The Death of Wang Bei: Cosmetic Surgery as a Moral Choice

 Editor's note: This post was picked up from www.thehealthculture.com.

In my customized Google news, I have a category for cosmetic surgery. Most items that turn up are self-serving PR announcements, but recently there was lengthy coverage of the death during cosmetic surgery of aspiring Chinese pop star Wang Bei.

The details are tragic: She was only 24. Ironic: She was already beautiful. And dramatic: Her mother was having the same procedure at the exact same time. So her mother woke up to discover her daughter was dead. Or perhaps not. According to conflicting reports, her mother was told nothing until the next day. The news reports out of China do not strike me as especially reliable.

For example, Wang Bei's death was first reported as an anaesthetic accident, but the majority of stories describe the cause of death as bleeding from the jaw. Wang was having facial bone-grinding surgery "to make her jaw line fashionably narrow and her face smaller." (Chinese women are said to prefer an oval face shaped like a "goose egg.")

The blood from Wang’s jaw drained into her windpipe, and she suffocated. Is that an "anaesthetic accident"? Wang’s surgeon claims the operation was a success and that Wang died of an unexpected heart problem several hours after the procedure.

The Chinese Ministry of Health asked the provincial health department (where the surgery took place) to conduct an investigation and report back as soon as possible. Wang died on November 15, and there is still no official word.

The sociologist and the plastic surgeon
Press coverage of the Wang Bei story – in addition to describing the young woman’s failed attempt to become a successful entertainer after her 2005 appearance on the Chinese equivalent of American Idol - was almost entirely about the importance of finding a qualified surgeon for your next cosmetic procedure. This is big business in China. In 2009, the Chinese spent $2.2 billion dollars on three million procedures, a figure that grows annually by 20%. China ranks third highest in the world in number of procedures (after the US and Brazil), and it’s number one in Asia.

There were a few – but not many – comments on why an attractive 24-year-old would want her jaw shaved. Typical was the following, which juxtaposed the question of motivation with the affirmation that, of course, a young girl wants cosmetic surgery.

Xia Xueluan, a sociologist at Peking University, told the Global Times that he also strongly disagreed with undertaking cosmetic surgery simply in order to improve one's looks.

"The concept of beauty has also been greatly distorted nowadays," he said. "Doing plastic surgery reflects people’s vanity and lack of confidence about themselves."

A plastic surgery expert surnamed Jia at the PLA 309 Hospital in Beijing told the Global Times that it's understandable that young women wish to have surgery to improve their looks – but he added that they should choose credible and qualified hospitals and doctors to avoid fatal accidents.

The sociologist versus the medical profession. I wonder whose voice the public prefers?

Fixing what can be fixed: The moral choice
In his wonderful essay "Emily’s Scars," sociologist Arthur W. Frank raises the question: Where do we draw the line when it comes to "fixing" the self?

Is there some core of me that I should work with, not work on, or are some body parts no more than unwanted contingencies, like warts, that temporarily intrude on my life? If the latter, is the decision to fix determined only by a comparatively simple cost- and risk-benefit assessment? Need I ask only whether the promised improvement will be worth the time, trouble, and pain to me that the fixing involves?

Frank goes on to distinguish protectionist from Socratic bioethics. Protectionist bioethics was the prevailing response to Wang Bei's death. The consumer of cosmetic surgery should be protected from harm. Doctors should be adequately trained and highly competent. There should be full disclosure of any risks. It all boils down to a cost-benefit analysis of a consumer purchase: What exactly am I getting, what is the benefit, what is the cost, and what is my risk.

Socratic bioethics, on the other hand, digs a little deeper. It asks – Socratically enough – what is the good life and what should health mean in this good life. When we choose to have cosmetic surgery – on our faces, our feet, our thighs – we tell ourselves this is entirely a personal and private decision that affects only the individual patient/consumer. But in fact, each one of us who makes the decision to have cosmetic surgery changes the standards of acceptable appearance in which everyone else must live. In that sense, the decision to have cosmetic surgery is communal and thus ultimately moral.

Fifteen minutes of fame
Who set the standards of appearance that prompted Wang Bei to undergo surgery? Should we condemn individuals, the media, celebrity culture, consumer culture, the competitive nature of modern life?

After her unsuccessful appearance on SuperGirl - a hugely popular singing contest in which the television audience votes on the winner (democracy in action in China) - Wang Bei took part in Dream China, a 2006 talent competition. Using her modest fame from SuperGirl, she secured a number of media appearances in the following years. She had hoped to sign with a record label, but this never happened. Her performances in subsequent competitions are described as "lackluster." By the summer of 2010, she was singing in a bar in the industrial port city of Qingdao.

My favorite bioethicist, Carl Elliott, believes the issue of appearance boils down to the logic of consumer culture.

You can still refuse to use enhancement technologies, of course – you might be the last woman in America who does not dye her gray hair, the last man who refuses to work out at the gym – but even that publicly announces something to other Americans about who you are and what you value. This is all part of the logic of consumer culture. You cannot simply opt out of the system and expect nobody to notice how much you weigh.

Nor, evidently, can you compete for fame without acquiescing to the rising standards of appearance set by those who opt for cosmetic surgery. Standards, as Jonathan Metzl puts it in another context, that are "wholly mainstream and impossible to attain."

Wang Bei had achieved sufficient fame to have fans. One report noted that some of those fans – on hearing the news of her death – accused her of staging a publicity stunt to attract attention. Alas, the news was true. In her death Wang Bei found the fame that had eluded her in life.

Update 12/6/10:Wang Bei’s Ultimate Sacrifice to Beauty

This is not an official report on Wang’s death, but observations from an anonymous doctor who was part of Wang’s "rescue" team. Other sources have also reported on Wang's previous cosmetic surgeries.

An error on the part of the surgeon … led to a bleed from Wang’s lower jaw into her trachea. … As she was under general anesthetic, by the time surgeon realized what had happened she had already gone into shock. …

"She had already undergone facial surgeries on her eyes, nose and lower jaw in addition to the bone-grinding procedure mentioned on the Internet. Respiratory tract obstructions are a risk during simultaneous surgery on the nasal cavity and lower jaw, which is why such cases need careful observation," the doctor said, adding, "Wang didn’t die during surgery but in the observation period afterwards. The surgery called for tight bandaging over the patient's chin and mouth. As the nasal surgery impeded nasal breathing, assisted respiration was necessary. It appears that Zhong'ao Cosmetic Surgery Hospital was deficient in its observation procedure after surgery, and is hence responsible for Wang's death." 

Update 12/7/10:Plastic Surgery & Chinese Singer

Here's speculation from the California Surgical Institute Blog on what may have happened (purely hypothetical), plus reassurance that it wouldn’t happen here.

[T[he most likely scenario was that the surgeon nicked a vein, allowing blood and mucous to trickle into Wang’s intubation tube and into her lungs. In short, she drowned on the table. Or, her lungs were so stressed by the fluids, they sprung a heart attack.

Can that happen in US plastic surgery? Given a board certified plastic surgeon working with a board-certified anesthesiologist (who is another medical doctor) it is very, very unlikely.

Update 12/22/10:As China's obsession with plastic surgery grows, so too do the pitfalls (Washington Post)

A comment from the Western press on the popularity of cosmetic surgery in China. Number of surgeries much higher than officially reported.

"I feel people have a higher standard of beauty right now," [Dr] Xu [Shirong] said. “I tell many of my patients they score 98 already, and that’s good enough, with no need to pursue a perfect 100. But most of my patients still choose to add those two missing points."

Related posts on www.thehealthculture.com:Character, personality, and cosmetic surgeryBibi Aisha: Fixing what can be fixedMutilated Afghan woman on the cover of TimeAfghan women empowered to practice beautyThe tyranny of health then and nowThe tyranny of healthActions surrounding the moment of death are highly symbolic

Resources:

Image source (head shot): N24

China’s ugly obsession,Sydney Morning Herald, December 2, 2010

Zhang Xiang (ed), Beauty has an ugly side, Xinhua News Agency, November 30, 2010

Jin Jianya, Beijing woman dies during plastic surgery procedure,Global Times, November 26, 2010

Arthur W. Frank, Emily’s Scars: Surgical Shapings, Technoluxe, and Bioethics, Hastings Center Report, March-April, 2004

Jonathan Metzl and Anna Kirkland, editors, Against Health: How Health Became the New Morality