Plastic Surgery and Cosmetic Surgery

Plastic Surgery and Cosmetic Surgery

Introduction

One of the wonders of modern medicine is the newly devised ability of surgeons to ‘sculpt’ different parts of the human anatomy to the minutest detail, in most cases with amazing effect. Cosmetic surgery, such as stomach tucks, face-lifts, nose construction and lipo-suction are gaining in popularity.

Plastic surgery for trauma victims which is medically-indicated is allowed by Jewish law, but there are divergent opinions regarding purely cosmetic surgery, which is the focus of this article.

The Issues

There are several halakhic and philosophic issues involved in cosmetic surgery. They include the following:

1. Wounding oneself or others.

2. Dispensation to heal.

3. Exposing oneself to danger.

4. Improving God’s handiwork.

5. Psychological factors.

6. Finding a mate / marital bliss.

7. Vanity.

8. Cosmetic surgery for men.

1. Wounding Oneself or Others

Is one allowed to wound oneself or others? Wounding oneself is prohibited1 because a person has no proprietary rights over him or herself.2

The source for not wounding3 another person is the negative commandment mentioned in Deuteronomy 25:3. “Forty shall he strike him, he shall not add; lest he strike him an additional blow beyond these, and your brother will be degraded in your eyes.”4 The Sifri comments: “If the judge will exceed the forty lashes he will violate this negative commandment.” All the major halakhic authorities (Rif, Rosh, Rambam, and Shulhan Arukh) agree that wounding another without a great need is prohibited.5 The guiding principle is that a person has no proprietary rights over others.6

Is a patient allowed to submit to any procedure of wounding unless there is a great need?7

If the cosmetic surgery being performed were not halakhically permissible the physician would be transgressing the law of not wounding others and the patient would then transgress the law of ‘mesayaia’ (assisting someone else to sin). As in the case of a person who allows a barber to shave his beard or ‘peot’ with a razor. (See Shulhan Arukh, Yoreh Deah 181:4).

2. Dispensation to Heal

Does the dispensation to heal apply to cosmetic surgery? A physician is not allowed to treat a patient without the Torah’s dispensation to heal. This dispensation is derived from the verse “and he shall cause him to be thoroughly healed.”8 Is cosmetic surgery without medical necessity included in the dispensation given to physicians to heal someone even by wounding them?

3. Exposing Oneself to Danger

Is one allowed to voluntarily expose oneself to the dangers involved in elective surgery? All the legal decisors (poskim) agree that it is prohibited to voluntarily expose oneself to danger for no valid reason. The only disagreement is whether this is a Torah law based on Deuteronomy 4:9 “Only guard yourselves and guard your souls very carefully...” or a rabbinic proscription.

It is well known that any kind of surgery necessitates a variety of risks, such as reactions to anesthesia or to post-operative complications.9 Jewish Law clearly allows taking minor risks for significant benefits. As the risks increase and the benefits decrease, the question of prohibition becomes significant and a competent rabbinic authority should be consulted.

A cornerstone of halakhah is the primacy of ‘pikuah nefesh’10 - the preservation of human life in the face of risk or danger. All the commandments of the Torah are set aside in deference to ‘pikuah nefesh,’ except the three cardinal sins of: murder, idolatry and adultery.11 Life may not be shortened by any positive action, and extreme care is required lest life be accidentally shortened.12

4. Improving God’s Handiwork

Is a person allowed to improve the handiwork of God? Rabbi Eliezer Waldenberg raised the following philosophical issue: If a person was born with, or later developed, certain non-life-threatening cosmetic defects, would that person be allowed to interfere with and improve God’s handiwork?13 Rabbi Waldenberg is of the opinion that this is a point of concern.14

5. Psychological Factors

Does psychological well-being play an important role in this decision? Aesthetically motivated plastic surgery contains risks but is devoid of any physically curative purpose, although it may serve to enhance one’s self esteem and one’s psychological well-being. Is this sufficient ground to allow one to take risks to undergo this procedure?

Rabbi Lord Immanuel Jakobovitz, Chief Rabbi emeritus of the United Kingdom and commonwealth, does take the psychological factor into account. Today we are much more aware that psychological well-being plays an important role in physical health.

6. Finding a Mate / Marital Bliss

If a person is unable to find a mate because of aesthetic factors, or if cosmetic surgery can prevent marital problems that develop after the wedding, can this be taken into account when making a decision? Marriage and peace at home are legislated and advocated by Jewish law and philosophy. Are they important enough factors to allow elective cosmetic surgery?

7. Vanity

How vain is a person allowed to be? Is it allowed to undergo cosmetic surgery for no other reason than to satisfy ones vanity? Beauty has value and is not to be denigrated.15 However, beauty that causes one’s evil inclination and desires to grow, is spiritually detrimental and excessive.16

8. Cosmetic Surgery for Men

Rabbi Yosef Karo in the Code of Jewish Law (Shulhan Arukh) forbids men to look in mirrors17 based on the biblical proscription that a male should not wear female clothing.18 Since women are the ones who usually go for cosmetic surgery, would men be allowed to do so? Many authorities state that this proscription depends on the accepted norms of a particular society.

Rulings by Eminent Halakhic Authorities19

Opinions that prohibit purely cosmetic surgery:

Rabbi Eliezer Waldenberg the former Head of the Jerusalem Beth Din (rabbinical court), author of the responsa Tzitz Eliezer, argues forcefully against purely cosmetic surgery.20

(a) He states that the Torah does not give the physician permission to practice his craft in a non-healing21 context.

(b) As a result of this being a non-healing context, the prohibitions of wounding oneself and others22 are operative.

(c) He points out that there is also a prohibition of exposing oneself to danger of anesthesia and the risk of surgical infection and other effects of the procedure.

(d) From a philosophical perspective, he states that it is a hutzpah to interfere with our God given individuality and to declare His creation to be flawed to the extent that it needs our correction.23

Rabbi Isaac Jacob Weiss24 a noted halakhic authority and former head of the rabbinical court of the Eidah Haredit in Jerusalem also concludes that elective plastic surgery is forbidden.25

Even though Rabbi Weiss maintains that Rambam26 (Maimonides)27 only prohibits wounding if it is performed in a contentious and purposefully harmful manner, he nevertheless agrees with Rabbi Waldenberg that the prohibition of putting oneself in danger would apply to cosmetic surgery.28

Opinions that allow cosmetic surgery:

Rabbi Moshe Feinstein,29 one of the great recent American legal decisors,30 and Rabbi Ovadia Yosef, 31 former Sephardic Chief Rabbi of Israel,32 interpret Rambam’s prohibition on wounding oneself and others as only applying when done in a contentious manner. Cosmetic surgery is usually done to remedy humiliation that is suffered, and therefore would not be considered a wound in the halakhic sense.33

Rabbi Feinstein goes one step further in finding a leniency for cosmetic surgery even without this last interpretation. He posits that all halakhic authorities would agree that any surgical procedure which is: (1) with the patient’s consent and (2) for his benefit would be allowed, and is even an obligation.34 Rabbi Feinstein states that entering into danger is also not an operative principle here since the Talmud35 points out that a person may engage in commonplace activities even if there is an element of danger, once it has become a universally-accepted risk.36 Cosmetic surgery today, with all its contingent risks, is so commonplace that it may be considered a universally-accepted risk in the same categories as car travel and living in an earthquake zone. (Author’s addition: Smoking, on the other hand, is today universally recognized as a health hazard and is categorically prohibited.37)

Rabbi Lord Immanuel Jakobovitz,38 a leading universally recognized expert in the field of medical ethics, concludes that all reservations could be set aside:

a) If the procedure is medically indicated, e.g., following an accident or for grave psychological reasons.

b) If the deformity to be corrected is serious enough to make it difficult for a person to find a marriage partner or to maintain a happy marriage.

c) To enable a person to play a constructive role in society and, in particular, to earn a decent livelihood.

Conclusion

a) Men or women, who because of their physical appearance are ashamed to appear in public or are unable to find an appropriate spouse may undergo cosmetic surgery.

b) Married women may also undergo cosmetic surgery so as to be more desirable to their husbands.

In all these cases a well-qualified and experienced surgeon must be used.