The Cosmetic Medicine Revolution, the Goals of Medicine, and Bioethics

There is an assumption in the philosophy of medicine that the cardinal goal of medicine has constantly and universally been to pursue health. According to this view, if the practice is not directed at the goal of health it is no longer medicine. This article examines the assumption that health is the fixed and universal goal of medicine in light of the development of the new field of cosmetic medicine, a field that has transformed the practice of medicine by adding the goal of beauty. The article reviews the social and cultural underpinnings of this change and argues that the cosmetic medicine revolution is congruent with the bioethical revolution, in that both tend to emphasize the importance of a patient's values and goals in life for medical decision-making. However, while the bioethical revolution has mainly secured a series of negative liberty rights for patients, the cosmetic medicine revolution has made possible starting the clinical encounter with certain positive demands about improving the patient's physical appearance and asking the physician to help fulfill that goal. The philosophical assumption of the fixed goal of health fails to capture the dynamic relation that exists between social and cultural norms on the one hand, and the practice of medicine and its goals on the other.