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A recent paper from the Netherlands illustrates the philosophical pitfalls involved in cosmetic surgery by taking the hypothetical standpoint of a parent discussing rhinoplasty with her adolescent daughter.

The scenario is that the daughter has returned from working as an au pair in America and wishes to undergo surgery to correct what she sees as an overly long and pointed nose. Her mother wants to ensure that this is a considered judgement and decides to talk it through with her, raising five main issues that need to be considered and addressed: whether or not the decision is one that the daughter is qualified to make at this moment; her perception of surgery as a technique to produce a pleasing appearance; the amount of importance that she places in bodily beauty; whether her expectations of the surgery are realistic and, finally, how she will cope with the consequences of her decision in the future.

By using this case as a hypothetical example, the author argues that the preferential manner in which to measure competence for similar decisions is to go beyond the formal conceptions of autonomy and to evaluate each case on an individual basis. Particular attention should be paid to issues of personal identity and identity formation when dealing with adolescents, given the emotional turmoil and psychosocial development experienced at that age and the effect that it can have on decision making.