"Erst kommt das Fressen, dann kommt die Moral"--first comes a full stomach, then comes ethics

With the first partial face transplant carried out in France, there is much in the news about this event and the ethics involved. I am not sure, if face transplants are to be carried out only to rehabilitate the injured or diseased faces, that there is much ethical debate necessary. The main ethical requirement, as with other surgery and experimental procedures, is that the patient be fully informed as to the risks and expected outcome before patient consent is given. It is doubtful that any total face transplant will result in the same face and facial expressions that were present on the donor.

There is another issue, however, which this news has brought out. That issue is regarding the work of the professional ethicists with regard to investigating societal issues in ethical terms and if these issues are found ethically wanting then to publicize the problem and suggest ethical remediation. To some, it appears that bioethicists have, in recent decades, seemingly devoted their time and energy to what has been considered as minor ethical issues when greater ethical issues loom in the United States and throughout the world.

One such critic of current bioethical concerns is Dr Erich H. Loewy,
Professor of Medicine (emeritus), Founding Alumni Association Chair of Bioethics, Associate of Philosophy, University of California, Davis. He has repeatedly argued in favor of ethicists dealing with those bigger issues.
He wrote the following comments to a bioethics listserv today and I have obtained permission from him to reproduce his comments here below. As you read in the newspapers and watch on TV what ethical issues are discussed by the ethics consultants, do you think that there is merit to Dr. Loewy’s concerns? ..Maurice.

I do not--from a technical point of view--know enough about facial transplant to say anything worthwhile. If the technique works well, then accident, burn, etc. victims
most certainly be allowed to benefit from this just like a man with an accidentally amputated limb should have a prosthesis. My fear is that now this will become another plastic surgery device for the rich and well-born like liposuction, etc. It is interesting that on the German discussion list we have for two weeks discussed what is called BID (body image distortion) and doing amputations of perfectly healthy limbs because the person allegedly feels that their body image requires such a reputation. My own feeling is that this is probably a psychiatric problem, that the patient belongs under psychiatric care and above all whether such an amputation actually heals or whether three weeks later they must have some other part chopped off. Then, of course, they are entitled to support for the disabled, etc., etc. should this be called the "Van Gogh Syndrome?" It is remarkable that anorexia nervosa or bulimia is rare in the Ghetto.

In a time and age where poverty throughout the world is widespread, where going without basic health care (either in the US in the uninsured) or in the developing world because basic things are lacking we should really waste our time discussing these "far out" problems rather than concentrating our energy on filling empty stomachs, giving to all access to basic health care and education, etc. I feel that we spend far too much time on "rich man's ethics" (partly because that's were the power is) and far too little on innovative ways of bringing good basic health care and eliminating crass poverty for all.

Ms. Blare--who works on an $ 8.50 job, has not enough to feed her child (this is beneath the poverty line), has no time to be trained for a better job and has no time to do so seems a more worthy subject of discussion than the ownership of a dead man's sperm, BID or facial transplants. We do (or ought to) have priorities in what we spend our time doing. And in my view poverty, malarial swamps, universal health care, hunger, poor education, exploitation of the "developing world" using children to work and produce inexpensive matting for our patio are far more important subjects. "People live lives of quiet desperation" is, I think, true enough.

Brecht in his three penny opera put it, I think, quite right: "Erst kommt das Fressen, dann kommt die Moral"--first comes a full stomach, then comes ethics.