Previous Nuffield Council publications

Cosmetic procedures:

ethical issues

Nuffield Council on Bioethics

David Archard (Chair from May 2017) Jonathan Montgomery (Chair until March 2017) Simon Caney Tara Clancy Jeanette Edwards* Ann Gallagher Andy Greenfield Erica Haimes Julian Hughes (Deputy Chair) Roland Jackson David Lawrence Shaun Pattinson Tom Shakespeare Mona Siddiqui Christine Watson Robin Weiss Heather Widdows Adam Wishart Karen Yeung** Paquita de Zulueta

* co-opted member of the Council while chairing the Working Party on Cosmetic procedures: ethical issues ** co-opted member of the Council while chairing the Working Party on Genome editing and human reproduction

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Secretariat

Hugh Whittall (Director) Katharine Wright Peter Mills Catherine Joynson Sarah Walker-Robson Shaun Griffin

Kate Harvey Bettina Schmietow Anna Wilkinson Carol Perkins Ranveig Svenning Berg Busayo Oladapo

The terms of reference of the Council are:

To identify and define ethical questions raised by recent developments in biological and medical research that concern, or are likely to concern, the public interest;

To make arrangements for the independent examination of such questions with appropriate involvement of relevant stakeholders;

To inform and engage in policy and media debates about those ethical questions and provide informed comment on emerging issues related to or derived from NCOB's published or ongoing work; and

To make policy recommendations to Government or other relevant bodies and to disseminate its work through published reports, briefings and other appropriate outputs.

The Nuffield Council on Bioethics is funded jointly by the Medical Research Council, the Nuffield Foundation, and Wellcome.

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Acknowledgments

The Working Party would like to express their gratitude to all those who contributed to the production of this report: through responding to the open call for evidence or online survey, attending factfinding sessions to share their expertise and debate issues with Working Party members, taking part in deliberative events, or acting as external reviewers of the draft report (see Appendices 1 and 2). In addition, we would like to thank Diana Harcourt, Philippa Diedrichs, Tingy Simoes, and Rosamund Scott for their helpful advice on specific aspects of the report. The Working Party also benefited considerably from the Nuffield Council's partnership in the AHRC-funded Beauty Demands Network, which ran from January 2015 to June 2016, bringing together academics, practitioners, and policy-makers to consider the changing requirements of beauty in a series of seminars that informed and stimulated the Working Party's discussions.

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Foreword

The task that the Nuffield Council on Bioethics set itself ? to investigate the use and provision of invasive, non-reconstructive cosmetic procedures ? was both bold and timely. Bold insofar as it required consideration of the wider social, political and economic contexts in which cosmetic procedures are growing in popularity, and timely insofar as it was in step with, and in some ways ahead of, growing concerns, from many quarters, about the regulation, safety and consequences of some of these procedures. It has been a great honour and privilege to work with my fellow Working Party members and the Nuffield Council on this task.

I want to immediately and unequivocally extend a special thank you to Katharine Wright and Kate Harvey. The strengths the reader finds in this report are due to their skills, dedication and hard work. In addition, Kate's direct work with young people provided us with valuable new material and Katharine's facility for rendering multi-layered and multi-vocal meetings into coherent (and very helpful) minutes, and for asking just the right probing question at just the right time, was invaluable.

It is banal (and not very helpful) to say that the field of cosmetic procedures (from both user and provider perspectives) is complex. However, to ask ethical questions of it required us to scrutinise social, economic, psychological and cultural domains of social life that are not confined to cosmetic procedures. Amongst other things, we were compelled to think about the reach and limits of consumer culture, the medicalisation of the body and beauty, the ubiquity of social media, issues of mental health and body image ? especially amongst young people, and the contours of discrimination and prejudice. Such scrutiny required and benefited from the kind of multidisciplinary working party, augmented by input from a wide range of `stakeholder' perspectives, that has been a hallmark of the work of the Nuffield Council over the years. Clearly no one discipline or profession can adequately address the sprawling and diverse questions that arise in the current field of cosmetic procedures. And while the report has benefited from the wide range and substantial expertise and experience within the Working Party, it is greater than the sum of its parts.

As will be the case with readers, not all members of the Working Party necessarily agree with the emphasis at every point in the report. Indeed, we have not always agreed on how to treat the evidence available to us. However, we are agreed that evidence is sorely lacking and that, amongst other things, much better records need to be kept and made available. We are also in no doubt that this is an important, worthwhile and necessary report that begs attention - now.

We have made a number of strong recommendations geared towards specific actors and institutions on the understanding that some could be implemented immediately while others may take time. Here, I would like to thank members of the Working Party for their hard work and passion. And, on behalf of the Working Party, to thank the Council and the Council sub group for their constructive comments and criticisms throughout the process, and the external reviewers for their extremely helpful and considered feedback on an earlier draft.

I would like to extend a large and personal thank you to everybody who contributed to our survey and consultation exercises, attended our factfinding meetings, and agreed to be interviewed by members of the Working Party. I am both grateful and impressed by the efforts people put into our requests and of how generous they were with their time.

During our deliberations we heard from many thoughtful and thought-provoking people: workers, professionals, campaigners, regulators, researchers, administrators and managers

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