A number of features of cosmetic procedures raise particular challenges for regulation, when compared with ‘therapeutic’ interventions:
- Cosmetic treatments will usually be initiated by the patient/consumer, rather than proposed by a health professional after a diagnosis. This may affect the nature of the consent process. It also raises questions as to the professional’s responsibilities if they believe the procedure is not in the patient’s best interests, or if there are other less invasive ways that patients/consumers might be able to achieve their goals.
- Most cosmetic procedures are provided by the private sector, rather than the NHS. Information accessed by patients/consumers will often be in the form of marketing material, rather than ‘patient information’, and people may feel a degree of pressure to go ahead with treatment.
- Outcomes may be more subjective: a professional may regard a treatment as ‘successful’, while the patient may feel disappointed that their expectations have not been met.
Over the past decade, there have been a number of expert inquiries in the UK looking into the way cosmetic procedures, in particular surgical procedures, are regulated,(11) culminating in the 2013 Review of the regulation of cosmetic interventions (the Keogh report) commissioned by the English Department of Health.(12) Repeated concerns raised include issues of patient safety (particularly with reference to the quality of implants and injectable fillers); the training and qualifications of those providing procedures; and the quality of information available to potential patients, both with respect to the risks and likely outcomes of procedures, and with respect to choice of practitioner.
The Keogh report highlighted the absence of any standards of accredited training for those providing non-surgical procedures, whether health professionals, such as doctors, nurses, or dentists; or others, such as beauty therapists. The report recommended the development of such standards, accompanied by compulsory registration of all practitioners providing cosmetic procedures, with the aim of ensuring that only practitioners who had acquired the necessary qualifications to achieve registration should be allowed to practise. The Department of Health’s response did not accept the need for such a registration system, but promised to explore other legislative options, including a possible role for health professionals taking a supervisory role with respect to some cosmetic procedures carried out by non-health professionals.(13)
In the light of other recommendations made in the Keogh review, there has been considerable activity by regulatory and educational bodies in the past two years, with a particular focus on defining standards for those providing cosmetic procedures (whether clinically qualified or not), and making it easier for patients to identify appropriately qualified practitioners and to make informed choices:
- Health Education England has been commissioned by the Department of Health to develop accredited qualifications for providers of non-surgical procedures, and its final report, including implementation proposals, was published in January 2016.(14)
- The General Medical Council (GMC) is developing a system of ‘credentialing’ so that doctors with a credential in a particular field of practice, such as cosmetic practice, can have this recorded in their entry on the medical register.(15) The GMC has also issued draft ethical guidance for all doctors who offer cosmetic procedures.(16)
- The Royal College of Surgeons has established a Cosmetic Surgery Interspecialty Committee (CSIC) with a remit to develop standards for training and certification across the range of specialties offering cosmetic surgery; develop high quality patient information; and develop clinical outcome measures.(17)
Particular regulatory issues may arise with respect to access to cosmetic procedures by children and young people, or by others regarded as vulnerable in some way, such as people with body dysmorphic disorder (BDD). With respect to children, while parents are legally entitled to provide consent for their children’s medical treatment, their authority to provide consent for invasive procedures undertaken for cosmetic purposes is more uncertain. Comparisons may be drawn with other areas of regulation, such as the Tattooing of Minors Act 1969 which specifically prohibits practitioners from tattooing persons under the age of 18.(18) Similar regulations apply to the use of sunbeds by children and young people under the age of 18, other than when under medical supervision.(19)
9. Do you think that people seeking cosmetic procedures are ‘patients’ or ‘consumers’, neither, or both?
10. What information should be made available to those considering a procedure?
11. Are there (a) any people or groups of people who should not have access to cosmetic procedures or (b) any circumstances in which procedures should not be offered?
12. To what extent should parents be allowed to make decisions about cosmetic procedures for their children?
13. Should there be any guidelines or regulation on who can provide non-surgical cosmetic procedures?
14. What are the responsibilities of those who develop, market, or supply cosmetic procedures?
15. Do you believe that current regulatory measures for cosmetic procedures are appropriate, too lax, or too restrictive?
For footnotes 11-19, see the full call for evidence document.
How to submit your response
Please email your response to Kate Harvey at email@example.com, with ‘Cosmetic procedures’ in the subject line. If possible, responses should be in the form of a single Word document, with question numbers clearly indicated.
If you would prefer to respond by post, please send your submission to:
Nuffield Council on Bioethics
28 Bedford Square
London WC1B 3JS