The injection of silicone oils has been used to modify body contours around the world, most commonly to increase breast size. As surgeons, we find ourselves increasingly being called to deal with problems generated by this illegal form of breast augmentation—bilateral breast tumors, some painful, some not; hard masses that are often confused with advanced breast cancer; and axillary tumors, all caused by silicones. Such complex scenarios give rise to several tough questions: How should surgeons act? What do and should such patients expect? Does such a situation indicate the immediate need for surgery, or can some patients be monitored? Should surgery be conservative or radical? Should patients be left surgically untreated if they refuse surgery? If so, should their clinicians require that they sign a letter indicating that they have been adequately informed about the implications of their clinical presentation and the need for surgical intervention, and yet they willingly choose to reject it? Is such a letter legally valid?
A good doctor is one who has developed attitudes of respect and solidarity with others, who can conceive the patient as equal to him- or herself, and who is able to recognize the right that others have to carry out their own lives, however different they may be from their own. The “biology” is as important as the “biography” of the person, and the medical act is not understood merely as a technical act but as a social fact in which cultural factors, beliefs, and values coincide.
Among many bioethics experts, there are no problems, in a strict sense; rather, there are dilemmas or, more accurately, true quandaries. This is because there is no single solution, and any solution chosen may give rise to new problems. What can we do? What should we do? What do patients actually “want”?
As we accept patients as individuals capable of creating their own life plan, elaborating their wishes in ways that can be understood, we also must recognize their beliefs and wishes as valid and their rights respected. The right that patients have to choose the therapy they want necessarily gives them the right to refuse treatment they do not want. As long as they are deemed legally competent to make such decisions, we must respect them, even when they seem foolish and ill-reasoned.
KeywordsBioethics Informed consent Rejection informed Autonomy Beneficence
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