Page 2 - Principles Of Ethics Continued
Beneficence means acting in the patient’s best interest. The doctor should be able to benefit the patient through a surgical intervention. The surgical procedure should be shown to have benefited other patients who have undergone it. Clinical studies have shown that cosmetic limb lengthening surgery not only increases the height of all patients (2–4), but also improves the person’s self-esteem (3). Denying height gain surgery to a patient who has reasonable justification for opting for the procedure would mean violating the principle of beneficence.

Non-maleficence means refraining from doing any harm to the patient. All surgical procedures are associated with some complications; however, the benefit of the intervention must be greater than the risk involved. The surgeon should not cause any harm to the patient intentionally or unintentionally. There should not be any malafide intentions in undertaking the surgical procedure. The incidence of complications of limb lengthening surgery has been reported to range from 37% to 72% (3, 4). However, most of these problems are related to soft tissue and bony parts and are of a relatively mild nature, not causing any permanent disability or handicap (3).

Justice involves the fair and appropriate allocation of resources, depending on the need. Justice also means taking a decision that would benefit not only the patient, but society as well (5). According to the principle of justice, the surgeon must exercise restraint as far as the type of surgical procedures to be performed is concerned, depending on the resources allotted. In the private healthcare system, patients pay for healthcare and hence, are in a position to choose the type of surgical procedure they wish to undergo. At present, there are no laws stating that cosmetic limb lengthening should not be undertaken in the country.

Hence, the decision to perform a surgery for height gain in patients who subjectively feel that they are of short stature is in accordance with the four basic principles of ethics. It can be argued that denying this surgery to a patient who requests it for a valid and reasonable cause would violate all four principles.

Ethical Theories
When one encounters a complex ethical question, it is advisable to evaluate the question using different ethical theories (5, 6).

The utilitarian doctrine states that an act is justified only when it maximises the “happiness” of the entire society (6). Irrespective of whether one is rich or poor, of short stature or normal stature, everybody is given equal importance. As per the utilitarian outlook, there is only one right act in a given situation (6). An act is right or wrong depending on the ultimate consequence. The final outcome is given more importance than the means to reach the outcome. If patients achieve the height they wanted to achieve, then they are likely to be satisfied with the outcome. If the patient is satisfied, the act of intervening surgically to lengthen the limb would be right. One is likely to obtain an answer to whether the surgical intervention has been satisfactory at the end of one year to 18 months after the intervention, and the final verdict will be delivered by the patients themselves.

Duty-based moral theories state that an act is justified and appropriate only if it is in accordance with moral values, against the background of rationality (6). As per this theory, there might be more than one act that is right in a given situation. Here, the nature of the act is more decisive than the final consequence. A shoe raise is a non-operative option for gaining height, but it entails wearing a shoe at all times. If this option has been discussed with the patient and they want a permanent solution instead of a temporary one, the only remaining option for a skeletally mature individual is surgical limb lengthening. Thus, offering surgical limb lengthening to a patient who does not want to opt for a shoe raise or is unsatisfied with a shoe raise is a reasonable option.

Virtue ethics states that an act is right if a virtuous person would act similarly in a similar situation (6).