Transplanting a Face: The Ethical Issues
(Fowler Hall Series from June 19, 2016)*
A face transplant is different from other kinds of transplants, medical ethicists said on Wednesday, and the risks and benefits to the patient must be weighed carefully.
For one thing, the surgery requires the patient to spend a lifetime on immunosuppressant drugs, which can have negative side effects and even cause death.
“Not to downplay the difficulties of having a facial disfigurement, but one can live a long life and be disfigured,” said Stuart G. Finder, director of the Center for Healthcare Ethics at Cedars-Sinai Medical Center in Los Angeles.
On the other hand, he said, the benefits of a face transplant are not just cosmetic.
“The repair of the face can also have significant social consequences,” he continued, “like the ability to speak, or the ability to eat that can be replaced because of having lips.”
Dr. Mark Siegler, director of the MacLean Center for Clinical Medical Ethics at the University of Chicago, said face transplant surgery should be evaluated in the same way other surgical innovations were.
“What you need is a kind of process that assures four things,” he said. Those criteria are “adequate scientific background” to suggest that the procedure has a good chance of success; a medical team with the skill and experience to pull it off; a medical institution motivated not by the desire for publicity but by a perceived medical need, and the “open display, public evaluation and professional discussion” of the proposed surgery well before it is performed.
That said, Dr. Siegler added, “the face is a little different from internal organs because so much emotion and expression is in the face.” For that reason, he believes that many families will be reluctant to allow a deceased loved one to become a face donor.
Dr. Finder said a broader “social justice” cost-benefit analysis should also be done, perhaps especially in the current climate.
“This is very resource-intensive, and we are at a time when economically our nation is seriously shaken,” he said, adding that some people would ask: “Is this the best way that our health resources ought to be used? This helps one person. How many children could have received basic health care and for how long?”
The other side of that argument, he said, is that medical innovations often have wider benefits that cannot be predicted. “With face transplant, we know that we will learn something about something, but we can’t say what that is. We know that it will help many people beyond those getting the surgery. Some people will say you take the risk now with the expectation of a payoff later. Others will say, ‘No, we have a problem now.’ ”
Professor Finder recommended that for now, surgeons hold off on further face transplants.
“We’ve done this, so we now know it’s technically possible,” he said. “We probably shouldn’t be going wholeheartedly, guns blasting away, down the road to do this. Now we need to pause and say, ‘Is this the right thing to do?’ ”
(Fowler Hall Series from June 12, 2016)*
Nadya Suleman birthed six male and two female children, conceived via in vitro fertilization (IVp) on January 26, 2009, in Bellflower, California. They are only the second full set of octuplets to be born alive in the United States and, having survived more than a week, surpassed the previous worldwide survival rate for a complete set of octuplets. Nadya had six children already – some foster children under care, some her own biological children.
- Was it morally permissible for Suleman’s doctor to implant 12 embryos into her at once?
- Would it have been morally permissible for Suleman to accept the embryos, but then abort a certain number to reduce the number of embryos after implementation?
- Is restriction of the number of embryos implanted a violation of
What about the embryos? What is our moral obligation toward and embryo?
Is a restriction on the number of embryos implanted in the embryo’s interests, in Nadya’s, society’s at large – Whose interests are considered and advanced by such a restriction?
On What basis (i.e. what kinds of reasons and considerations are relevant) in making the decision on the moral permissibility of Suleman and her doctor’s actions?
(Fowler Hall Series from June 5, 2016)*
You have been shipwrecked on a desert island with ar woman who has with her a hoard of gold. She asks that, if she dies, to promise to honor her request on how to dispose of her large assets.
- What are the goods realized in agreeing to honor her request?
What are the goods realized in not committing yourself to honor her request? Would you agree to her request?
The wealthy dowager is from South Adelaide, where you also have lived for many years. Assuming you have agreed to her request to dispose of her assets, she asks that you give her assets to the South Adelaide Jockey Club, despite the fact that they are well endowed and that there are other pressing needs in the community, given the divide between landowners and most workers. This includes limited medical resources, such as the unavailability of prenatal care, childhood inoculations, and dental care. Despite any protests you offer, she insists that you honor your promise. After you agree, she writes down her will and on a separate piece of paper names you as executor to dispose of her considerable assets. She signs both documents. No one else is aware of her desires and these two documents.
Our wealthy dowager dies. You are then rescued. You find yourself weighing whether or not you should honor her request or destroy the will and otherwise dispose of some or all of her assets.
- What goods are realized in honoring the person’s request to give all to the Jockey Club?
What goods are realized in giving some or all of the assets to the community center? What would you do? Why?
- What would you do if the request were to give the money to the Australian Ku Klux Klan?
Why is your response the same or different then when you were asked to give her assets to the South Adelaide Jockey Club?
Developed by Timothy F. Sedgwick from a classic case described in Sissela Bok, Lying: Moral Choice in Public and Private Life (NY: Vintage, 1978), p. 54.
Reflections from Timothy Sedgwick, Clinton S. Quin Professor of Christian Ethics, Virginia Seminary
Moral decisions arise from the conflicts of goods which happen in the course of life.
Some goods are always sacrificed for the sake of other goods; hence, human life and specifically the moral life has to it a certain pathos or suffering. This suffering is the experience of limitations pressed upon us. As parents and friends well know, to honor another’s choice is sometimes to suffer that choice in our lives, for example, in terms of the burden of disappointment we may bear or in terms of what we may subsequently do.
To honor someone’s request is to honor his or her freedom and more specifically self-determination. We might say, to be a person is to make choices about one’s own life. This is spoken of as a matter of respect for autonomy, literally respect for giving the law to oneself. We invoke this good as a reason for action when we say that we should follow the principle of respect for autonomy. In other words, respect for autonomy is a warrant for our actions.
To refuse to honor someone’s self-determination is to claim that another good outweighs or trumps a person’s choice. We may believe we know what is best. In such cases, there are other goods that we believe outweigh a person’s self-determination. This is often expressed by saying we should do the greater good. The moral principle that expresses this reason for action is the principle of beneficence.
We might also refuse to honor someone’s self-determination because to do so would be to harm others. In such cases, we say that we “do no harm.” The moral principle that expresses this reason for action is the principle of nonmaleficence.
Principles do not tell us what to do. Rather, they name the different goods (or kinds of goods) that we seek to honor or realize when we act. Their most important task is first of all to help us see the goods that may be in conflict.