I am an anesthesiologist at a busy multisurgeon plastic-surgery practice. One of the surgeons has started offering a “tongue bifurcation” procedure wherein the tongue is split down the middle, creating a lizardlike appearance for patients who are interested in body modification. I find I have a deep aversion to this surgery, to the point where I would like to refuse to take part. However, this means that one of my partners would be stuck with the work or — worse — that a procedure might need to be canceled and rescheduled, to the inconvenience of patient and surgeon. I also recognize that I willingly take part in other body modifications like breast implants, rhinoplasty and gender-affirming surgery. Is it reasonable for me to draw a line? Name Withheld
People who seek this lizardlike look are doing something to their bodies that — in most states — they are free to do. No third parties are being harmed. So ask yourself what basis you have for not participating in their surgery. If your revulsion derives from an aesthetic disagreement, does that mean you think all the other surgeries you engage in result in aesthetic improvements? Is it any of your business if clients chose to make themselves less attractive to you?
The most obvious reason not to participate in this procedure would be an undue risk of complications. The American Dental Association advises against tongue splitting, deeming it an invasive procedure “with negative health sequelae” — including severe bleeding, infection and nerve damage — “that outweigh any potential benefit.” It’s unclear how the association calculates the benefits. People who want split tongues aren’t trying to appeal to you or me; they’re presumably trying to look cool or otherwise attractive to members of a particular subculture. Buttock augmentation may appeal to a wider set, but it, too, can involve various risks: infection, capsular contracture, sciatic neuropathy, fat embolism. And if you generally objected to surgery performed without a medical objective, you would surely have a range of other procedures in your sights too.
Is there a principled distinction to be drawn here? Possibly. You would have to have reliable data about the rates of serious complications. (In England, an appeals court has agreed that it constitutes, in one instance, “grievous bodily harm,” and two official medical bodies have cited the risks of hemorrhage and nerve damage.) If it turns out that the chances of adverse consequences really are substantially higher for this procedure than for the others that your practice offers, you would have a solid “First, do no harm” argument not only for refraining but also for discouraging your colleagues from continuing to offer the service. But if you find yourself making this case, be sure that it’s more than a “yuck” response masquerading as a safety concern; you don’t want to be speaking with a forked tongue.
For 48 years, I have regretted my behavior in abandoning a pregnant girlfriend. But I have done nothing. Should I now?
We dated during the final weeks of our senior year in college. When she learned she was pregnant, I urged her to get an abortion, because I didn’t want the responsibilities of fatherhood or marriage. She had no interest in abortion and, in the ensuing argument, told me she never wanted to see me again. I used that as a get-out-of-jail-free card, left town for a postgraduate fellowship and never saw her or spoke to her again.
In the half-century since, I made desultory efforts to track her down, to no avail. (She had a very common name and left no obvious tracks.) Now, I believe I have found her. I would like to write to her to apologize for being such a self-centered coward and abandoning her when she most needed support. But she might not welcome such a gesture so late in the game. She has made no effort to contact me, and neither has her child (if the pregnancy produced one). Should I reach out? Name Withheld
