the patient from dying during the operation, and a great deal of the personnel involved have similar duties.
And then we get into the justice issues (e.g. we are having a major shortage of several anesthetics) which complicate things further.
Reprinted from the other thread…