【Opinion Column】“The Real Risk of Cosmetic Surgery Lies in Anesthesia”
“The Real Risk of Cosmetic Surgery Lies in Anesthesia”
United Daily News Network, November 23, 2025
Po-Chang Lee / Distinguished Professor, School of Public Health, Taipei Medical University
Recently, Taiwan’s Ministry of Health and Welfare proposed a plan to prohibit physicians who have not completed PGY surgical training from performing cosmetic surgery. In reality, one to two years of PGY training in surgery is largely an assistant role in a surgeon’s development and does not equate to fully mastering the core of medical practice. While the policy’s intent—to enhance cosmetic surgery safety and reduce disputes—is commendable, examining the issue from legal and clinical perspectives suggests that it may not truly address the core risks behind cosmetic surgery incidents.
Article 2 of Taiwan’s Physician Act states that no one may practice medicine without a physician’s license. Article 28 provides that practicing medicine without a license constitutes a criminal offense, punishable by imprisonment of six months to five years and/or a fine. Whether a licensed physician “can perform surgery” is not determined by the Physician Act. Medical practice entails civil liability—assessing whether the physician met the prevailing standard of care and fulfilled the duty of care (preoperative assessment, intraoperative technique, and postoperative care). Civil law forms the basis for patient compensation claims. Criminal liability (e.g., negligent injury or professional negligence) focuses on whether the physician violated the necessary duty of care in the course of professional practice; criminal law represents the state’s coercive intervention.
From a medical professional perspective, the key to “cosmetic surgery safety” does not hinge on whether a physician completed a surgical PGY, but rather on the following:
1. Can the physician accurately assess the patient’s condition?
Medical competence depends on comprehensive medical education and clinical training; experience cannot be encompassed by two years of surgical PGY alone. I still remember, as a second-year surgical resident, when a senior asked me to take the lead in an emergency operation for a perforated gastric ulcer. Surgeons naturally want more operative experience and to achieve independence sooner—but did I truly dare to be the primary surgeon? Surgery entails legal responsibility, which is the core issue of medical practice. Later, when I was a chief resident, I performed a low rectal cancer resection as the primary surgeon and felt proud. My older brother admonished me: “Before you are fully independent, a senior must be present to guide you. That area has many blood vessels—what would you do if massive bleeding occurred? Can you judge whether a patient is suitable for surgery? Can you recognize preoperative risks?” These responsibilities are inescapable.
2. The true core risk of surgery is not technique, but anesthesia safety.
In most cosmetic-surgery-related deaths, the real causes are not surgical “technique,” but excessive sedation, drug allergies, unrecognized or untreated airway obstruction, anesthesia administered by unqualified personnel, or inadequate intubation and resuscitation skills. In earlier times, when anesthesiologists were less common, surgeons often administered general or spinal anesthesia themselves. I vividly recall performing spinal anesthesia for an acute appendectomy; midway through the operation, the anesthetic level rose toward the chest, causing respiratory distress, and we had to urgently intubate and provide oxygen. Experiences like this truly impress upon surgeons the critical importance of anesthesiologists.
As a surgical professor, my conviction is that the “knife” is not the most dangerous element—anesthesia is. Reducing a complex issue to whether a physician has completed surgical PGY training warrants reconsideration.
In my work in organ donation and transplantation, the Ministry of Health and Welfare clearly stipulates the personnel and facility qualifications required for a hospital to perform transplant surgery, as well as the number of procedures a physician must participate in before being approved to procure or transplant organs.
Taiwan’s medical safety indeed requires more precise governance. The core of medical risk lies in anesthesia and assessment—not PGY status. True surgical safety always comes from accurate risk evaluation, rigorous anesthesia quality, and qualified facilities and teams.
Original source:：https://udn.com/news/story/7339/9157079
