“Primum non nocere” And Cosmetic Limb Lengthening

“Primum non nocere; first do no harm” is the fundamental ethical pilon of the medical profession derived from the Hippocratic oath itself. At the 2nd combined ASAMI-BR and ILLRS meeting in Brisbane in 2016, the issue of ethics and regulation of cosmetic limb lengthening was debated and although no formal consensus was reached, there was broad agreement on the guidelines that need to be set for cosmetic limb lengthening.

Athens BJR endorses this effort and implicitly adheres to the following proposed guidelines for ethical cosmetic limb lengthening:

  1. ​Surgery must only be performed by experienced fellowship trained limb reconstruction surgeons.
  2. Surgery must only be performed in major hospitals with backup facilities.
  3. While initial consultations may be through remote means such as the internet, there must be at least one in-person consultation before surgery. There must be a detailed informed consent procedure.
  4. There must be a psychological assessment of the patient, and ongoing pastoral care of the patient.
  5. There must be a minimum cooling off period to allow the patient to call off the surgery, without any financial or other penalty.
  6. There must be clear avenues for complaint for the patient, including the right to redress in case of unacceptable outcomes and complications.
  7. The surgeon must have a commitment to manage the patients till the completion of their treatment, including rehabilitation and management of their complications.
  8. There must be no financial exploitation of patients. This includes a prohibition on nonrefundable deposits, and a commitment to manage complications for little or no extra cost, irrespective of the patient’s ability to pay.
  9. National bodies have a duty to report or reprimand underperforming or exploitative colleagues, and those that indulge in unethical practice.
Reference: Patel M. Cosmetic limb lengthening surgery: The elephant in the Room. Harm minimization not prohibition. J Limb Lengthen Reconstr [serial online] 2017 [cited 2017 Nov 12];3:73-4. Available from: http://www.jlimblengthrecon.org/text.asp?2017/3/2/73/213565