Eyes wide open: surgery to westernize the eyes of an Asian child.

January-February 2009 Douglas Opel and Benjamin Wilfond, discuss other real-life examples of cosmetic surgery in cognitively impaired children. They argue that it is all too easy—and wrong—to dismiss such procedures if the psychological benefit to the parents is clearer than the benefit to the child. “[E]xploring parental motivations and clarifying parental values may be precisely what is needed before performing cosmetic surgery on children with profound cognitive impairments,” they write. Erik Parens offers some advice to parents of children with profound cognitive impairments who are considering cosmetic surgery. The insights come from children with physical disabilities who have considered cosmetic surgery and their reasons for either going with it or refusing it. Parens, a senior research scholar at The Hastings Center, led a research project on surgeries to reduce physical deformities in children. Gregory Kaebnick, editor of the Hastings Center Report, analyzes one of the objections to the Ashley intervention— that it was “against nature.” Even if one believes that leaving nature alone can be valuable, does it follow, he asks, that messing with nature is wrong? Kaebnick, who recently completed a research project funded by the National Endowment for the Humanities that explored moral appeals to nature, concludes that the answer is no. Where possible, though, he believes that decisions about cosmetic surgery should be postponed until they can be made by the children themselves. Queensland’s new law is not aimed at medically necessary procedures. The law does not affect procedures to correct congenital abnormalities or to reduce the disfigurement caused by a trauma. It does outlaw breast augmentation and liposuction for children under eighteen. Asian eye surgery would probably be banned, too. But legal lines are brighter than ethical ones. What about medical and surgical treatment for gender identity disorder? Or a feeding tube implanted into the stomach of a profoundly disabled child to make feeding easier? Or the Ashley treatment? Between the extremes of medical necessity and enhancement, the border disputes continue.