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INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA

FINAL EXAMINATION
SEMESTER 2, SESSION 2015/2016
CENTRE FOR LANGUAGES AND PRE-UNIVERSITY ACADEMIC DEVELOPMENT

Programme : ALL Level of study : ALL

Time : 3pm Date : 19 May 2016
Duration : 2 hours 30 min Section(s) : ALL
Course Code : LE 4000 Course Title : EAW

ANSWER KEY
CONFIDENTIAL

ARTICLE 1:

Author(s): Sayed Reza Mousavi

Year: 2001
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Page(s): 38 - 39
Title: The Ethics of Aesthetic Surgery.

1 In the past few years the abuse of ethical principles in plastic surgery has become
increasingly noticeable. In 1979, Beauchamp and Childress published Principles of
Biomedical Ethics, in which they presented principles that have since been adopted as
the ethical basis for contemporary medical practice. They argued that these principles
bridged high-level moral theory and what they described as lowlevel common morality.
While they were developed to guide physicians treating those suffering from ill health,
they provided the ethical framework which underpinned modern surgical practice. Since
the concepts of beauty undergo changes, wrinkles, fat deposits and sun-damaged skin
no longer fit into our concept of a neat society. These real or perceived ageing problems
received greater attention from patients and doctors, hence the need to focus on the
ethical considerations.

2 In general, competent adults have the right to decide whether they wish to undergo a
surgical procedure or not. The patients’ wishes and thereby their right to an informed
decision must be respected, provided they have been given sufficient information. Such
information must include the risks of surgery together with alternative options. These
principles apply even more to aesthetic surgery where patients are not suffering from
any illness. Elective aesthetic treatments, which may lead to long-term adverse effects
on body function and health, involve serious ethical concerns. In such situations, the
patients’ right for autonomy may contradict the physician's principle of non-
maleficence, and therefore, proper consideration is needed before deciding on such
treatments. Surgeons must therefore ensure that the patients’ expectations are realistic.
Surgeons need to explain the probable benefits of surgery, alternative non-surgical
options, as well as, the risks of surgery and anaesthesia.

3 The second principle requires that medical practitioners act in the patients’ best
interests. Undertaking surgery to improve a patients’ self-image and esteem is
acceptable. However, defining the patients’ best interests can be very difficult. Many
people experience real pain, discomfort, social handicap and suffering because they are
self-conscious about their appearance. These groups may benefit from aesthetic surgery.
One such group is those suffering from Body Dysmorphic Disorder (BDD) which is a
psychiatric syndrome, characterized by a pre-occupation with a non-existent or minimal
cosmetic defect associated with persistent attempts to have the defect surgically
corrected. BDD is increasingly recognized and may be becoming more prevalent.

4 Next, non-maleficience ensures that an aesthetic surgeon never acts against the patients'
best interests or in a way that may harm a patient. Aesthetic surgeons should be
reluctant to operate on those with unrealistic expectations as the risks of surgery may
outweigh any benefits. Patients with serious health problems are at increased risk of
suffering complications under general anaesthesia, and again the risks may outweigh the
benefits. All such assessments need to be made on an individual basis. In the past,
there has been a perception that surgeons have a potential conflict of interest in the
independent sector. No surgeon should ever proceed with an operation merely for

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personal monetary gain. All aesthetic surgeons need to take their duty of caring for their
patients very seriously.

5 Ultimately, doctors are also required to ensure that medical care is available to all.
Equitable access to healthcare is regarded as a basic human right. However, resources
are limited and it is not possible for any health service to provide aesthetic surgery for
all those who would like it. 'Rationing' takes place on the basis of clinical need.
Inevitably, this introduces subjective judgements about whose need is greater. This is
apparent in the private sector where those who can afford to pay, undergo surgery.

6 At present, aesthetic surgery is undergoing an identity crisis as well as an acute ethical

dilemma. A closer look from an ethical viewpoint makes it evident that the doctor who
offers aesthetic interventions faces many serious ethical problems, which have to do
with the identity of the surgeon as a healer. Aesthetic surgery makes profit from the
ideology of a society that serves only vanity, youthfulness and personal success and one
which is losing sight of the real values. Aesthetic surgeons should feel the obligation to
resist these modern ideologies and should attempt to help people get a more authentic
attitude about themselves rather than judging the real value of individuals by their
appearance.

7 Heightened attention to traditional duties and new attention to proposed responsibilities

will enhance patient safety and choice. It is not always possible to disregard the fact that
what really motivates social changes in attitudes and demands for our intervention is not
for us to decide. Also, there is no need to feel guilty when our technical gesture is
aesthetic. Establishing an ethical code, which would entail all necessary moral sanctions
in aesthetic surgery, would act favourably in the protection of those surgeons who
perform their work according to the moral and ethical principles of their profession.

ARTICLE 2:

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Author(s): Quin Hoskins

Year: 2012
Page(s): 72
Title: Legal Regulations for Cosmetic Surgeries

1 We live in the age of images and illusions, where two-dimensional airbrushed images
of perfect men and women flash before our eyes constantly, whether it is on TV
screens, on billboards or in magazines. As image and external appearance are
perceived to be more and more important in our society, it is not surprising that
cosmetic surgery is more popular today than ever before. There is a plethora of
surgical operations that qualify as cosmetic surgery; some popular procedures include
breast enhancements, bottom implants, chin correction surgery and rhinoplasty or a
nose job.

2 While the number of cosmetic surgeries performed in the United Kingdom (UK) is
rapidly on the rise, what is alarming is that the legal regulations surrounding these
procedures are surprisingly lax. Irrespective of whether it is for cosmetic or medical
purposes, surgery is a medical procedure and thus the cosmetic industry should be
regulated as a branch of medicine. The problem with the cosmetic industry, however,
is that in terms of laws and regulations, it is not at all treated like a branch of medicine.

3 It is important to understand the different players in the cosmetic industry to discern

where more regulation is required. For instance, the General Medical Council and the
Care Quality Commission do regulate premises and practitioners both private and
public which are directly involved in the performance of a procedure. However, there
is no regulation of the entire industry as such. This means that it is unclear as to what
kind of services can be offered by private cosmetic clinics and there is no regulation of
the expected standard of efficacy of the procedures or the standard of equipment used.

4 The picture is not as grave elsewhere in Europe. In other European countries such as
France and Denmark, there are clear legal guidelines which state what type of
surgeries can be performed and which practitioners offer what type of services. Here, a
vet could deliver Botox injections if the patient was okay with it.

5 We hear stories about people who, falling prey to advertisements for cheap cosmetic
procedures, travel to countries where healthcare is poorly regulated and end up with
seriously dangerous complications or possible death. However, the situation is not very
different here at home. Here in the UK, there are lunchtime cosmetic clinics that offer
potentially dangerous cosmetic treatments, many of which have not yet been studied or
approved as safe. Conversely, countries such as Thailand and India claim to have put
in place stringent regulations for cosmetic procedures so as to protect as well as
promote their image as safe medical tourism destinations.

6 Another area of the industry that could do with some serious control is advertising.
Offers on cosmetic procedures such as limited-time offers, two for one or buy one, get
one free may sound bizarre but are not uncommon and can place unnecessary pressure
on clients to make hasty and often unsafe decisions. It may be argued that people
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should take responsibility and choose wisely but that would be an unfair argument.
The cosmetic industry may be poorly regulated in the UK but it operates under a quasi-
medical jargon that is difficult to see through.

7 Going by the recent case of substandard and non-medical-grade silicon used for breast
implants and how most private surgeries in the UK have managed to get away without
taking any responsibility for the mess, it is crucial that stricter laws and regulations be
put in place to protect patients. The demand for cosmetic surgery is on the rise and it is
an industry that generates tremendous profit annually. Nonetheless, the profit should
never be allowed to interfere with the delivery of healthcare and the trust that patients
place upon healthcare professionals.

ARTICLE 3:

Author(s): Bishara Shafik Atiyeh, Mohamed Kadry, Shady Nehmatallah Hayek, Ramzi
Musharafieh

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Year: 2008
Page(s): 2
Title: Aesthetic Surgery and Religion: Islamic Law Perspective.

1 There is a balance and perfection in the creation and in nature that must not be ignored:
“He Who created the seven heavens one above another: No want of proportion wilt thou
see in the Creation of Allah Most Gracious. So turn thy vision again, do you see any
flaw?” (67:3). “We created Man in the most perfect form” (95:4).

2 These dictums stress that each human life has its own inherent value and goodness but
may theoretically render further improvement in one’s appearance rather inconceivable.
Islamic teachings does not deny the capacity for autonomy and selfdetermination. In
cases of absolute necessity wherein religiously lawful alternatives do not exist, it allows
even for sacred law to be suspended temporarily: “But if one is compelled by necessity,
neither craving nor transgressing, there is on him no sin, for indeed Allah is Clement,
Merciful” (2:173).

3 It is imperative, however, that any alteration of creation be addressed with the utmost
care. Moreover, one must remain vigilant so that the market for altered creation, be it
genetically modified crops or aesthetic surgery, may remain mercy driven rather than
profit driven.

4 Is aesthetic surgery to be condemned as a futile luxury, or is it answering to a real

physical and psychological need? Well-informed scholars divide plastic surgery into two
categories. The first is essential surgery genuinely needed to correct congenital or
acquired defects. Such surgery is permissible because it is not meant to change the
creation of God. Many hold the opinion, however, that this provision allows the
improvement of an ugly appearance causing physical and psychological suffering. Next
is surgery performed for beautification. Such surgery is unnecessary and is therefore
unlawful and not permissible. The body given to us is a trust and ‘changing the nature
created by Allah’ is a sin inspired by Satan. Some scholars report that surgeries for
beautification are the result of the Western materialistic pattern which mainly focus on
the body and its desires. Standards set by Hollywood stars, celebrity athletes and the
media are the main driving force for such increasing popularity. Men and women who
are more preoccupied with form than with substance or with body than with soul, indulge
in excessive beautification and reshape their bodies unnecessarily by changing what God
has created and subjecting themselves to torture, pain and waste of money. So, aesthetic
surgery is spreading fast in Muslim countries.

5 Mutilation of one’s body is also clearly prohibited in Islam. Cosmetic surgery may be
considered as deliberate self-mutilation, which in some cases may end in failure. It may
also be considered as a form of oppression that can be damaging to women’s freedom
and potential for development. Conservative scholars have even ruled that medical
students are allowed to learn cosmetic surgery, but that they should not perform
it in unlawful cases. For instance, surgeries meant to disguise criminals are unacceptable.
Sex change operations and giving in to stray whims are also definitely prohibited.

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However, operations to decide the sex in cases of pseudohermaphroditism (the condition

in which an individual of one sex has external genitalia superficially resembling those of
the other sex) are allowed. They should rather advise patients against it. Perhaps their
advice may have a stronger effect.

6 On the other hand, it has been ruled that because there is no explicit directive forbidding
plastic or cosmetic surgery, nobody has the right to forbid what God has not forbidden. It
has been ruled as well that in the case of an unusual physical defect attracting the
attention of others and causing physical and psychological pain, a person may seek
treatment to alleviate humiliation. Allah the Most Merciful has imposed no hardship on
us in religion. If the surgery is needed to eliminate distress or offers a better quality of
life, it cannot be considered unlawful and must be allowed. It is narrated by 'Abdullah ibn
Mas'ud that the Prophet mentioned “Allah is beautiful and loves beauty” although
theological interpretation of this saying may give it a different meaning than what is
apparent.

Reminder to examiners:

Please indicate grammar, spelling, citation problems on scripts and justification of marks
when necessary.

1. The following question is based on Article 1.

State 3 principles for contemporary medical practice. (3 marks)
a. Competent adults have the right to decide whether they wish to undergo a
surgical procedure or not.
b. Medical practitioners act in the patients’ best interests.
c. Non-maleficence ensures that an aesthetic surgeon never acts against the
patients' best interests or in a way that may harm a patient
d. Doctors are also required to ensure that medical care is available to all.

2. The following question is based on Article 2. (2 marks)

State the 2 areas in plastic surgery industry that require control and supervision.
a. Law / legal regulations / law and regulations (Para 2)
b. Advertising (Para 6)

3. The following questions are based on Article 3, paragraph 4.

Main idea: Plastic surgery can be catergorized into two.

i. One is essential surgery genuinely needed to correct congenital or

acquired defects.
ii. Next is surgery performed for beautification.
* For question 3, if main idea is wrong but supporting details correct, NO marks to
be awarded.

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4. With reference to Article 1, paragraph 6, paraphrase the following sentence:

(4 marks)

Aesthetic surgeons should feel the obligation to resist these modern ideologies
and should attempt to help people get a more authentic attitude about themselves
rather than judging the real value of individuals by their appearance.

People’s true worth cannot be based on their exterior, thus aesthetic surgeons have the
commitment to oppose these contemporary beliefs, and encourage patients to embrace
themselves just as they are.

Mark Description for Language and technique

4 Complex manipulation and/or substitution of grammatical and

lexical items. High degree of accuracy of form. No copying or
lifting.

2.5 – 3.5 Some appropriate adaptation and re-expression of grammatical

and/or lexical items. Generally accurate use of structure and
vocabulary. Only little copying done.

1.5 - 2 Limited adaptation and re-expression of grammatical and/or

lexical items. Some errors in structure and vocabulary. Some
copying from text.

0.5 - 1 Little or no re-expression of structure and vocabulary.

Intrusive errors of grammar and vocabulary. Total lifting from
original.

5. The following questions are based on Article 2, paragraph 5.

a. From Article 2, state the implied main idea of paragraph 5. (2 marks)
Many cosmetics clinics are not being accountable for their services.

*For question 5 a. award 0.5 mark for

attempt/paraphrase minus 1 mark for major
grammar mistakes minus 0.5 mark for
minor grammar mistakes ** Accept any
possible answers.

b. Provide 2 supporting details from paragraph 5 to support your answer above.

(2 marks)
i. misleading advertisements
ii. dangerous cosmetic treatments
iii. questionable stringent regulations
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*For question 5 b.
Award marks for correct supporting details even though implied main idea may
be incorrect.

6. With reference to Article 3, summarise the circumstances where aesthetic surgery

is unnecessary and not permissible from the Islamic perspective, in a paragraph of
not more than 120 words. Use the correct citation for introducing the writer of the
article. (10 marks)

Accepted citation detail : Bishara Shafik Atiyeh, Mohamed Kadry, Shady

Nehmatallah Hayek and Ramzi Musharafieh (2008) / Bishara Shafik, Mohamed,
Shady Nehmatallah and Ramzi (2008) / Atiyeh, Kadry, Hayek, and Musharafieh
(2008) / Bishara, Mohamed, Shady and Ramzi (2008)

Introduction to the summary: According to …….. (1.5 marks for correct citation
and introductory phrase, 0 marks for incorrect citation and no
introductory phrase )

Content (0.5 marks for each) INDICATE each content as P1, P2, P3, etc accordingly.

Sample answers:
a. change the creation of God
b. beautification
c. mutilation
d. disguise criminals
e. sex change operation
f. giving in to stray whims

Language marking scheme Q 6

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Breakdown Description Marks

Introduction 1.5 mark for correct citation and introductory 0 - 1.5

phrase, 0.5 for incorrect citation or no
(1.5 mark) introductory phrase (details: IP, name, year)

Content Refer to the above content 0 -3.0

(3 marks)

Very good to excellent: Summarised 4.5-5.5

using own words. Meaning correctly
Language and vocabulary, organisation

interpreted. No lifting done. Few errors in

sentence construction. Highly coherent and
cohesive.
3-4
(5.5 marks)

Average to good: Attempts to use own

words but almost similar in style/sentence
construction as the original. Some lifting
done. Some errors in sentence construction
and choice of words but meaning not
obscured. Some coherence with the use of
cohesive devices. 1.5-2.5

Fair to poor: A lot of lifting done or poor

sentence construction and word choice till
0-1
meaning obscured. Lack of coherence and
cohesion.

Very poor: Total lifting or not enough to

evaluate.

Note:
*Deduct 1 mark if students exceed 120 words but do not penalize if students can

summarize well in less number of words.

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7. Write an opinion based essay on the topic given below. Your essay should include a
clear thesis statement with 3 main points. You are to use the 3 articles given to
support your points. You have to demonstrate the ability to use at least 3 of the 4
techniques taught (quotation, paraphrase, summary, synthesis). Your essay should be
of about 350 words. (14 marks)

Cosmetic surgery should be commercialized in Malaysia.

Essay marking scheme (14 marks)

Breakdown Description Marks

Very good to Excellent: Clear thesis statement 4-5

marks

with a stand and main points. The points have

Cont
ent

been clearly presented and voice fully

)

developed. Excellent response.

(5

Average to good: Clear thesis statement with a

stand and main points/general main points.
2-3.5
Ideas and voice are relevant but may be
inadequately developed or unclear. Good
response.

Poor to Fair: Has a stand but main points and

support are mostly irrelevant/non existent. 1-1.5
Ideas may be repetitive, irrelevant or not well
supported. Voice poorly developed. Not
fluent. Poor response.

Very poor: Fails to address the question. No 0-0.5

stand and no development. No voice. Not
enough to evaluate.

*For incomplete essays (3 paragraphs and

below), highest mark that can be awarded is 2.5
(provided with specific Thesis statement)

** use your discretion accordingly

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Very good to Excellent: Sophisticated range

(6 marks
and effective word choice. Appropriate register.
5 -6
Language, vocabulary and organisation

)
Use effective complex structure, few errors of
agreement, tense word order etc.
Well-organised. Logical sequencing. Cohesive.
No lifting of words/sentences from passages.

Average to good: Adequate range and 3-4.5

occasional errors of word choice but meaning
not obscured. Use effective but simple
structure, minor problems in complex structure,
several errors of agreement, tense, etc but
meaning not obscured. Loosely organised but
main ideas still stand out. Some lifting of
1-2.5
words/sentences from passages but attempts to
use own words.

Poor to Fair: Limited range and frequent errors

of word choice and meaning obscured. Major
problems in simple/complex structure, frequent
errors of agreement, tense, etc. Meaning
0-0.5
obscured. Lack of coherence. Mostly lifting of
words/sentences from passages.

Very poor: Virtually no mastery of sentence

construction. Dominated by errors or not
enough to evaluate. No recognizable
organisation. Mostly lifting of words/sentences
from passages.

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Very good to excellent: At least three 3

Techniques

(3 marks
techniques used. Full, correct citation given.

)
Good use of techniques.

Average to good: At least three techniques

used. Occasional errors in citation. Some errors 2-2.5
in the use of techniques.

Poor to Fair: Less than three techniques used.

Frequent errors in citation. Frequent lifting of 1-1.5
words/sentences from passages. Not many
attempts to use own words.

0-0.5
Very poor: Only one technique used. No
citation given. Major lifting of words/sentences
from passages or not enough to evaluate.

Note: (applicable for COMPLETE ESSAYS ONLY) Deduct 1

mark from TOTAL essay mark if only TWO articles used.

Deduct 2 marks from TOTAL essay mark if only ONE article used.

Article 1
Sayed Reza Mousavi (2001) / Mousavi (2001) / Sayed Reza (2001)

For Against

Many people experience real pain, Elective aesthetic treatments, which may lead
discomfort, social handicap and to long-term adverse effects on body function
suffering because they are and health, involve serious ethical concerns.

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selfconscious about their (Para 2)

appearance. These groups may
benefit from aesthetic surgery. (Para
3).

Equitable access to healthcare is Aesthetic surgeons should be reluctant to

regarded as a basic human right. operate on those with unrealistic expectations
(Para 5) as the risks of surgery may outweigh any
benefits. Patients with serious health problems
are at increased risk of suffering complications
under general anaesthesia, and again the risks
may outweigh the benefits. (Para 4)

Aesthetic surgeons should feel the obligation

to resist these modern ideologies and should
attempt to help people get a more authentic
attitude about themselves rather than judging
the real value of individuals by their
appearance. (Para 6)

However, resources are limited and it is not

possible for any health service to provide
aesthetic surgery for all those who would like
it. (Para 5)

Article 2
Hoskins (2012)

For Against
In other European countries While the number of cosmetic surgeries performed
such as France and Denmark, in the United Kingdom (UK) is rapidly on the rise,
there are clear legal guidelines what is alarming is that the legal regulations
which state what type of surrounding these procedures are surprisingly lax.
surgeries can be performed and (Para 2)
which practitioners offer what
type of services. Here, a vet
could deliver Botox injections if
the patient was okay with it.
(Para 4)

The demand for cosmetic We hear stories about people who, falling prey to
surgery is on the rise and it is an advertisements for cheap cosmetic procedures,
industry that generates travel to countries where healthcare is poorly
tremendous profit annually. regulated and end up with seriously dangerous
(Para 7) complications or possible death. However, the
situation is not very different here at home. Here in
the UK, there are lunchtime cosmetic clinics that
offer potentially dangerous cosmetic treatments,

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many of which have not yet been studied or

approved as safe. (Para 5)

Article 3 (Islamic Perspective)

Bishara Shafik Atiyeh, Mohamed Kadry, Shady Nehmatallah Hayek, and Ramzi
Musharafieh (2008) / Bishara Shafik, Mohamed, Shady Nehmatallah, and Ramzi
(2008) / Atiyeh, Kadry, Hayek, and Musharafieh (2008)

For Against

The first is essential surgery genuinely

needed to correct congenital or acquired
defects. Such surgery is permissible
because it is not meant to change the
creation of God. (Para 4)

However, operations to decide the sex in Next is surgery performed for

cases of pseudohermaphroditism (the beautification. Such surgery is
condition in which an individual of one unnecessary and is therefore unlawful
sex has external genitalia superficially (haram) and not permissible. The body
resembling those of the other sex) are given to us is a trust and ‘changing the
allowed. (Para 5)
nature created by Allah’ is a sin inspired
by Satan. (Para 4)
Many hold the opinion, however, that this Mutilation of one’s body also is clearly
provision allows the improvement of an prohibited in Islam. Cosmetic surgery
ugly appearance causing physical and may be considered as deliberate
psychological suffering. (Para 4) selfmutilation, which in some cases may
end in failure. (Para 5)

If the surgery is needed to eliminate For instance, surgeries meant to disguise

distress or offers a better quality of life, it criminals are unacceptable. (Para 5)
cannot be considered unlawful and must
be allowed. (Para 6)

It is narrated by ‘Abdullah ibn Mas’ud Sex change operations and giving in to

that the Prophet mentioned “Allah is stray whims also are definitely
beautiful and loves beauty” (Para 6) prohibited. (Para 5)

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