Down syndrome girl has cosmetic surgery (2 Viewers)

[boris]

Because you just know eh? I think it could just be your brain being instinctual instead of critical that leads you to this conclusion.

I'm getting to why I think that mang.

 

[youBROKEmyLIFE]

You can't blame them. But I still feel that it's intrinsically wrong. I know they're doing it based on a perceived future threat towards their daughters emotional well being, but a part of me also cant help but think they've got their own motives.

I have a big problem with this concept of 'intrinsically wrong', nothing is... you have to justify why. As for their own motives:

- Who are you to speculate on that, based on nothing?
- If their less than altruistic motives align with the betterment of the child, who cares anyway?

If it were me I would be focusing on helping the child deal with it, atleast until early adolescence, and then I would propose the option of surgery. Atleast then I think they'd be better equipped mentally to understand what they've got, what its implications are and how the surgery could possibly help. Even if it's on a basic level.

Well you could go down that road, but it's not necessarily better, especially since I can't imagine even at that age them being able to comprehend the surgery completely (surely they wouldn't have the legal right to consent to such surgery). The benefits of going early are that the child receives whatever advantages it can have at a younger age and perhaps some procedures are much easier when children are younger. The benefit of waiting till the child is older and asking them is that then they will have a choice in the matter, but for the most part it's doubtful they'll understand it anyway.

My concern would be the unrealistic expectations the child may have from such a minor procedure. For arguments sake, lets say on a limited level the child understands they're different. How do you explain to the child that they're going to have surgery to make them look more normal without giving them the unrealistic expectation that it's going to alleviate any future bullying based on looks?

I say you don't. The child probably goes to the doctor enough times, if you need to tell them something just say you're taking them to the hospital to make them better.

 

[boris]

I think in regards to burns victims, people who have lived previously without disfigurement and who understand on a better capacity, plastic surgery is important more so for psychological well being than anything.
Now we can argue that the psychological well being of somebody with Down Syndrome is just as important, as it is, but on that same level they’ve never lived as a person with a fully functioning mental capacity.

Conclusions: The results of the study suggest that the extent of burns is not so important when compared to the possibility of disfigurement from the point of risk of developing a psychiatric disorder.

(Psychiatric Disorders in Burn Patients: A Follow-Up Study)
So you have people who have lived without disfigurement are suddenly faced with the prospect of being horribly disfigured, as opposed to somebody who has been born with a facial deformity.

Depression and post-traumatic stress disorder (PTSD), which are prevalent in 13-23% and 13-45% of cases, respectively, have been the most common areas of research in burn patients. Risk factors related to depression are pre-burn depression and female gender in combination with facial disfigurement

(Psychopathology and Psychological Problems in Patients with Burn Scars: Epidemiology and Management. Therapy In Practice. American Journal of Clinical Dermatology. 4(4):245-272, 2003. Van Loey, Nancy E E 1; Van Son, Maarten J M 2)

 

[boris]

I have a big problem with this concept of 'intrinsically wrong', nothing is... you have to justify why. As for their own motives:

- Who are you to speculate on that, based on nothing?
- If their less than altruistic motives align with the betterment of the child, who cares anyway?

And who are you to spectulate that their motived are based on nothing but love and fear for their child?
Of course what I'm saying is based on nothing. To me it's intrinsically wrong. It's hard to explain, you know? Deep down a part of me feels that it's wrong, yet when I sit and think about it I can come up with 10 more reasons to justify the surgery.

I say you don't. The child probably goes to the doctor enough times, if you need to tell them something just say you're taking them to the hospital to make them better.

So we lie?

 

[youBROKEmyLIFE]

And who are you to spectulate that their motived are based on nothing but love and fear for their child?

I don't need to speculate because it doesn't matter. The question should be whether it's ok for this surgery to happen, since it's if anything something that is potentially positive and in no way negative for the child's wellbeing I honestly do not see how you could argue to say it.

Of course what I'm saying is based on nothing. To me it's intrinsically wrong. It's hard to explain, you know? Deep down a part of me feels that it's wrong, yet when I sit and think about it I can come up with 10 more reasons to justify the surgery.

The choice is to either come up with a way to logically justify what we feel on some emotional level is wrong or to accept that our own feelings are logically flawed.

So we lie?

Is it lying if you don't tell someone something that they won't understand anyway?

 

[^CoSMic DoRiS^^]

You haven't explained the difference (to the point of it being any reasonable defense of your position) and again my point will be that if you're for giving it to a 5 year old burns victim and not a child with DS you need to properly explain why.

Okay.

You seem to be operating under the assumption that a five year old burn victim and a five year old child with DS are the same thing, or equivalent to each other, which is obviously not the case. If that's what you think then you also have some explaining to do.

As for my argument - DS is a condition that affects your mental capacity to make important decisions and process complex information. As such, a child with it is not able, in my opinion, to form a clear judgement and could be easily led by what their parents and doctors tell them. Who are we to make the decision for someone that their physical appearance that they were born with needs correcting for aesthetic purposes? I understand that parents don't want their child to be picked on, etc, but I also think that a) they are making a huge deal out of something which in the scheme of things is not such a big thing - I'm thinking about children born with massively grotesque deformities here, b) DS facial malformations are very hard to totally correct with surgery and I don't think it's worth the stress, c) Even if the child was made to look "normal" they're still going to be picked on for being mentally challenged. The only people who gain from the surgery are the parents who get to feel all smug about 'doing the best' for their child when in reality the child has gone through a painful procedure that they didn't understand only to still be teased because they talk funny.

A child who gets burned in an accident is a completely different matter. You cannot compare the two. Horrific burn scars look a LOT worse than DS facial features, for one thing. Secondly, If you get badly burnt enough there will be medical reasons why you need surgery - people's sweat glands can stop functioning, their movement is severely impaired, and so on. Thirdly fixing burns with surgery will help fix the other physical problems that come with them. Fixing the physical characteristics of DS will not fix anything else. To me, it seems like a stressful waste of time to put a kid through surgery like that when you're not even sure they understand what's happening. A burn victim (DS or not) will at least benefit noticeably from the surgery, BOTH physically and mentally.

Tully is right, it's hard to put this argument across clearly in words. But to treat the two situations as one and the same is grossly oversimplifying the issue.

 

[youBROKEmyLIFE]

You seem to be operating under the assumption that a five year old burn victim and a five year old child with DS are the same thing, or equivalent to each other, which is obviously not the case. If that's what you think then you also have some explaining to do.

I'm aware there are differences, however I feel none of the differences justify a change in decision.

As for my argument - DS is a condition that affects your mental capacity to make important decisions and process complex information. As such, a child with it is not able, in my opinion, to form a clear judgement and could be easily led by what their parents and doctors tell them. Who are we to make the decision for someone that their physical appearance that they were born with needs correcting for aesthetic purposes?

What's the difference between if we're telling them they need to change the appearance they were born with or the appearance they have been given due to an accident? For the most part obviously young children can't make such decisions and as such it's up to their parents to decide, I'd say usually they'll decide on the basis of how they will feel when they're older / whether it will assist them to live a more normal life / the general happiness, wellbeing of their child.

I understand that parents don't want their child to be picked on, etc, but I also think that a) they are making a huge deal out of something which in the scheme of things is not such a big thing - I'm thinking about children born with massively grotesque deformities here

Not such a big thing? According to who? As far as I can tell beauty is one of the most important things in the world to most people, as much as they'd like to deny it. I mean why bother dressing them nicely? Why bother brushing their hair?

b) DS facial malformations are very hard to totally correct with surgery and I don't think it's worth the stress

Ok, but her parent does. We don't even know exactly what surgery she's getting (as far as i remember) so why make such hasty conclusions? It could be something simpler which has less of an effect but still in the parents mind contributes to make the child look more 'normal' which will lead to somewhat greater social acceptance.

c) Even if the child was made to look "normal" they're still going to be picked on for being mentally challenged.

So? If the DS child suffered burns we'd still make them look more normal because we're aware that even though they're mentally challenged they can still benefit from looking nicer.

The only people who gain from the surgery are the parents who get to feel all smug about 'doing the best' for their child when in reality the child has gone through a painful procedure that they didn't understand only to still be teased because they talk funny.

This assumes that the surgery doesn't help the child in any way/shape/form, possible, but I disagree. I mean, for the most part many deformities will still leave people getting teased a little even after we do our best to eliminate them, but we're trying our best and I do believe it makes somewhat of a difference.

Horrific burn scars look a LOT worse than DS facial features, for one thing.

So you think there's some sort of a thresh-hold for when someone looks weird enough to deserve surgery? IMO no matter how small their abnormality is (let's not get too ridiculous though) if their parents think it will make them happier overall to live without it (including into their factoring whatever pain the child could feel) then they're doing a just thing. If a child is born with a 3rd nipple for example, I think it makes sense for the parents to get rid of it...

 

[boris]

Hi 5 abortion!



I'm sort of tempted to reignite the prenatal screening/abortion option for people who are pregnant with a Down Syndrome foetus.

 

[^CoSMic DoRiS^^]

I'm aware there are differences, however I feel none of the differences justify a change in decision.



What's the difference between if we're telling them they need to change the appearance they were born with or the appearance they have been given due to an accident? For the most part obviously young children can't make such decisions and as such it's up to their parents to decide, I'd say usually they'll decide on the basis of how they will feel when they're older / whether it will assist them to live a more normal life / the general happiness, wellbeing of their child.

Ok, fair enough, you do need to take the future into account. The difference I see is that, well, personally (and I know not everyone will agree with this, it's a contentious thing) - if you are born with a condition but don't have any actual physical impairments, as in, something that affects your ability to breathe for example, then cosmetic surgery is both unnecessary and somehow insulting. I mean, you can't help this, you were born this way, this is who you are, and yet everyone around you is pushing for you to have your appearance surgically altered? Something about that is just wrong. I think it says more about society than it does about the needs or wants of disabled kids. On the other hand, if your are disfigured in an accident, more often than not you'll need corrective surgery for medical reasons, and also, you have changed physically, so it's okay to want to go back to how you looked before. DS children look the way they do from birth, there's something insulting about insinuating that they'd necessarily want to look different.

Not such a big thing? According to who? As far as I can tell beauty is one of the most important things in the world to most people, as much as they'd like to deny it. I mean why bother dressing them nicely? Why bother brushing their hair?

I wasn't denying that beauty is an important thing to most people. I just meant that there are people with deformities that are so much worse and in comparison DS is not such a big thing. I'm not trying to downplay it, just pointing out that people should be looking at the bigger picture before they make a decision like putting their child under the knife (which I don't think they should have the right to do but then, that's me).

Ok, but her parent does. We don't even know exactly what surgery she's getting (as far as i remember) so why make such hasty conclusions? It could be something simpler which has less of an effect but still in the parents mind contributes to make the child look more 'normal' which will lead to somewhat greater social acceptance.

You are right. But the key words here are "in the parents mind". Not the child's, the parents. I understand the logic behind it. I just think it's a bit sick to go that far for a tiny bit more social acceptance. For the record, I've never seen a DS person be openly teased or ostracised outside of a schoolyard setting and to be honest, kids will tease you about anything they can get their hands on, surgery isn't going to do a whole lot to help that if the kid is already being teased.

So you think there's some sort of a thresh-hold for when someone looks weird enough to deserve surgery?

Well...yes. I do. There are some things that are not worth the stress of surgery.

IMO no matter how small their abnormality is (let's not get too ridiculous though) if their parents think it will make them happier overall to live without it (including into their factoring whatever pain the child could feel) then they're doing a just thing. If a child is born with a 3rd nipple for example, I think it makes sense for the parents to get rid of it...

Well this is where we'll probably always disagree. IMO people get way too hung up on things that are really not that noticeable. Third nipple? Who cares? When the kid is older, if it bugs them they can get it removed at their own discretion.

 

[KFunk]

I mean, you can't help this, you were born this way, this is who you are, and yet everyone around you is pushing for you to have your appearance surgically altered? Something about that is just wrong. I think it says more about society than it does about the needs or wants of disabled kids. On the other hand, if your are disfigured in an accident, more often than not you'll need corrective surgery for medical reasons, and also, you have changed physically, so it's okay to want to go back to how you looked before. DS children look the way they do from birth, there's something insulting about insinuating that they'd necessarily want to look different.

Why does 'change' alter how we should view a situation? E.g. consider a hypothetical in which you compare a) a burns victim who is somewhat disfigured but without any functional losses and b) a child born with the same disfigurement as the result of a genetic anomaly. What is the significant difference between (a) and (b)?

 

[^CoSMic DoRiS^^]

Why does 'change' alter how we should view a situation? E.g. consider a hypothetical in which you compare a) a burns victim who is somewhat disfigured but without any functional losses and b) a child born with the same disfigurement as the result of a genetic anomaly. What is the significant difference between (a) and (b)?

Well that's a bit hard to answer considering that what you're proposing is extremely unlikely unless there is some genetic deformity exactly like burn scarring that I don't know about, and also that if you are burned to the extent that you are disfigured some functional loss will be inevitable.

 

[KFunk]

Look, it's not that far out a hypothetical. Firstly you can have severe burns (in terms of appearance) which, after the initial stages, do not impeed the function of limbs/airways/eyes (etc) to any significant extent (I'm not counting sweat glands as being functionally significant). Secondly, you can get a lot of strange looking babies as the result of genetic abnormalities or complications in the womb relating to infection or drugs. All you need do is grant that a similar type of physical abnormality might be produced by either process - prenatal complication or postnatal injury.

But really, the important point is not possibility, but rather the approach you take in your moral reasoning. Once again: what is the difference between these two types of cases?

 

[boris]

Hello... I commented on burns victims... Earlier... Did anybody see? Feedback please

 

[KFunk]

Ok, well, firstly it's great that you brought in a proper study. However, you would need to cite the mean age of participants in the study in order to make it relevant. If it is populated with people > 12yo (or similar) then of course they are going to have a strong sense of before/after. The relevant age range, in our present discussion, is really quite young so you would need data within this range in order for it to be properly relevant.

I think in regards to burns victims, people who have lived previously without disfigurement and who understand on a better capacity, plastic surgery is important more so for psychological well being than anything.
Now we can argue that the psychological well being of somebody with Down Syndrome is just as important, as it is, but on that same level they’ve never lived as a person with a fully functioning mental capacity.

Two issues:

(1) Firstly, even if it were the case that invividuals with Down syndrome stood to suffer less psychological harm than your average burns victim, it would still not show that cosmetic surgery is not useful in their case.

(2) Secondly, the mechanism for harm that has been suggested (for kids with Down sydnrome) is a different one (involving persecution/teasing) rather than a process dominated by self-reflection.

In any case, the efficacy of cosmetic surgery in kids with Down syndrome is nonetheless rather dubious. I had a quick look at some articles on medline and they tend to go both ways. Some claim that peer perceptions of intelligence/socialbility/attractiveness increase post-operatively, while others suggest that there is no change and others suggest that any positive change might be caused by an accompanying change in parental behavior. Unfortunately a lot of the studies are saddled with either subjective data (e.g. perceptions of improvement by teachers or parents) or ethical presuppositions (i.e. most articles with "Should ... ?" in their title). This muddies the waters somewhat. Despite difficulties in the interpretation of these studies it can generally be concluded that cosmetic surgery likely yields only a small benefit, and possibly even none at all in some cases, for the child. I would be interested, however, to see the results of a study foccussing on either high functioning individuals (IQ 70-85) or those attending a school with bad bullying problems (or both).

A general ethical debate can still be had here [because there are two very different questions (1) would cosmetic be beneficial in most cases and (2) in a case where surgery would yield benefits, is it ethically justifiable?]. In particular - suppose that a DS child can be found (it doesn't matter how many there are to be found) where it is likely that cosmetic surgery will improve some aspects of their life. Can one ethically justify carrying out the surgery?

 

[boris]

Oh youre right. One was a paediatric study and the other wasn't. It was actually very hard to find articles on it, and those I did find were often only abstracts. I've got accounts with SciencePlus, Medline and MJA but I wasn't going to pay $30 for an article I was going to use once

It's a shame they can't make information more readily available.

I would argue though that a 5 year old would have a significant understanding of before and after, especially if they've had an active social life/have interacted with other children for a long time. I'm not sure PTSD would be applicable to children < 12.

 

[boris]

Can one ethically justify carrying out the surgery?

I'm torn on that issue. If you read above, Chadd (youbrokemylife) suggested we lie to the child, because even if we tell them the truth they're not going to understand anyway?

I think that contradicts the entire argument for allowing them to have the surgery. If you think they won't understand the significance of the surgery and if you're really considering lying, why bother?

I would really like to meet a doctor who would be willing to do the surgery knowing the child has been lied to.

 

[youBROKEmyLIFE]

I think that contradicts the entire argument for allowing them to have the surgery. If you think they won't understand the significance of the surgery and if you're really considering lying, why bother?

The argument for allowing the surgery is more acceptance from their peers, they can receive more acceptance without knowing why it happened. The truth is that even if you told them the truth they probably won't get it anyway.

In any case, the efficacy of cosmetic surgery in kids with Down syndrome is nonetheless rather dubious.

I agree, but it's the sort of thing whereby I think it's fair enough to let a parent make the decision. I mean they're the person that's going to be looking out for this child probably for the entirety of their life, surely they should be trusted to do what's best for the child and have the most intimate knowledge of their needs (unless we have some striking evidence otherwise).

Also, it says she's having an operation to do something with her tongue (can't remeber what it said, and can't be bothered to load it again), wouldn't that enhance her speech?

Well here's the thing, these guys don't know what exact surgery is being done and yet they're questioning it's efficacy. It could be some simple corrective surgery to remove a few extreme abnormalities such as a peeled up upper lip or something of that nature.