Introduction
CHAPTER 9 Ethics in Dermatologic
Surgery
Jonathan Kantor
SUMMARY
Ethical action, like informed consent, is a process.
Most ethical challenges occur when there are conflicting principles, conflicting
duties, or conflicting concepts of to whom the greatest—or least—ethical allegiance is owed.
Beginner Pearls
For centuries, philosophers have struggled with the distinctions between ethics,
morality, law, and—more recently—professionalism.
Ethics reflects a social imperative that is based on moral underpinnings; ethics can
therefore be conceptualized as morality in action.
Expert Pearls
Professional morality may be broader and deeper than common morality, as it
addresses the moral expectations for a particular group.
Principlism, perhaps the most popular ethical framework, relies on the (equally
weighted) principles of autonomy, beneficence, nonmaleficence, and justice. These four principles are frequently used as a litmus test for ethical legitimacy.
Morality is a social institution, and the common morality represents the core group of
morals that are considered universally binding.
Don’t Forget!
Other approaches to ethical decision-making abound, including utilitarianism,
aspirational ethics, casuistry, deontological approaches, rights theory, and virtue ethics.
While cosmetic dermatology patients may interact with physicians as if they are
consumers, rather than patients, they should still be treated as the latter.
Pitfalls and Cautions
Keep in mind that there is often more than one reasonable solution to an ethical
quandary.
An action can be legal without being ethical and ethical without being legal.
Body dysmorphic disorder is a common condition, and identifying such patients is an
important challenge for the cosmetic dermatologist, not least because the patient is likely to be dissatisfied after any intervention.
The need for a consistent ethical framework led to the expansion of principlism to the
point that the four principles are frequently used as a litmus test for ethical legitimacy, though the challenges of this model of applied ethics may be substantial.
CHAPTER 9 Ethics in Dermatologic