The sum of my parts

I worry of late that I am not as good looking as I used to be. I stopped exercising about a year ago after a move to the country. The bucolic setting disagrees with me. Recently, I turned 36 years old. But these aren't the bases for my complaint. The problem is that time has treated me more cruelly than others similarly situated. The rest of my birth cohort seems filled with vim and vigor. I, on the other hand, am fleshy, pallid, and prone to fits of profuse perspiration. This year, I vow to do something about it. My first stop is my general practitioner, the best doctor I have ever had.“Stewart, this is the year I do it; tell me where I should start.”He reminds me of visits around this time over the last 3 years when he talkedme out of Prozac (1997), Viagra (1998), and an all-protein diet (1999).“I am way beyond all that. This is about releasing a happier me from a corporeal prison. A more beautiful me. A...” I go on at some length.Stewart suggests diet and exercise. “Impossible,” I retort,“I am up for tenure in the Fall.” He tells me that I'd have to gain a lot more weight before I am eligible to take a diet pill. I ponder this dilemma for some time. Then, in a flash, the answer comes to me: cosmetic surgery. Relief floods over me like warm butter. The Web site www.medicineonline.com reads as if it was written just for me.The “Bid for Surgery” section of the site describes itself as an“E-exchange for cosmetic surgery, dentistry, ophthalmology, and podiatry.” Inside is a virtual road map to bodily enhancement. Three dozen procedures are offered to stretch or snip my parts on cosmetic surgery's procrustean bed. I am to select one or more procedures, fill out a form detailing medical information, and then wait for the bids to flow in from practitioners across the United States. Narrowing the field of procedures is going to be a problem. I decide to ask my life partner to select for me. A mistake. I get back a list of 8 procedures: Botox injections (for laughter lines—“Nothing's that funny,” my partner says), correction of enlarged male breasts, eyelid surgery, liposuction, nose surgery, scar revision (longstory), laser surgery for myopia, and teeth whitening (too much coffee while writing snappy commentaries). Clearly, we are going to need to set priorities.After a long heart-to-heart discussion, we settle on 4 procedures: eyelidsurgery, liposuction, laser surgery, and teeth whitening. Sharing a quality moment, we fill out the forms together and on their completion pause, warmed by the glow of my computer's new flat screen monitor. We both sit transfixed by my image reflected by the digital surface. Somehow, I already seem slimmer, more beautiful. My partner's hand rests on mine as I click the left mouse key:“submit—register and request a bid.” Yes, submit. The bidding among the various specialists lasts for 7 days. In the meantime, I ponder the ethics of all this—it is, after all, my day job.In short, it is perfectly acceptable to auction cosmetic surgery services. The clearest I can make it is to compare it to prostitution. My favorite political philosopher, Michael Walzer, argues that the distribution of a good (be it sex or health care) is determined by its meaning for a particular society.“People who believe that sexual intercourse is morally tied to love and marriage are likely to favor a ban on prostitution.... Sex can only be sold when it is understood in terms of pleasure and not exclusively in terms of married love...” (Spheres of Justice, Basic Books, 1984). If you believe that cosmetic procedures in particular, or medicine in general, is a commodity, then you are committed to view free market forces on price, bidding, and unequal access based on wealth as wholly unproblematic. As Walzersays, “there is no such thing as a maldistribution of consumer goods. It just doesn't matter, from the standpoint of complex equality, that you have a yacht and I don't...” (p 108). Nose jobs are the aesthetic equivalent of yachts, and cosmetic surgeons who ply their trade on the Internet are the new captains of medical industry. After a week, I had 4 bids on 2 procedures. Next time, I will have to say that I am willing to travel to California, the home of“Medicineonline.com.” I ponder how to choose the right doctor: the most procedures per year, best patient ratings, fewest lawsuits, cheapest, or most expensive? I decide that the procedure I use for selecting sushi restaurants is most appropriate: pick the most expensive. Like raw fish, surgery should not be cheap. The cost for the new me? $6591. Of course, I have6 more procedures to undergo. Sure it's a lot of money, but if I'm not worthit, who is? Of money—and he might have said the same of cosmetic surgery—the Bard said it is “that which makes the wappen'd widowwed again” (Timon of Athens IV:3).

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