An ethics analysis of the rationale for publicly funded plastic surgery
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(2020) 21:94
RESEARCH ARTICLE
Open Access
An ethics analysis of the rationale for publicly funded plastic surgery Lars Sandman1,2,3*
and Emma Hansson4,5
Abstract Background: Healthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations. The aim of this article is to normatively analyze different suggestions regarding how publicly financed plastic surgery should be delineated in order to identify a wellconsidered, normative rationale. The scope of the article is to discuss general principles and not define specific conditions or domains of plastic surgery that should be treated within the publicly financed system. Methods: This analysis uses a reflective equilibrium approach, according to which considered normative judgements in one area should be logically and argumentatively coherent with considered normative judgements and background theories at large within a system. Results and conclusions: In exploring functional versus non-function conditions, we argue that it is difficult to find a principled reason for an absolute priority of functional conditions over non-functional conditions. Nevertheless, functional conditions are relatively easier to establish objectively, and surgical intervention has a clear causal effect on treating a functional condition. Considering non-functional conditions that require plastic surgery [i.e., those related to appearance or symptomatic conditions (not affecting function)], we argue that the patient needs to experience some degree of suffering (and not only a preference for plastic surgery), which must be ‘validated’ in some form by the healthcare system. This validation is required for both functional and non-functional conditions. Functional conditions are validated by distinguishing between statistically normal and abnormal functioning. Similarly, for non-functional conditions, statistical normality represents a potential method for distinguishing between what should and should not be publicly funded. However, we acknowledge that such a concept requires further development. Keywords: Plastic surgery, Esthetic surgery, Rationing, Prioritizing, Normality, Functional condition, Psychosocial condition, Etiology, Healthcare need, Patient experience
Background Healthcare systems are increasingly struggling with resource constraints, given demographic changes, technological development, and citizen expectations. In publicly funded welfare-type healthcare systems (i.e., with a strong emphasis on equal access to healthcare), * Correspondence: [email protected] 1 National Centre for Priorities in Health, Department of Health, Medicine and Caring Sciences, Linköping University, S-581 83 Linköping, Sweden 2 Västra Götaland Region, Sweden Full list of author information is available at the end of the article
this implies a recurrent re-evaluation of what should be reimbursed and what should be rationed. Decisions on reimbursement can be made at different levels of such systems, including natio
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