Should face transplants be undertaken? This article examines the ethical problems involved from the perspective of the recipient, looking particularly at the question of identity, the donor and the donor's family, and the disfigured community and society more generally. Concern is expressed that full face transplants are going ahead. "Facial transplant ethics" it has happened. According to the New Scientisti the case was made out by a team in Kentucky, USA, in1 and the first partial face transplant was performed in Lyon, France, in November on a woman whose face was mutilated by a dog.
But even before the flurry of activity in lateit was clear that this latest venture in transplantation technology would proceed: It is sometimes suggested that face transplants are morally analogous to limb transplants.
This paper considers the ethical Facial transplant ethics of face transplants. Another paper will explore some of the legal questions. In considering the ethical issues, it is important to separate those which principally concern the recipient from those which affect the donor and the donor's family. But we must not ignore the interests of the disfigured community and those of society at large, and consideration will be given to those two interest groups as well.
Transplants of organs are now not uncommon, and although some questions remain contentious eg, whether they can be sold 14on the whole their therapeutic use is uncontroversial. The same applies to skin grafts and reconstructive surgery.
"Facial transplant ethics" cannot live without certain vital organs, such as the heart, but these are internal to us and are visible neither to ourselves nor to others. But even so, recipients of an organ may feel that their identity is Facial transplant ethics changed in some way.
These problems are, we believe, accentuated when a face is transplanted. As an expressive part of our body, it represents identity in a way no other part of the body does. It is the most intimate, the most individual characteristic of our body.
It is what we recognise as ourselves and what others recognise as us. The Royal College of Surgeons report holds that:. The face is central to our understanding of our identity.
Faces help us "Facial transplant ethics" who we are and where we come from. Morris et al6 p And Margaret Lock 18 has argued that. The importance of this in the context of face transplants cannot be underestimated. There are implications for consent. It may even be an area where paternalism has a strong claim to our attention. Disfigured persons are, it may be assumed, a particularly vulnerable group.
One of their main problems centres on social interaction. They are also subjected to unwanted intrusions, such as staring or unwelcome comments. Clarke quotes Macgregor that people who have experienced disfiguring This is likely to lead in many cases to a desperate, compulsive desire to alleviate their suffering. Recently published research 427 vii suggests that people are.
But the body part for which people are willing to trade most years of life is by some margin a transplanted face. For a face they would take on even more risk than for a kidney.
If this research is convincing—and we must express some scepticism as far too little information is vouchsafed viii —it suggests that the disfigured may well feel compelled to consent to a face transplant. On any interpretation of informed consent and this legal doctrine is Facial transplant ethics uniform across jurisdictionsa potential recipient would have to be alerted to substantial risks.
That there are risks is accepted even by advocates of face transplants Wiggins et al1 pp 3—5. And there are psychological risks as well:. Wiggins et al1 pp 4—5. In addition, there is the possible trauma in adjusting to a new identity.
No doubt, recipients can be taught to manage failure, but is any work being directed to such coping strategies or are the resources and the skills being devoted to the technology? Is consent then possible? The assumption of advocates of face transplants, as represented in the article by Cunningham et alis that this can be proved objectively.
But is it rather the product of values, such as experience, trust, a sense of control, regret
Facial transplant ethics fear? Risks are acknowledged, but also, we suspect, underestimated. For example, insufficient attention has been given to the problem likely to be caused by a paucity of donors.
Publicity about transplants may well stimulate demand, and this will exceed supply. What will be the effect of being on a waiting list? What is the relationship, if any, between coping strategies before and after a transplant?
Given the significance of the face, the recipient will have a different life after a transplant. It may be a better one, it may be worse. Adjustment is bound to be difficult. There may initially be psychological shock of a dimension equal to or exceeding that caused by the disfigurement.
There may be a sense of violation. Most of our communications are facial. The recipient may acquire different interests and even, it has been suggested, different eating habits. It is not clear whether potential recipients will be given any choice or any opportunity to view the prospective donor alive or dead.
And should this extend further to their family? And why not to the donor's family as well?. There will be matching for blood and tissue, but what about age? Could a man choose a woman's face, in which case the prospect looms of face transplantation as part of a sex reassignment operation? And what about race? And if a market were to develop, 35 would value depend on attractiveness? Might it become possible to buy the face of a model or a football icon?
Could face banks eventually emerge?. To whom will face transplants be offered? Butler et al 36 of the Royal Free Hospital admit:. Selecting appropriate recipients will be difficult and will take a considerable time. This process [will] involve identifying those patients who would have functional benefit and who also had realistic expectations of the procedure. The patient would have to be determined and resolute in adhering to the rehabilitation and the need for chronic immunosuppression.
The patient must be robust enough to cope with these challenges and the psychological effects involved. So, appearance by itself is not enough to warrant surgery. Butler et al admit that:. The concern for us as clinicians … is that this group may also cope poorly with face transplantation; thus, the very group who might benefit most are those who are least likely to cope …, particularly if the results fall short of their expectations.
Butler et al36 p Does this mean that those for whom a transplant is clinically indicated are also those least able to give genuine consent? And, concomitantly, that those robust enough to consent can cope adequately without and so do not need this surgical intervention?.
And what comprehension can the potential recipient have when the surgeons themselves know so little Facial transplant ethics the benefits and the harms? This is a candid admission that we are still in the realm of medical experimentation, Facial transplant ethics itself has implications for the question of consent.
Of course, voluntariness is a matter of degree. As Joel Feinberg 38 has observed:. At one end of a spectrum the acts and choices [which are] perfectly voluntary. Only the actions of normal adult human beings in full control of their deliberative faculties can qualify for that description. Such persons assume a risk in a perfectly voluntary way if they shoulder it when fully informed of all relevant facts and contingencies …, and in the absence of all coercive pressure.
In the ideal case, there must be calmness and deliberateness …, no distracting or unsettling emotions, no neurotic compulsion, no misunderstanding. To whatever extent there is compulsion, misinformation, clouded judgment … or impaired reasoning … to that extent the choice falls short of perfect voluntariness.
Facial transplant ethics answer to this may be to draw an analogy with the desperately ill, for example, those with AIDS, prepared to throw caution to the wind, willing to try anything, in the hope that they—or for the more altruistic those who come after them—may be cured.
Our concern is that we are here focusing on a particularly vulnerable group of people. Nor is there any evidence, as there is, at least anecdotally, with those with AIDS that participation may be motivated by a desire to promote a more healthy population. We know quite a lot about the physical risks Facial transplant ethics. The recipients may be seeking normality, but may feel less normal than they did when possessed with their disfigured face.
The recipients will look neither like themselves nor like the donor: The emphasis has been on whether face transplants can be accomplished, on the science and the technology. Christian Byk 45 has asked:. Hidden by the law under the concept of a "Facial transplant ethics," but empirically revealed by our biomedical techniques, will the human body come to have the status of a thing to be utilized, to be dismembered for the benefit of the individual or the community, each claiming rights in it?
Facial transplant ethics the law … dig the grave of the living human body? Will it become a thing?. Commodification of the human body is not new, but facial transplantation may be the most striking example of the results of this reductionist view of the human body. The Royal Free London NHS Foundation Trust has permission to provide full- face transplants. Find out more about Facial transplant ethics to face transplant ethics. The evolving ethical debate over face transplantation is analyzed in a special topic paper in the December issue of Plastic and Reconstructive.
It is the ethical issues associated with the risks and benefits of performing facial transplantation that have posed the greatest challenges leading up to performing .
Should face transplants be undertaken? That article examines the ethical hitchs involved from the perspective of the recipient, looking particularly at the question of identity, the donor and the donor's system, and the disfigured community and society more generally. Concern is expressed that full face transplants are going ahead.
So it has happened. According to the New Scientist , i the case was made out via a team in Louisville, Kentucky, USA, in , 1 and the first partial face resettle was performed in Lyon, France, in November on a woman whose face was mutilated aside a dog.
But even the flurry of activity in late , it was quit that this latest venture in transplantation technology would proceed: It is sometimes suggested that lineaments transplants are morally analogous to limb transplants. This paper considers the ethical issues of eyeball to eyeball in defiance of transplants. Another paper will survey some of the legal questions. In considering the ethical issues, it is important to bifurcate those which principally concern the recipient from those which influence the donor and the donor's family.
But we must not ignore the interests of the disfigured community and those of society at large, and considerateness will be given to those two interest groups as affectionately.
Copyright American Medical Confederation. While 7 go up against transplants partake of tired performed approximately the era, to latest, there remains polemic anent the validity of that method. We submit that performing a facial transplant—in the correctly selected patient—is technically defensible and ethically din. By means of outlining the technological and good boundaries of the argument, responding to the main arguments against the continue, and describing its motivations and the right stuff benefits, we shape our justification of facial transplantation.
Arguing the Ethics of Facial Transplantation. Pre-eminent Facial Plast Surg. Ethics and Known Action. Alexander, MD ; Daniel S. Alam, MD ; Patrick J. Transfer in to access your subscriptions Sacrifice in to your dear tale.
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Changing identity – face transplant ethics
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Purchase access Subscribe to JN Learning for one year. Copyright American Medical Association. Hastings Cent Rep 34 18— The recommendation is that face transplants only be carried out: Clarke quotes Macgregor that people who have experienced disfiguring burns. Well done to our amazing occupational therapists at the Royal Free Hospital. Even if we accept the premise that disfigured persons are unable to enjoy the good life, it is not their disfigurement that constitutes the barrier.
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Mitch Hunter Describes His Face Transplant Video - Brigham and Women's Hospital
Ex-gf re-initiated contact...what the hell now!?The Royal Free London NHS Foundation Trust has permission to provide full- face transplants. Find out more about response to face transplant ethics. The evolving ethical debate over face transplantation is analyzed in a special topic paper in the December issue of Plastic and Reconstructive..
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These concerns have been officially highlighted in a face transplant ethics report from a special committee of the Royal College of Surgeons RCS. Our UK face transplantation team welcomes these views but takes a pragmatic approach. We feel there is no value in repeatedly revisiting the arguments without conducting further research.
So, our approach is to use the RCS report as a framework, and carry out research to address and respond to the issues raised around face transplant ethics. The research that we do includes working with patients with severe facial injuries, as well as with healthcare professionals in the field, such as those working in organ transplantation and families of organ donors.
In short, the position of the Royal Free London face transplantation team is that ethical issues are best met by rigorous research that practically addresses the theoretical issues raised.
To ethically manage patients undergoing this procedure, our face transplantation team also endorses the proposal of the American Society of Plastic Surgeons in producing guidelines for good practice. The recommendation is that face transplants only be carried out:
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