Freedom of Choice

Some First Principles Concerning Labiaplasty, Vaginoplasty & Clitoral Unhooding Procedures

Autonomy and Freedom of Choice Regarding Access to Elective or Cosmetic Procedures

In many general news outlets, much has been written about what should be regarded as “appropriate” in the area of cosmetic surgery . . . specifically in the area of Feminine Cosmetic Genital (or Plastic) Surgery. A significant part of this opinion is from a few people who have sought to criticize providers of labiaplasty, vaginoplasty and clitoral unhooding procedures and those prospective patients who desire these necessary medical treatments—because they view such procedures as not needed. Much of what has been presented amounts to no more than the critics’ own personal opinions and speculations. Below, we focus instead on the philosophy, sociology, psychology, and clinical science of these increasingly common but sometimes still controversial elective feminine cosmetic genital procedures.

In the first part of our discussion, we speak of the philosophy involved in the societal decision-making process and views of these processes . . . one’s right to choose and individual autonomy. Other key issues in this discussion will also be provided in subsequent writings to provoke readers to offer their commentary and concerns.

Respect for Individual Autonomy

From The Oxford Dictionary:

au•ton•o•my ??tänam??–freedom from external control or influence; independence. From Greek autonomia, from autonomos, ‘having its own laws,’ from autos ‘self’ + nomos ‘law.’

“Life, liberty, and the pursuit of happiness.” Familiar words from the Declaration of Independence—the core of the freedoms enjoyed by Americans for over two centuries now. But are we, as a society, really consistent in our affirmations of these concepts?

Not really.

When it comes to the liberties required for the pursuit of happiness, we often tend to cherish and take for granted implied rights that are important to us, individually, but mistrust and are too easily persuaded to limit, deny, or eliminate those that apply to others. This sort of double-standard becomes very evident in the election of a labiaplasty, vaginoplasty, or clitoral unhooding procedure to enhance one’s self-esteem.

In a classical philosophical perspective, it is simply obvious that we should respect and protect the autonomy of all others around us. Such a respect for individual autonomy is often characterized as a basic human right. For example, an obvious constraint on the exercise of individual rights is that such exercise should not infringe on the ability of others to exercise their rights. But, even where the right of personal choice is provisional, it is generally and rightly treated as a kind of default: unless some very good reason can be offered for limiting or refusing to allow individual choices to be made, the freedoms required to permit such autonomous choices is regarded as presumptive.

This presumption has the result of what might be called a quality of “shifting the burden” in the case of the debate about whether or not something—in this case, the personal election of having a labiaplasty, vaginoplasty and/or clitoral unhooding procedure performed, for whatever reason—should be ethically, socially, or legally accepted. Typically, that debate—about whether or not individuals should be allowed to do something they choose to do—is not equally shared by those in favor versus those opposed. The core question in any such debate, then, is not and should not be, “should we allow this?” but rather, “why shouldn’t we allow this?”

In the case of a medical procedure on one’s own body, unless there is a completely compelling reason not to allow it, such as definitive proof that such a medical procedure is harmful, the respect for individual autonomy that is at the very heart of any free society mandates both tolerance and support for the exercise of individual choice, even if and when the ideas or activities in question seem alien to us, or make us uneasy. That’s simply part of social freedom allowing people to make their own choice(s). The decision to restrict someone’s autonomy, accordingly, must always be regarded as a heavy one, and will always have at least the appearance of despotism.

The reasons why open societies respect individual freedom are numerous, but at least one of these reasons derives from respect for others.

For example:

One very good reason why people should desist from trying to limit or eliminate others’ freedom of choice is that it is a reasonable expectation in civil society that we conceive of one another as deserving respect as choice-makers. Obviously, some of us would not make the same choices that others make. But, again, one would need some very good reason for denying others the opportunity to make their own choices, and when some of us do deny others that opportunity, one element of such a denial is a lack of respect.

Such a denial shows no respect, because it shows that those who deny others some opportunity, think of those prevented from making their own choice as people who make such bad choices that they shouldn’t be allowed to make choices at all—at least when it comes to issues such as the one in question.

An important reason, then, for regarding individual autonomy as a basic human right is that a refusal to do so shows a kind of scorn or contempt for others, a lack of respect for them and for their right to make the choices that will shape their lives in ways that might be different from the way that others might do. This is not at all the way we are supposed to think of our peers, our fellow human beings.

One good way to think about an argument to limit freedoms, then, is this: The person who is making that argument thinks that anyone who thinks or might do otherwise doesn’t deserve to have the right to make such decisions. There had better be a very good reason for taking such an attitude—on the face of it, this qualifies as a bad attitude to take towards one’s fellow human beings! On the other hand, those who would refuse to limit some freedom do not force others to agree with or conform to their opinions; instead, those who support some freedom simply respect others’ ability to make their own decisions in their personal matters.

There are many freedoms we recognize but choose not to exercise in a free society. We choose to practice one religion or another, or none at all. But in making such a choice, if we respect freedom, we show no disrespect for those who choose differently. It is those who deny choice, then, who show disrespect, contempt for any opposing or alternative choice.

The many forms of xenophobia, however, push against our instinct to respect others and to permit autonomy. The more alien or odd some choice seems to be—the more outlandish to the way we are used to thinking about things ourselves—the easier it is for us, psychologically, to accept the idea that such a choice should not be permitted. But lack of familiarity is very obviously not a good reason for limiting or eliminating others’ rights to choose for themselves. Again, the right to personal autonomy is very strong and can only be overturned by very good reasons. The fact that something seems strange or makes some of us feel uneasy is no reason at all for denying someone else the right to choose that thing. Where personal autonomy is honored, those who choose not to do something, as well as those who choose to do it, are all respected and permitted to make their own choices.

This, then, is why we rightly resent it when people seek to deny to us the opportunities to make our own choices and to shape our own lives—and especially when those who would interfere with our autonomy do not provide overwhelmingly good and decisive reasons for not respecting our ability to make our own choices. It is also why we should be especially wary of being seduced into limiting choices simply out of unfamiliarity or some uneasiness we might feel about a certain topic.

We must remind ourselves: Are we being given logical, decisive reasons for limiting freedom here? Or are we simply being seduced by bad reasoning in this case—reasoning we would never accept if it were applied to some kind of choice we find more familiar? Does the person whose choices we are seeking to restrict really deserve our disrespect? Is their judgment really so contemptible that it is right for us to do what—on its face—looks like a kind of moral aggression, the plainest intolerance? Accordingly, we should ask, in the case of labiaplasty, vaginoplasty and clitoral unhooding procedures; “is there any very good reason to scorn those who would elect to have such procedures done—to hold them in such contempt that we should deny to them even the most basic right to self-determination with respect to their own bodies?” The answer is no.

As we will now go on to show, not only is there no good reason to deny this right, there is, in fact, compelling medical and psychological evidence in the form of clinical studies, for defending patients’ rights of access to these procedures.

Bringing The Argument of Autonomy Home—The Right to Govern One’s Own Body

The assignment of liberty in the pursuit of happiness can become complicated and controversial when the method one person chooses to pursue happiness conflicts with another’s viewpoint on what constitutes happiness. But, this sort of problem simply does not apply to the choices we make about what we do with our own bodies. That is not to say that others may not still disagree with one’s choices even when these are most clearly our own decisions/choices and not those we would ever allow others to make on our behalf.

Perhaps you might like another’s opinion about styling one’s hair, or whether one should—or not—get a tattoo, wear a tie, or have one’s ears pierced. But, it is simply inappropriate to limit or control one’s choices when it concerns one’s own body. If someone were to interfere on these matters, our reaction is swift and clear: “How dare you?” That is because on this sort of issue most of all we assume and defend our right to exercise individual autonomy. And that is also why attempts to limit or eliminate our choices, when it comes to this most sacred of our liberties to pursue happiness, are the most offensive and show the most disrespect to those we would seek to control. For adults, it is simply never another person’s right to decide what one may do with one’s body, when that decision does not in any way infringe upon anyone else’s freedoms, liberties, or well-being. If there are exceptions to this general rule, again, such exceptions would have to be based upon absolutely compelling and decisively good reasons. Are there, then, reasons that are so compelling, so decisive, that we should recognize anyone’s right to limit or eliminate our right to make decisions about how we want our bodies to be?