Body Modification Practices, Respect for Persons, and the Medical Monopoly

Abstract

People modify their bodies to achieve a number of things they value. These include health, novel psychological experiences, aesthetic goals, or creative self-expression. Although Body Modification Practices (BMPs) such as scarification or cosmetic surgery have received some attention in the bioethics literature, each procedure is discussed in isolation from the rest. What is needed is a unified account of when individuals should be entitled to pursue BMPs. In this thesis I develop just such an account, which I refer to as the Agency Approach. The basic idea is that individuals should be permitted to engage in BMPs as long as they can prove that they are competent to do so. To justify this I present an account of respect and argue that individuals who can demonstrate their competence are entitled to a Complete Right to Non-Interference. This right is a cluster-right composed of three separate rights: the Right against Checking Interference (RCI), the Right against Temporary Blocking Interference (RTBI) and the Right against Permanent Blocking Interference (RPBI). These rights protect individuals from interference by bystanders aimed at ascertaining their competence (RCI) or precluding them from pursuing their proposed course of action; either temporarily (RTBI) or permanently (RPBI). The resulting account is a permissive one, but not excessively so because I argue that competence is not always easy to prove. I defend a risk-sensitive account of competence, which holds that the required standard of competence becomes harder to meet as the proposed modification becomes riskier. When an agent engages in a harmless BMP, interference is hardly ever justifiable because the low competence threshold means it is easy to demonstrate competence via basic interaction. However, when an agent engages in a BMP that threatens serious self-harm or the destruction of their own agency interference is warranted, at least initially, in order to protect the agent. An agent who has temporarily lost their Complete Right to Non-interference in this way may restore it, but only by proving a very high degree of decision-making competence. Having outlined the Agency Approach, I then compare it to current practice, with a particular focus on how access to body modification technology is regulated. Under existing laws in most contemporary societies, when individuals want to engage in BMPs which fall outside the realm of conventional medicine they are effectively precluded from accessing the technology or help they need. This is due to the existence of what is often referred to as the medical monopoly. The medical profession exercises exclusive control over the legal terms of access to medical technology through professional societies, enabling them to control who can use the technology, how it is used and, by extension, what technology is available for use. I argue that the medical monopoly should be abolished. Individuals who wish to use medical technology to pursue goals other than health should not be hindered by physicians’ professional obligations to promote it. The thesis ends with a discussion of some further implications of the Agency Approach. In particular I discuss two problems related to abolishing the medical monopoly: addiction and people engaging in BMPs on the basis of mistaken empirical beliefs. I argue that Temporary Blocking Interference ought to be used to give unwilling addicts and those acting on mistaken beliefs an opportunity to reconsider their course of action.

Date of Award	31 Dec 2019
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Richard Child (Supervisor) & Christian Schemmel (Supervisor)