A ‘Wellbeing’ Paradigm: A Concept-Based Study of Body Art and Regulatory Challenges

Round 1

Reviewer 1 Report

The discussion of healthism and wellbeing is extensive and interesting, but doesn't link well into the case study identified in the title. In particular, it assumes that all aspects of the extended model of health will attract equal gravity, but provides no basis for this assumption. 

There are many examples where the autonomy of the individual is subjugated to other considerations. That subjugation reflect the well being of both the individual and the community. Examples you might care to consider are the non-recognition of consent to being murdered or eaten; the literature about removal of limbs and the associated ethical and legal considerations in certain psychological disorders; and the extensive literature around autonomy and consent in the scope of female genital mutilation and male circumcision. 

The paper would be strengthened by engaging with some of the regulatory theory- while a national scheme of regulation might be desirable, it is not clear from the paper that expansion of the scope of practice is either necessary or desirable. An alternative characterisation of R v BM is simply that the defendant was operating outside the scope of practice he was licensed to operate within, and as such no amount of consent by the client could ever legitimise the activity. Autonomy is significant, but it is not the only facet of well-being. 

Author Response

I have uploaded a revised version of the paper on which my changes are tracked. However, I thought that it might be helpful if I also explained how I have adjusted the paper in light of the referees’ specific comments. I address all of the referees’ suggestions and remarks below.

Referee 1:

(i) Referee 1’s concern was that the paper:

“The discussion of healthism and wellbeing is extensive and interesting, but doesn't link well into the case study identified in the title. In particular, it assumes that all aspects of the extended model of health will attract equal gravity, but provides no basis for this assumption.”

I am grateful for being pushed on this point and have thought long and hard about it. I have clarified the discussion on this and have also reduced the discussion on healthism.

(ii) Referee 1 also writes:

“There are many examples where the autonomy of the individual is subjugated to other considerations. That subjugation reflect the well being of both the individual and the community. Examples you might care to consider are the non-recognition of consent to being murdered or eaten; the literature about removal of limbs and the associated ethical and legal considerations in certain psychological disorders; and the extensive literature around autonomy and consent in the scope of female genital mutilation and male circumcision.”

I am most grateful for this to be raised by the reviewer. I fully accept that there are many situations where autonomy does not trump other considerations and other rights and duties, nor should it; but I think it is clear in the paper that I am not suggesting wholesale support of autonomy over other principles. I am arguing instead that an analysis of health should encompass a wider spectrum of factors than have traditionally been the case. I do not support the notion that all aspects of health should necessarily attract equal treatment or the same financial input in support of well-being, simply that a broader conception of health would be valuable for an individual’s good health. The level of discussion on this is necessarily restricted: I have sought to ensure the paper is not too long and sits within the word limit range as is typical in legal journals. Accordingly, I am simply not in a position to expand significantly the paper.

(iii) Referee 1 also notes:

“The paper would be strengthened by engaging with some of the regulatory theory- while a national scheme of regulation might be desirable, it is not clear from the paper that expansion of the scope of practice is either necessary or desirable. An alternative characterisation of R v BM is simply that the defendant was operating outside the scope of practice he was licensed to operate within, and as such no amount of consent by the client could ever legitimise the activity. Autonomy is significant, but it is not the only facet of well-being.”

I am grateful for this helpful suggestion, which I have implemented throughout the paper. I have added several new sections from line 467 – 506 in response to this. I have more clearly articulated the challenges of the existing regulatory systems and the benefits that would come from adopting a more consistent nationwide system of regulation.

Reviewer 2 Report

The analogy might be considered of transgender surgery, when surgeons remove internal or external sexual organs.  This is legally acceptable only when subjects have been approved by psychologists or psychiatrists who identify (gender) dysphoria.  Gender dysphoria is no longer considered by the WHO International Classification of Diseases as a mental and behavioural disorder, but a condition related to health.  The approach through psychological assessment might be appropriate for more extreme forms of bodily intervention.  

You might consider indicating the type of regulation you consider appropriate.  

At line 483, instead of "prospective", do you intend "perspective"? 

Author Response

First and foremost, I would like to thank both LAWS for considering my paper for publication and the referees for their time and constructive comments. I am also grateful for the opportunity to reflect on my paper in light of their suggestions and remarks.

I have uploaded a revised version of the paper on which my changes are tracked. However, I thought that it might be helpful if I also explained how I have adjusted the paper in light of the referees’ specific comments. I address all of the referees’ suggestions and remarks below.

(i) Referee 2 wrote:

“The analogy might be considered of transgender surgery, when surgeons remove internal or external sexual organs.  This is legally acceptable only when subjects have been approved by psychologists or psychiatrists who identify (gender) dysphoria.  Gender dysphoria is no longer considered by the WHO International Classification of Diseases as a mental and behavioural disorder, but a condition related to health.  The approach through psychological assessment might be appropriate for more extreme forms of bodily intervention.”

Thank you for raising this. I acknowledge this point fully and the analogy is clear. I have recognised this in fn. 137. While there is a great deal more that could be said on this, again I feel constrained by word length and the focus of the paper.

(ii) Referee 2 also comments:

“You might consider indicating the type of regulation you consider appropriate.”

Thank you for noting this. I have dealt with this in some detail on pages 16 and 17.

(iii) Referee 2 observes:

“At line 483, instead of "prospective", do you intend "perspective"?”

Thank you for highlighting this oversight – it has been changed accordingly.

Round 2

Reviewer 1 Report

Thankyou for your constructive engagement with reviewers comments. Your amendments have strengthened the coherence of the paper, and demonstrate reflection about what regulation might actually look like, rather than simply citing it as a generic solution to all ills, as often occurs.