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Face On December 5, 2005

Posted by decode in Culture.
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Joe Shaw has been talking about the recent first face transplant operation. As he notes, the technology and skill to perform such an operation has been around for a while, but it has not been done before due to “ethical issues.” Unfortunately, the CNN article he links to has little information on what these issues are, which makes things somewhat confusing. The BBC has better coverage of this, and the issues were discussed in the Slashdot comments. Basically, it seems to come down to three major issues:

  • The donor must be alive when the transplant is performed. These types of things are usually done on comotose, brain dead patients with no chance of recovery, but there is always the question of whether the person might have a “miraculous recovery” or if there was a misdiagnosis.
  • The patient must take large amounts of immunosuppressive medications for the rest of his or her life. These drugs are necessary to prevent rejection of the transplanted organ, but also make the body much more susceptible to infection. This requires that the good effects of the transplant be weighed against the increased health risks of immunosuppression. For certain transplants, like a heart transplant, it seems obvious that having a working heart is worth the risk of infection. The patient who received the first face transplant mostly had issues with eating and talking (she didn’t have lips to control her food or speech), but was not in physical danger because of those issues. Situations like this make the issue less clear.
  • The effects of doing a face transplant are as yet unknown, since it is so new. It could be that it doesn’t work well (or at all, on the long term), and the patient could end up worse off then he or she started. This is an issue with the “never do harm to anyone” clause in the Hippocratic Oath.

The first issue is common to a number of kinds of transplants, so conclusions there can probably be applied. The third one can only be known by actually doing face transplants and seeing what the results are. The most interesting ethical questions lie in the second issue, which can probably only be answered on a case-by-case basis, making appropriate general policy about the practice difficult to determine.

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Comments»

1. IC - December 5, 2005

the issue is it was the French who did it. Thats all. It wasnt the English or Americans. It was the French. Thats why people have a problem with it. If it was anyone else there would be “ehtical” debate. But not on this scale.

2. axel - December 6, 2005

You list three issues that you claim are ethical problems with face transplants.

The first one, needing the donor to be alive, is indeed an ethical problem, but it is one that must be faced (no pun intended) with most types of organ trnsplants, so it is nothing new. Why bring it up specifically with face transplants?

The second issue (health risks) is also common to all types of transplants, but aside from that I fail to see how this is an ethical issue.

The third issue (new technology, unknown results) is indeed a problem for this specific type of transplant, but how is it an ethical one?

Some people are willing to risk their health and even their life for a chance of greatly improving their health and quality of life. I strongly feel that this should be a choice left to the individual, and as such it is in no way an ethical problem. To imply that the government, or civilisation as a whole should have the moral right to judge what risk a medical procedure can have for what benefit in order to be ‘ethical’ is a concept that leaves me very uneasy.

3. decode - December 6, 2005

The three issues above are ethical issues for the doctors potentially performing the operation. Any time I knowingly perform an action that will harm or help another person, it has ethical ramifications. Kant, for example, would say that even the way you treat your waitress at the local restaurant is an ethical issue, and it should be shaped by the categorical imperative, most clearly seen in the second formulation. As the doctors are the ones who refrained from performing the operation in the past, it is they who recognized and were concerned with the “ethical issues.” I made no implication that this particular operation should be regulated by the state or other governing body, but since it involves an unwilling and unknowing participant (the donor), perhaps it should be.

4. Olivia - November 29, 2006

The woman who received the face transplant has recovered so well that people no longer notice her scars:

http://news.bbc.co.uk/2/hi/health/6190612.stm


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