Bioethics Discussion Blog: Facing the Ethics of Face Transplanting

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Sunday, December 07, 2008

Facing the Ethics of Face Transplanting

The ethics regarding the transplant of a face from a dead donor to a living person who needs an intact and functioning face to replace a face severely damaged by trauma or otherwise disfigured is one which goes beyond any ethical considerations of other bodily organ transplants, such as heart, liver or kidneys.

The procedure as 2008 is ending is still experimental and facial transplants on humans have, as yet, been only partial and perhaps only in a few publicized cases at most. The problems of full functionality and rejection has yet to be met. Beyond that is the social, psychologic and ethics involved in considering and actually carrying out such surgery.

To learn more about the details of these considerations, read the 2006 American Society for Reconstructive Microsurgery and the American Society of Plastic Surgeons Guiding Principles for facial transplantation.

Setting the discussion of the ethics of facial transplantation, the American Society for Reconstructive Microsurgery in their 2006 position paper wrote:

The ethics of facial transplantation go beyond the life and death issues common to most transplants and engage other topics that heretofore have not influenced medical decision processes. The face represents the most identifiable aspect of an individual’s physical being and is central to communication. One might expect that a facially deformed patient is markedly impaired, but most studies confirm that the severity of deformity does not necessarily correlate with distress. Most patients with facial deformity adapt quite well and accept their physical appearance as “self”. The psychology of acquiring another person’s identity is very complex; the psychology of losing that newly acquired identity can only be imagined. Similarly, the psychologic repercussions of a facial transplant on family and friends of both donor and recipient cannot be underestimated. The ethics of inflicting an untried, and potentially fatal or deforming remedy for the purposes of advancing science must be carefully weighed against the Hippocratic credo of doing no harm. Those against facial transplantation argue that the desperation of disability never justifies the infliction of a hopeless remedy. Proponents of facial transplantation argue that selected patients who seek improvement in their quality of life in certain circumstances are prepared to assume risks to achieve it. Answers to these ethical issues can be easily manipulated to comport with most viewpoints. In the final analysis, however, ethics must be regarded as a means for discussing the issues of facial transplantation and not, necessarily, for resolving them.

What is your opinion regarding further research or if surgical and immunological problems can be overcome to have full facial transplant become a standard procedure for patients with facial disfigurement? ..or even for just for a simple cosmetic attempt to “look better”. Finally, what does a persons face mean to you and should it be only their own? ..Maurice.

3 Comments:

At Tuesday, December 09, 2008 8:41:00 AM, Anonymous Moof said...

Dr. Bernstein, although I've been quiet, I have started "lurking" again. I'm now accessing your posts via my Google Reader.

This was such an interesting question that I had to take a moment to comment.

First of all, ethically, I believe that informed, consenting adults should be allowed to make decisions on their own behalf.

Secondly, these procedures will not advance without the help of willing participants from both sides of the aisle.

Thirdly, I believe that there will always be people who are helped by such radical procedures, while others with similar, or even better, outcomes will suffer some sort of emotional trauma.

If alterations of this type are considered ethical in any way whatsoever, then why not for someone who would wants to fix something that is actually seen as being "broken" in some way?

I'm not saying that face transplants are a good idea, or that they should even be suggested to people with facial disfigurations ... but rather that they should not be denied to those who request them for valid reasons.

"Valid" could follow whatever criteria might be applied to any facial alteration, such as vanity plastic surgeries.

About whether a person's face should be "their own" ... while it might be jarring to see someone you know and love with a different face, that's just the wrapping. The same person is still underneath that wrapping. I have to assume that you're talking about a person who's known and loved, because when meeting someone you don't know, whichever face they're wearing doesn't make a difference - if you're really looking at the person, and not just the appearance.

I can't imagine someone shunning a loved one because of surgery done in an effort to make them (the disfigured person) feel better about themselves; no one but the disfigured person knows how badly they feel they need it. I think that love for the individual would remain, whether the face was disfigured, or transplanted. With the proper attitudes, everyone could help everyone else adjust to the changes. Over time, perhaps with a bit of counseling if necessary, I think that any identity problems would recede into the background.

But then again, I haven't thought any of this out very deeply, and I could be missing a lot of factors.

Thank you, Dr. Bernstein, for keeping this wonderful blog going.

.

 
At Tuesday, December 09, 2008 10:00:00 AM, Blogger Maurice Bernstein, M.D. said...

Moof, glad to see you back on my blog and also your thoughtful comments.

I just wonder whether society has any responsibility in establishing how a person appears to others. Nudity in the general public is prohibited by society. Face and body are analyzed by society and even publicized as "handsome" or "attractive" or "over-weight" or "unkempt". Facial appearance in our Western society provides identification both of person but also of character. In other societies, society agrees that the face of a woman should not be shown in public. Does this involvement of society in personal appearance and society's often financial involvement in research and treatment give society some clout or validity to set standards regarding facial transplants? ..Maurice.

 
At Monday, December 22, 2008 4:00:00 PM, Blogger Maurice Bernstein, M.D. said...

John Lantos, physician-ethicist write in the Practical Bioethics Blog regarding whether there is a separation between facial tissue transplant and personal identity.

"The face is visible in a way that internal organs are not. Further, it is visible in a way that is highly associated with one’s individual identity. If we have someone else’s face, are we really and truly our self? Do we become, in some weird way, the donor? Is a face transplant really an identity transplant?"


Should research and therapy be held up because of this concern? ..Maurice.

 

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