Nip/Tuck, now in its 7th season, follows two plastic surgeons, Sean McNamara and Christian Troy, in their practice together as they deal with issues in their personal lives and the often unusual procedures requested by their patients. As we approach the end of the series on March 3rd, it seems appropriate to take a look back at what has gone before. Over the course of its run, the consistently shocking series has presented a wide variety of unusual and uncomfortable situations, raising difficult ethical questions and serving as a good exploration of how society may react to issues relating to morphological freedom.

Each episode is named after one of the patients that McNamara/Troy operates on, and the doctors typically begin their consults by non-judgmentally asking a client to “tell me what you don't like about yourself.” Series creator Ryan Murphy is often quoted as saying that the show’s medical cases are "90 percent based on fact,” and being familiar with cases similar to some of the more bizarre ones featured on the show, that may be fairly close to the truth. Although it is known that a large number of the surgeries McNamara/Troy performs are typical breast enhancements, the patients that are the focus of each episode are almost never as simple. For instance, one couple this season came in because they wanted to be the perfect Ken and Barbie couple. However, the woman didn’t want breast implants or even liposuction; she wanted to have her nipples removed so she could be just like Barbie and live a celibate life. Throughout the episode Sean is intrigued by her idea that sex interferes with relationships, although he ultimately rejects the idea, saying that “it isn’t natural” and that sex is worth whatever pain it may bring later.

One of the aspects that I find fascinating about Nip/Tuck is how plastic surgery is so often used to eliminate the appearance of aging. While I am far more interested in real attempts to defeat aging such as SENS, giving people greater freedom to choose how they look is, at least in theory, quite a good a thing. However, in practice it seems that a quest for outer beauty often comes into conflict with “inner beauty.”

The 6th season episode Lola Wlodkowski was an excellent example of this conflict. Lola is an obese woman who comes in for a consult to have her moles removed, but due to personal reasons Christian breaks from the nonjudgmental approach of having the patient tell him what they want changed to insisting on offering her liposuction. Lola, who is actually a member of a nudist colony where if you’re fat you’re supposed to be proud of it, for a long time insists that she likes the way she is because she “was raised to think it's a sin to love myself, any other way than the way I am.” Eventually she gives in though, saying “I want to know what it feels like not to pretend I don't care about what people think” and is about to let Christian operate on her until at the last minute, her friends discover what she’s doing. They march in, fat and unclothed, to keep her from going through with it. One of the nudists says “plastic surgery steals a person’s humanity,” and another tells Lola they love her ,i>exactly the way she is.

While certainly there are more important things than bodily appearance, why should that mean embracing one’s flaws as Lola’s friends encourage? Just because we have historically, and even today, found it difficult to seriously alter our body, that doesn’t mean we should rationalize our flaws and stop trying to change them altogether. At the same time, that is not to say that it is a good thing to deny those who either have different ideals of beauty, or want to be less beautiful, the option of changing their appearance.

We see an example of the latter case in the 7th season episode Willow Banks, where a very pretty woman comes to Christian and asks to be made less beautiful so as to draw less attention. Christian, himself smitten with her, refuses while saying that he spends all his time working with other clients to make them look like her. In the end, she intentionally crashes a car she is driving in the hopes of disfiguring herself. Willow gets her wish, but she hates being stared at her for her ugliness even more and Christian tells her that there is nothing he can do to make her look the way she used to.

Desperate individuals such as this are powerful illustrations of why working towards a society where it is easier for people to alter their appearances and morphology is a good thing. While of course providing citizens with the capability and freedom to alter their bodies as they see fit is generally a lower priority than providing universal health care and the tools needed to be healthy, the easier and cheaper it is for individuals to alter their appearance and be who they want to be, the better. Even with today’s relatively primitive technologies, though, very difficult questions arise about how to balance giving people control over their own bodies and keeping them from harming themselves.

In the 3rd season episode Ben White a successful architect requests that Christian perform surgery on him; not to make him look better, but to remove one of his legs. Ben White says that he is normal and psychologically healthy in every other respect, but that he’s long had a consuming desire to remove his leg. The episode was based on the real life condition Body Integrity Identity Disorder (BIID), where otherwise healthy people have a very strong desire to remove one of their limbs. This overpowering desire can lead to a number of problems in daily life, and attempts to treat BIID with drugs or psychological counseling such as Cognitive Behavioral Therapy have not been shown to be effective.

There is considerable revulsion at the idea of intentionally removing a limb as these patients desire. Doctors often feel that doing so would violate their Hippocratic Oath to first do no harm. However, as much as I am for human enhancement and life extension, I find it difficult to see the justifications for denying these patients surgery. As it stands, it is incredibly difficult for BIID patients to find a doctor willing to operate on them. But, if as advocates for BIID patients claim, the amputation of one limb does not fuel a new obsession with removing another body part and in fact alleviates their problems, I think serious consideration should be given to allowing these patients to go through with their desired procedures. This is a rare enough condition that, as Mind Hacks concludes, there seems to be a lack of studies following up BIID patients to assess such claims, but that means we need to perform more research, not dismiss requests for amputations out of hand.

Perhaps it’s just that I’ve always placed a greater importance on mental well-being than physical well-being, but subjecting someone to live with the overwhelming feeling that they don’t have the right number of limbs doesn’t seem to be an act of “no harm,” but rather at least as much harm as the loss of a limb. That is not to mention the fact that BIID patients may resort to attempting to perform amputations themselves, putting them in even more danger.

This is what happens in Nip/Tuck when Christian refuses to perform the requested amputation, and the BIID patient ends up shooting himself in the leg in an attempt to force the emergency room doctors to remove his leg. When Ben White gets to the hospital the doctors believe they can save his leg despite his best attempts to shoot an area that would make it irrecoverable, but ultimately with Christian’s help he has the leg amputated instead.

Similarly, in a controversial episode drawing the ire of the Parents Television Council, we were introduced to Roxy, a woman whose mother and sister had died of breast cancer and who therefore wanted her breasts removed and replaced. Although she’d had a genetic test that didn’t find a predisposition to the breast cancer her mother and sister had died of, she still wanted a mastectomy. Christian at first consents to this, telling his anesthesiologist that “you can’t just be pro-choice when you agree with that choice,” but when she’s under he decides he can’t go through with the surgery. As a last resort, Roxy ends up trying to do the operation herself with an electric carving knife in the McNamara/Troy waiting room, after which Christian finishes the operation.

Now, this woman may have had other issues besides an irrational fear of breast cancer that could have been impairing her judgment, and she should have undergone counseling to think about the consequences of her decision, but what if she had still wanted her breasts removed? I do not know where the compromise should be made between protecting morphological freedom and protecting individuals from making choices that harm themselves, but I can certainly sympathize with wanting a medical procedure that your doctors feel is unnecessary or wanting to avoid a risk others feel is negligible. Moreover, I feel much more comfortable with otherwise psychologically healthy adults making the choice to remove an unwanted limb or organ than I do with say, refusing a life-saving blood transfusion for religious purposes.

This is only a sampling of the much greater variety of patients and situations that have been presented in Nip/Tuck over the years, but it’s still sad to see the show end in what I am sure will be an excellent finale. While the subject matter and graphic surgery scenes have always meant that it is not for everyone, it can be hoped that Nip/Tuck’s popularity has done something to make people just a bit more comfortable with the ideas of morphological freedom, just how unique some people are, what they can modify their bodies to become, and what they could be in the future.