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'Operating is the easy part': Surgeons' decision-making processes and responses to parental requests for elective
Lauren Notini1, Lynn Gillam2, Merle Spriggs3
1Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton 3053, Victoria, Australia; Department of Paediatrics, University of Melbourne, Reception Level 2, West Building, Royal Children's Hospital, 50 Flemington Road, Parkville 3052, Victoria, Australia; Melbourne Law School, University of Melbourne, Level 9, 185 Pelham Street, Carlton 3053, Victoria, Australia; Biomedical Ethics Research Group, Murdoch Children's Research Institute, 50 Flemington Road, Parkville 3052, Victoria, Australia.
Abstract:
Some parents request elective appearance-altering facial surgery for their children for cosmetic, psychological and/or social reasons. These operations have attracted controversy in the bioethics literature. They are also the subject of professional guidance documents internationally, which leave much to individual practitioners' discretion. Despite their controversial nature, very little is known about surgeons' practices and decision-making processes regarding these operations. Individual semi-structured interviews were conducted by 22 plastic surgeons and oral and maxillofacial surgeons in Australia to explore their descriptions of the types of parental requests they receive for these operations, their decision-making processes and their responses to these requests. Interviews were audio-recorded, transcribed and analysed using inductive content analysis. Surgeons reported parents often request these operations to alleviate or prevent teasing and associated psychosocial distress. However, surgeons expressed concern some parents may be requesting surgery to further their own interests, rather than their child's. Surgeons reported considering multiple factors when making decisions about the ethical justifiability of facilitating these parental requests, including children's wishes about surgery, the severity of the facial difference, the child's growth stage and parents' reasons for requesting. Although most surgeons appeared comfortable denying parental requests when they believe surgery is not in the child's best interests, some indicated they will acquiesce if parents persist. This study provides insights into surgeons' practices and decision-making processes regarding elective paediatric appearance-altering facial surgery requested by parents. It also highlights implications for clinical practice and education, and identifies areas warranting further research.