| News broke recently that a team of U.S. surgeons is on the verge of conducting the world’s first face transplant. What until now has remained in the realm of science fiction and bad movies – 1997’s Face/Off and 2002’s Die Another Day – is, it seems, about to become reality. Whether this is a good thing remains to be seen. More to the point, perhaps, it also remains to be fully debated in public.
Last month the Cleveland Clinic in Ohio announced that it had lined up 12 prospective patients, each severely disfigured, from whom the first transplant candidate would (or might) be selected. Heading the procedure is Dr. Maria Siemionow, who will perform both a physical examination and a psychological questionnaire before making any final decision. At that point, only the patient’s signing of a consent form stands in the way of medical – and possibly ethical – history being made.
The prospect of a face transplant has, in fact, been around for awhile. In England, Dr. Peter Butler of the Royal Free Hospital, London, has been perfecting the process since 1999. By 2003 he had experimented on more than 100 human cadavers, and in September of that year he announced that he was ready to conduct a transplant on a live patient. Ten such patients had signed up for the operation.
At this point, however, England’s Royal College of Surgeons intervened. It had commissioned an inquiry to assess face transplant risks, and in November 2003 declared them to be "far too high" to justify the operation. Butler’s work was put on hold, and the doctor conceded the need for more public debate. "The teams are confident they have overcome the technical hurdles to this procedure," he said, "[But] there are many moral, ethical and psychological issues which need to be debated before anyone has surgery."
I’ll turn to those issues in a moment. First, however, just what "risks" did the RSC have in mind? After all, the first organ transplant (a kidney, swapped from one identical twin to another) was done back in 1954, and since then surgeons have greatly expanded the range of body parts they’ve been able to work on. In 1998, for example, French surgeons conducted the world’s first successful "non-vital" transplant when they attached a new right hand to New Zealander Clint Hallam, who claimed he’d lost the original in a construction accident.
Advocates of face transplants often cite the success of hand operations in defence of their cause. "They said there should be a moratorium on hand transplants five years ago," said John Barker, plastic surgeon at the University of Louisville, Kentucky, in 2003. "Now more than 16 people have had the surgery and it’s considered a success."
However, surgeons later learned that Hallam was in fact a fugitive from the law who had lost his hand in a chainsaw "accident" while in prison. Worse still, it turned out that Hallam was unable to adjust to the new member and eventually let his hand rot.
Perhaps hopes were raised once more in 2003 when Viennese doctors reported that they’d completed the world’s first tongue transplant on a 42-year-old man suffering from tongue cancer. After eight months, they were happy to record that the recipient’s body had not rejected the new organ. But still, they had to concede, the patient was unable to move his new tongue and his sense of taste had not returned. When asked, no one was prepared to say if it ever would.
To their credit, surgeons have been equally open about the risks involved in any face transplant. One in 10 such grafts are likely to be rejected within the first year, one report acknowledges, while the success rate in the longer run may be no more than 50 per cent. While the surgical procedure itself may be relatively straightforward – the whole operation can be completed in just 10 hours – the real problem involves the recipient’s body’s ability to accept the new face.
Most discussions of the subject note the challenge in connecting old and new blood vessels and nerve endings, perhaps (or probably) limiting the eventual range of facial mobility and expression. Moreover, recipients almost certainly face a lifetime’s dependency on immuno-suppressants, drugs designed to minimize the chance of rejection. This prospect has led some ethicists to conclude that facial disfigurement, not in itself a life-threatening condition, simply does not warrant the risks that a total transplant poses.
And so back to the ethical arguments. Who is to make this judgment? "For many patients," claims Dr. Siemionow, "being able to go back to their normal lives is worth the risk of taking lifelong immuno-suppressants. Many of those patients do not leave their houses." Matthew Teffeteller, a severely injured firefighter from Knoxville, Tennessee, would appear to agree. "It’s a nightmare and it never ends," he admitted of his own facial scars. "Being burned is the worst thing that can happen to you."
But, and despite the admission that his face continues to scare young children, Teffeteller quickly rejected the idea of undergoing a transplant. "Having someone else’s face – that wouldn’t be right. When I look in the mirror, I might be scarred, but it’s still me. I’d be afraid if something would go wrong, too. What would you do if you didn’t have a face?"
That’s the question that needs debating right now. In a recent essay published in the American Journal of Law and Medicine, Rhonda Gay Hartmann concludes that "Despite the promising prospect of facial transplant, there are considerable reasons for concern…. Selfhood is distilled in the human face. As a vestige, perhaps the last, in distinguishing selfhood and shared humanity, value of the human face deserves nothing less than intelligent, incisive analysis."
Let’s hope it gets it. |
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