The most difficult informed consent problems are those that arise from competently performed but medically unnecessary procedures. The extreme cases are those that involve vanity procedures, such as facelifts, liposuction, and breast enhancements. These procedures pose an informed consent dilemma. As medically unnecessary procedures, they may be rejected in the same way that skydiving may be rejected. From this perspective, a physician should be allowed to require a patient to assume all the risks of a vanity procedure, including the risks of negligent treatment.

A more moralistic perspective is that it is improper for physicians to use their skills and position of respect to perform purely commercial treatments. This attitude would view the vanity surgery patient as a victim who should not bear the risks of the physician’s greed. This would lead to the rejection of assumption of risk for all risks, leaving vanity surgeons as guarantors of a good result.

Jurors tend toward the moralistic view. Although they are constrained to accept a proper informed consent, they are very suspicious of the motives of vanity surgeons. If the consent has any ambiguities or if there is evidence of overreaching (such as aggressive advertising that implies that the risks are minimal and the benefits fantastic), then they tend to rule against the physician.