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Reproductive Health Matters
An international journal on sexual and reproductive health and rights
Volume 18, 2010 - Issue 35: Cosmetic surgery, body image and sexuality
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Original Articles

A poor prognosis for autonomy: self-regulated cosmetic surgery in the United Kingdom

Pages 47-55 | Published online: 10 Jun 2010
 

Abstract

In recent years, cosmetic surgery in the United Kingdom, which is provided almost entirely by the private sector, has gained in popularity despite evidence of its potential risks to patients. Over 32,000 procedures were reported by one association of cosmetic surgeons alone in 2007, three times more than in 2003. This article examines the regulation of cosmetic surgery in the UK, in light of the need for informed consent and the importance of patient autonomy. Since 2000, the government has attempted through legislation covering all health care provision to regulate cosmetic surgeons' qualifications, patient rights to information, and the inspection and registration of premises. However, the risk to patients from unregistered and poorly qualified surgeons, and from private clinics with a poor quality of care, has still not been adequately addressed. Moreover, ensuring informed consent and the maintenance of standards has been left to professional self-regulation. An independent, government-funded umbrella organisation with lay representation and sufficient powers of registration and inspection of all relevant cosmetic surgery practitioners is needed to fully protect patients, and should have its roots in specific legislation governing cosmetic surgery.

Résumé

Ces dernières années, la chirurgie esthétique au Royaume-Uni, qui est pratiquée presque totalement dans le secteur privé, a gagné en popularité, malgré des informations faisant état de ses risques potentiels pour les patients. Plus de 32 000 procédures ont été notifiées rien que par une association de chirurgiens esthétiques en 2007, trois fois plus qu'en 2003. L'article examine la réglementation de la chirurgie esthétique au Royaume-Uni, compte tenu de la nécessité d'un consentement éclairé et de l'importance de l'autonomie du patient. Depuis 2000, l'État a tenté, par une législation couvrant tous les soins de santé, de réglementer les qualifications des chirurgiens esthétiques, le droit des patients à l'information ainsi que l'inspection et l'enregistrement des locaux. Néanmoins, le risque pour les patients soignés par des praticiens non agréés et peu qualifiés, dans des établissements privés dispensant des soins médiocres, n'a toujours pas été pris correctement en considération. De plus, le soin de garantir un consentement éclairé et de maintenir les normes requises a été laissé à l'autorégulation professionnelle. Une organisation indépendante, financée par l'État, où les non-professionnels seront représentés et qui disposera de pouvoirs suffisants d'agrément et d'inspection de tous les chirurgiens esthétiques, est nécessaire pour protéger totalement les patients. Elle devrait s'appuyer sur une législation spécifique régissant la chirurgie esthétique.

Resumen

En los últimos años, la cirugía cosmética en el Reino Unido, gran parte de la cual es ofrecida por el sector privado, se ha vuelto más popular a pesar de la evidencia de sus posibles riesgos a los pacientes. Más de 32,000 procedimientos fueron informados por una sola asociación de cirujanos cosméticos en 2007, tres veces más que en 2003. En este artículo se examina la regulación de la cirugía cosmética en el Reino Unido en vista de la necesidad de consentimiento informado y la importancia de autonomía del paciente. Desde 2000, el gobierno ha intentado, mediante legislación que cubre toda la prestación de servicios de salud, regular las calificaciones de los cirujanos cosméticos, los derechos del paciente a información y la inspección y el registro de locales. Sin embargo, aún no se ha eliminado el riesgo a los pacientes por cirujanos no inscritos y no calificados, y por clínicas privadas con calidad de atención deficiente. Más aún, la obtención del consentimiento informado y el mantenimiento de estándares se han dejado en manos de la autorregulación profesional. Se necesita una organización independiente, financiada por el gobierno, con representación de legos y suficientes poderes de registro e inspección de todos los practicantes pertinentes de cirugía cosmética, para proteger plenamente a los pacientes; ésta debe basarse en la legislación específica que gobierna la cirugía cosmética.

Notes

* The data are collected for the whole of the UK, though regulation of health care differs for England and Wales from that of Scotland and Northern Ireland.

† Independent data on such complications are not available.

* Statutes regulate health care practice in the whole of the UK. However, statutes will outline the separate regulatory schemes governing their implementation in Wales, Scotland and Northern Ireland, often through secondary legislation. England and Wales share a common law system, but this is separate from those of Scotland and Northern Ireland.

* This judicial support for doctors was followed in Gold v. Haringey Health Authority [1987] 2 All England Law Reports p.888 and Blyth v. Bloomsbury Health Authority [1993] Medical Law Review p.151, whether the treatment was therapeutic or non-therapeutic (as with contraceptive treatment in Gold, and thus with cosmetic surgery) or whether or not the patients asked particular questions.

† These are central tenets in all the most relevant UK statutes and EU regulations, namely Supply of Goods and Services Act 1982; Sale and Supply of Goods Act 1994 s.1; Consumer Protection Act 1987; Directive 03/12/EC; Medical Devices (Amendment) Regulation 2003; Unfair Contract Terms Act 1977 s.2; Unfair Terms in Consumer Contracts Regulations 1999.

** The Registered Homes Act 1984 was repealed and replaced by the Care Standards Act 2000.

* And in Wales by the National Assembly for Wales.

† The Healthcare Commission has different functions in Wales to those in England. The Healthcare Inspectorate Wales, based within the Welsh Assembly, is responsible for local inspection and investigation of Welsh NHS bodies. The private health care sector in Wales is regulated by the Care Standards Inspectorate for Wales.

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