Consent given under pressure to look a particular way is not the free choice the law assumes

The argument

A second argument for criminalisation concerns the quality of the consent on which the practice relies. Proponents argue that the decision to alter one's appearance surgically is rarely made in the conditions the law imagines when it treats consent as decisive. It is made by people who have been told, continuously and from an early age, that their appearance is inadequate, often by the same industry that sells the correction. Where a person's sense of how they look has been shaped by an interest in their dissatisfaction, proponents argue, their agreement to a procedure is not an independent judgment but the intended outcome of a campaign. Proponents point to features of the practice they argue are hard to reconcile with free choice: that demand concentrates on the features a particular culture happens to disfavour at a particular moment and shifts as the preference shifts; that patients frequently return for further procedures rather than being satisfied by the first; and that distress about appearance is a recognised feature of several psychological conditions, so that some proportion of those presenting are seeking surgery for something surgery cannot address. In each case the clinic has a financial interest in accepting the patient's account of what they need. The conclusion drawn is that regulation is structurally inadequate. Consent requirements, cooling-off periods and advertising rules all leave the clinic as the body assessing whether the patient should proceed, while the clinic is paid only if they do. Proponents argue that where a market depends on dissatisfaction it will reproduce the pressure faster than rules can constrain it, and that prohibition is the only measure that removes the interest rather than attempting to supervise it. On this view criminalisation protects people from a choice that was manufactured rather than restricting a choice that was theirs.

Premises

Counter-arguments

Critics argue that this reasoning, applied consistently, would justify overriding consent almost anywhere, since preferences for clothing, fitness, education and careers are all shaped by social pressure and commercial interest. They object that treating adults as incapable of deciding about their own bodies because their reasons are socially influenced is paternalism with no stopping point, and that it falls most heavily on women, whose choices are the ones most often described as manufactured. Critics also note that conflicts of interest are everywhere in medicine and are handled by independent assessment, disclosure and professional discipline rather than by banning the procedure, and that people presenting with a psychological condition are better served by screening requirements than by a prohibition that removes any clinical gatekeeper at all.

Rejecting the premises

[Rejecting P1] Almost every preference is shaped by social and commercial influence, so this test would invalidate consent across most of ordinary life. [Rejecting P2] Repeat procedures and shifting demand are equally consistent with people revising what they want, which is true of many settled choices. [Rejecting P3] Conflicts of interest are routine in medicine and are addressed by independent assessment and professional discipline rather than prohibition. [Rejecting C] Declaring that adults cannot consent about their own bodies is a paternalism that falls hardest on the women whose choices are most often described as manufactured.