Cutting to the core

Cutting to the Core, a book on surgical ethics, begins by quoting a portion of the Hippocratic oath: to “first, do no harm.” It is a fitting introduction, for the procedures addressed in Cutting to the Core propose to do just that — harm one’s patients. However, rather than refusing to perform surgery altogether (as Hippocrates would have physicians swear), this text would have us weigh each procedure on a scale of harm vs. benefit. Beyond the simple arithmetic of medical harms and benefits, however, lies a lot of ground. What should we do when what a person wants and what is good for him are at odds? What if the patients in question cannot speak for themselves? What right do guardians have to make these decisions? Can societal pressure constitute a “harm” or “benefit”? Addressing these questions, and multitudes more, the host of authors forges ahead into the murky fray that constitutes surgical ethics. David Benatar is editor, and I cannot help but admire his style. The book is laid out not as a heated debate between “for” and “against” arguments, but rather as carefully selected groups of articles that thoughtfully examine sensitive areas of surgical intervention. The authors sometimes reach similar conclusions, but often take alternate routes to get there. The book is divided into six sections. Each addresses a particular type of contested surgery. The topics range from common medical practices such as male circumcision and cosmetic surgery to more obscure and sometimes bizarre procedures such as face transplants. Certain topics are avoided, however, and Benatar is explicit in his reasons why. There is no discussion of amputation of healthy limbs, “diet” surgeries, or abortion. These topics, among select others, are determined to be beyond the scope of the text, or else addressed implicitly in other chapters. The tone, overall, is moderate. The conclusions drawn by most of the contributors tend to suggest that sometimes a surgery is called for — and sometimes not. It depends on the context: the personal feelings of those involved, severity of this particular surgery, etc. However, though the conclusions reached are rarely surprising, the journey to that decision is always thoughtful and thought provoking. In addition to the expected considerations of what constitutes autonomy, assault, and benefit, this book also raises deeper issues. For example, the distinctions between enhancement and normalization, whether our society’s strivings toward normality are warranted, what an individual’s responsibilities are toward changing society, and when this could result in personal detriment vs. accepting the status quo. I found Cutting to the Core to be a superb book. Despite the medical fields explored, the book is laid out like a philosophical treatise. The authors clearly state: These are my goals; here is how I will address them; this is my conclusion. Such simplicity of presentation makes the book accessible to non-practitioners and non-philosophers alike, without sacrificing content or depth.