A Question for my MD friends....

The link takes you to a story in the G+M about the possibility of Canadian surgeons attempting a 'face-transplant' from a cadaver to a human.

Here's the scenario - someone horribly scared, but not in a life threatening situation, volunteers for the opportunity to be a guinea pig for the first succesful face transplant.

Among the risks;

"Complications could include infections that turn your new face black and require a second transplant or reconstruction with skin grafts. Drugs to prevent rejection will be needed lifelong, and they raise the risk of kidney damage and cancer."

I also assume that since this is major surgery, at some level, 'death' is also a possibility.

So here's the question, knowing ahead of time that the patient will survive without the surgery, how is it ethically feasible to proceed with it even if the psychological benefits of receiving a new healthy face are tremendous? Isn't the downside still way too great to ethically proceed with what amounts to ultra-radical plastic surgery?


Richard said...


Very ethical. Very appropriate. Very necessary.

Facial deformities are among the most socially destructive disabilities you can have. (Consider the great disabled archetypes, who would you rather be: Homer (the blind sage), Beethoven (the deaf genius), Professor X (the brilliant cripple)
or Quasimodo/Elephant Man?).

People sincerely believe that "character" honesty and emotion can be read and expressed in the face. To not have a "normal" facial arrangement all but ruins your ability to interact socially. People whose faces are damaged and deformed can not live a full and normal life. Other people won't look them in the face, won't trust them, hesitate to communicate with them, inherently think they're of lesser intelligence, and stare at them.

The test as to whether or not it's needed is simple: these are the risks, are you willing to accept them? There are people who are so deformed by disease or accident that there would be no question.

Every novel medical procedure is initially very risky... then we get better at it. Just because it's dangerous, doesn't mean we shouldn't start doing it.

Anonymous said...

Surgery is not only for life-threatening conditions, but also for restoring health and improving function. I'll leave aside questions of body "enhancement" (cosmetic implants and so forth), because those ethical questions are inherently different, and could confuse the issue at hand.

First of all, this does indeed amount to "ultra-radical plastic surgery." As such, it is being contemplated only in the most extreme of circumstances: traumatic disfigurement. Given that so much of our identity revolves around facial recognition, the permanent loss of one's appearance is a terrible blow.

Secondly, this procedure will not graft one face onto another, merely the facial tissue. Though this may seem like an overemphasis on language, the FACE (as psychological concept tied to one's identity) is not the same as the face (nerves, muscles, fat and skin). The patient will end up not with their own face, nor the donor's face, but a third face different from either. The idea is to move their face closer to a normal appearance, and perhaps closer to their original FACE.

I believe Ms. Marchione's article may be misrepresenting Mr. Teffeteller's thinking when it quotes him as saying "Having somebody else's face ... that wouldn't be right." I would be curious to know the precise question that was asked of him. As indicated above, the recipient would not have the donor's face in an identifiable way. If Mr. Teffeteller does not want the procedure, he can decline (thereby exercising his right to "informed dissent").

The ethics are relatively clear, to my mind. If a procedure can be performed that takes someone from looking "horrible" (a situation where they are likely to be shunned by all but their closest family and friends) to one where they will look merely "different" (and I deliberately choose emotive words to describe the first impression they will make on many strangers), it is intrinsically ethical. As for the risks, the only way those can be measured are through a well-defined research protocol. Yes, the grafted face may die, but how likely is that - 1 in 3, 1 in 10, 1 in 100? We won't know until we try. If it's too risky in 2005, then perhaps it won't be in 2010 with better anti-rejection drugs, or early expression profiling of pro-apoptotic mRNAs.

For a novel procedure ever to become available, somebody has to be "patient number one." This is NOT the same as a guinea pig, for the simple reason that a researcher (unless perhaps a veterinary researcher) does not concern herself with the guinea pig's long-term well-being. The test animal is a means to an end, whereas patients are ends-in-themselves.