Informed Consent for Cosmetic Procedures: Navigating Psychological and Ethical Complexities
The scrutiny the Australian Health Practitioner Regulation Agency (AHPRA) is giving to cosmetic procedures shows no sign of slowing down. They’ve now turned their attention to non-surgical cosmetic procedures such as non-invasive treatments like fillers, lasers, anti-wrinkle and fat-dissolving injections. A key focus of AHPRA is the ethical labyrinth medical professionals and patients alike must navigate with care. The planned overhauls to rules for professionals who are not medical practitioners, such as nurses, dentists and dermal therapists, are likely to place a stronger emphasis on informed consent and pre-procedure consultation, including a patient suitability assessment. There will also be a focus on prescribing and administering prescription-only cosmetic injectables.
Surgical vs. Non-Surgical Consent
Surgical cosmetic procedures inherently come with greater risks, including anaesthesia complications, infections, and potential for scarring. As such, informed consent for surgical interventions is typically more thorough and comprehensive. Surgeons are obliged to discuss the full range of risks, alternatives, and post-operative considerations in detail.
In contrast, non-surgical procedures such as chemical peels and dermal fillers may involve simplified consent forms given the generally lower risk profile. However, lower risk doesn’t mean no risk. Physical side effects are still possible, and patients should be fully appraised before undergoing any cosmetic intervention because sometimes even minor side effects can lead to significant psychological distress.
The Psychological Capacity for Consent
The often-overlooked nuance in the realm of cosmetic procedures is the patient’s psychological capacity for consent. Ensuring that patients have a sound decision making capacity is crucial for ethical practice. This is particularly true when cosmetic procedures have the ability to change not just one’s appearance but also influence self-concept.
While most consenting adults are assumed to have the capacity to make healthcare decisions for themselves, this isn’t always straightforward in the context of elective cosmetic procedures. Practitioners are increasingly aware of the need to screen for underlying psychological conditions that might impair the ability to provide genuine informed consent. Of course, an important part of informed consent is being “informed”. Arguably patients need to be educated about the physical risks as well as the psychological risks to full have the capacity for informed consent.
Mental Health Concerns: Spotlight on Body Dysmorphic Disorder
Among mental health conditions, Body Dysmorphic Disorder (BDD) represents a significant concern among cosmetic patients. Characterised by an obsessive focus on perceived flaws in physical appearance, often to the point of severe emotional distress, BDD can complicate the informed consent process.
Patients with untreated or undiagnosed BDD are at high risk for dissatisfaction with cosmetic procedures, as these interventions rarely resolve the emotional distress at the core of the disorder. Many practitioners are already screening for BDD and suggest psychological evaluation from a psychologist when appropriate. In many cases, mental health treatment, rather than cosmetic intervention, may be more effective at increasing patient wellbeing.
Psychological Harms and Long-Term Considerations
The implications of cosmetic procedures are not merely skin deep. Potential psychological harms can ensue from unmet expectations, complications, or the social stigma attached to aesthetic changes. In the realm of informed consent, this means that practitioners have a duty to ensure that patients understand not just the physical but also the emotional risks involved.
Towards a Holistic Approach to Informed Consent
Given the complex interplay between surgical risks, psychological factors, and ethical considerations, a holistic approach to informed consent is vital. This would involve comprehensive medical and psychological assessments, a detailed explanation of risks and alternatives, and an ongoing dialogue that accounts for both physical and emotional well-being.
The prospect of a patient with body dysmorphia also raises important legal questions about medical consent and the practitioner’s duty to warn a patient of relevant harms.
The Australian legal standard of medical consent, established in 1991, requires a practitioner to warn the patient of all “material” risks – those that the specific patient does or would consider significant – posed by the treatment or procedure. The same principle was adopted by the English courts in 2015.
For patients with mental health issues, a practitioner would usually identify the likelihood of increased mental distress or possible dissatisfaction with the procedural outcomes as a material risk. Valid consent would therefore entail discussion of the psychological risks of treatment.
In the cosmetic gold rush, cutting corners on informed consent is not just legally precarious—it’s ethically risky. For cosmetic procedures to truly enhance lives, as they do for the majority of people who receive them, informed consent must remain the cornerstone of the practice.