1. If a claim arises from a client, can you justify its Medical or Cosmetic?
  2. Will your client agree her cheek enhancement was for medical reasons?
  3. Will your insurance cover you?
  4. Have you, as the customer, had a cosmetic treatment? Are you having this treatment for medical purposes?
  5. Many medics and non-medics remain closed whilst others carry out no medically related cosmetic beauty treatments.

 

 

Dear Lime Aesthetics, thank you for your response. Unfortunately you have made several errors in your criticism, so let me point these out to you here as we’re going round in circles . Can we assume some kind of standard discursive practice please? Let me suggest I proceed by selecting the bits of your message I want to discuss and then go on to discuss them. Here goes:

“Many medical aesthetic clinics were never legislated to shut and could have remained opened, however chose to close from a moral standpoint.’

Here you generalise about ‘medical aesthetic clinics’ implying there is such a legal or philosophical category of premises which was mistakenly swept up in UK government legislation. Look at the institutions, genuine medical clinics, which have shut their non-essential work down during coronavirus lockdown with good reason, to help stop the spread of the virus, and ask yourself why aesthetics should not be making its fair contribution to this national effort? Do you think that the aesthetics industry is immune already to the dreadful consequences of the disease? Do you think that we are so good at hygiene we will all be perfectly safe? Do you think that our contribution to the mental well being of our clients is so irreplaceable that we must be an exception? Unless you do think these things, and if you do please admit them so that I can set you straight, then there is little reason to believe that ‘medical aesthetic clinics’ were not intended to be included in legislation designed to prevent the spread of the deadly Covid-19.

‘The government guidance is very clear – healthcare professionals working from a medical setting are allowed to offer facial aesthetic treatments.’

Bless you Lime Aesthetics, nothing will stop you from believing that you must be allowed to work on facial aesthetics during the lockdown. I understand you must be frustrated, but the government guidance could not be clearer. If your facial aesthetics treatments are not medically essential then they should not be offered. Anything which skews the logic of the lockdown and all its following stages, to stop the spread and save lives and the NHS, is not in the long-term interests of your business, clients, patients, community or country. The logic of the legislation is to reduce the number of non-essential interactions between potential carriers and receivers of the virus, see the entirety of the SAGE advice for this, and such skewering of the meaning of ‘medically essential’ is therefore not a justification allowing you to offer facial aesthetic treatments.

‘The definition of a medical setting according to WHO is anywhere a healthcare professional works.’

Great to see that you are a fan of the World Health Organisation, what an amazing outfit and so full of interesting and helpful information on Covid-19 and the pandemic. It is a shame that you allow yourself to get trapped in the ontological argument about the existence or otherwise of medical settings as a category useful to your contention. This is a distraction. It might make you feel better to be part of the WHO definition, but so too are thousands of other medical professionals offering far more clinically important procedures than our facial aesthetic treatments and they realise that the rationale of the Government response to Covid-19 is not to give us an academic exercise in discovering the ‘medical’ nature of our settings but to prevent the further spread of this debilitating virus. We are not ‘medical’ in the abstract, we are ‘medical’ specifically within the legislative framework of UK governance which has spoken categorically about how to judge whether our facial aesthetic treatments are medically justified. Most of them are not.

‘I’m not sure why @cosmeticcouture are finding the legislation so difficult to understand?’

On the contrary, we find it very easy to understand. As we have explained. Come along to our regular discussions of Medical Ethics on our rolling programme of post-graduate continuous professional development. There you will meet many of the medical and non-medical staff working at Cosmetic Couture, all of whom would be willing to explain the JCCP’s, GMC’s and government’s guidelines.

‘limeaesthetics@cosmeticcouture_ who said anything about a medical diagnosis being needed?’

 

In liberal democracies people are the centre of the universe. Each person is given freedom to choose to do almost anything as long as it doesn’t harm another person without their consent.  During the pandemic governments have promoted various levels of lockdown as something that the whole of society must do to survive. This has meant that normal decision-making individuals have had to run their decisions through a different calculator, not just ‘does it do any harm?’ but, ‘does it actively contribute the general societal good?’

 

The implication of this is that for a facial aesthetic treatment to be medical it needs to clear a higher barrier than just being run-of-the-mill medical. That implies an extraordinary medical diagnosis, as stipulated by the JCCP. Many genuinely lifesaving medical procedures have been postponed during the pandemic because resources are scarce and need protecting. Whilst we may individually feel each of OUR medical procedures is the centre of the universe, as per liberal democracy, during the pandemic this individual feeling is subordinated to the feeling of society as a whole that in order to survive we need to stop doing certain things.

 

Unfortunately, the Dominic Cummings gaffe by the government has led people to believe that there are justifications based on ‘instincts’ which are appropriate, but the regulations and government advice does not support this. During the pandemic the great and the good have joined together in Sage and Cobra, H.M. Government and Parliament to thrash out the appropriateness of actions as intimate as caring for one’s dying daughter remotely and giving her one last cuddle, or not; to congregating to pay final respects to beloved parents, or not.

 

Surely in such circumstances we can as a profession stay on-side and figure out why it is important to standardise what is and what is not a medical need by employing a medical diagnosis if our facial aesthetic treatments are to get special exemption? Are you really saying that the emotional wellbeing ‘medical’ part of your ‘medical’ facial is more ‘medical’ than holding the hand of a dying sister as she gasps her last breath?

 

‘You are confusing “must be a medical practitioner working in a medical setting” with “needs a medical diagnosis”, not surprising being as you don’t hold a healthcare qualification. ‘

 

Here we go again, attacking the person rather than the argument. My qualifications are not the issue here, my team’s medical healthcare qualifications are not in doubt, all of whom agree that neither of these clauses out-of-context lend anything to your argument. The reason non-medical facial aesthetic treatments should not be carried out until the government imposed start date of the 15th August is precisely because during a pandemic of this severity society as a whole does not have the time, resources or the personnel to litigate each and every one of the ‘special cases’ that might present to your clinic for facial aesthetic treatment.

 

Being a medical practitioner working in a medical setting does nothing to change the problem of the dynamics of the pandemic nor the obvious need for medical diagnosis to support any such exception to the rules of virus-risk-taking, which are of medical proportionality,  i.e. some conditions included some excluded, a  matter not for medical aesthetic practitioners to decide but for medical ethics committees who then formulate guidelines for medical use in medical diagnosis.

 

Let’s get this straight now. Until the 15th of August nothing other than a proper written medical diagnosis of your specific client case will exempt you from complying with the general counter-Covid-19 rule that, in order to suppress the spread of the virus, non-medical facial aesthetic treatments should not be carried out.

 

It stings to feel left out, especially if you are a doctor or other medical practitioner, but get used to it, join the non-medics in looking up with pride to the hard work of the full time professionals in the field who have worked out this strategy, and defer to them.  We are working to a higher social rather than individual goal here, lets pull together and survive the virus.

 

‘But for the record yes, small lips etc are coded under ICD 10 and 11 and therefore are considered medical conditions regardless of your own personal view and misinterpretation of government guidelines.’ 

 

Rarely can an opinion have been more ironic. By definition it requires your personal view to ignore the circumstances under which ‘small lips etc.’ are considered medical conditions in order to make this statement. The irony being that what you are saying appears the opposite of what you are saying. It is not my personal view that non-medical facial aesthetic treatments should not be carried out.  Government policy as determined by scientific advice has deemed this.  ‘Medical conditions’ is not meant to be a catch-all phrase to be used to allow facial aesthetic treatments to be carried out.  Treatments which are firstly, again, by definition, ‘aesthetic’ not medical.

 

Really, at a time of crisis are we expected to swallow that? My ‘feeling’ that my lips are too small is to justify an exemption from counter Covid-19 regulations? Now, of all moments in history. In normal times I would be only too keen to articulate such freedoms to feel that the most important thing in the world is the relative size of your lips. But normal times just went whoosh down the medical grade clinic sink. We need to get a grip on the virus in order to return to those other priorities.

‘I wish all of my healthcare colleagues that have opened the best of luck – they are acting within the law and are insured to carry out treatments, good for them! X’

We can all agree that healthcare professionals need luck at the moment, Covid-19 is a disaster, but uncomfortable as it may be for them, if they have opened to provide facial aesthetic treatments without proper medical justification before the 15th August date they are not acting within the law, and, in spite of your assurances, are therefore not insured to carry out such treatments. Ouch.

Yours aesthetically

 

Maxine Hopley.