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Face Transplants: Are they ethical?

Discussion in 'General Debates' started by Quiddity, Dec 7, 2005.

  1. Quiddity

    Quiddity UndertheInfluenceofGiants

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    With a full U.S. transplant looming, some experts question when, if ever, the surgery is warranted

    WEDNESDAY, Dec. 7 (HealthDay News) -- French doctors who recently performed the world's first partial face transplant pushed not only scientific frontiers, but ethical ones as well.

    The feat, which has struck a chord among professionals and lay people alike, has spurred heated debates on everything from the meaning of identity to doctor-patient relationships and the future of medicine.

    The issues take on even more urgency as surgeons at the Cleveland Clinic in the United States screen candidates in preparation for the world's first full face transplant.

    "With a partial transplant of the sort they've done in France, the stakes are less high," said Kenneth Goodman, director of the Bioethics Program at the University of Miami. "The procedure contemplated in Cleveland raises very interesting questions about personal identity, and how people think of themselves. That raises questions about the psychological and psychiatric risks, and we don't know what those are. We don't know how to communicate to people what it would be like to completely have a new face."

    A large degree of uncertainty and mystery already surrounds the French case, which is acquiring all the elements of a Gothic novel.

    The patient, a 38-year-old French woman, became severely disfigured after her dog attacked her in May. Doctors grafted a nose, lips and chin onto her face in December.

    Beyond these bare facts, however, little else is clear. There have been allegations that the woman had attempted suicide by overdosing on pills and that the donor, a brain-dead patient, had hanged herself.

    These allegations, in turn, have raised questions about the psychological state of the patient and the ethics of doing this surgery on this patient, with this donor, in the first place.

    "The most important part of the relationship between doctor and patient is informed or valid consent. The patient needs to know what the risks are and what the alternatives are, and that requires that they be able to process information and make reasoned decisions," Goodman said. "Desperate people are poor models for the consent process. They're vulnerable by virtue of desperation."

    People with suicidal thoughts or tendencies also "raise especially crimson-colored red flags," Goodman added. "In this context, the questions having to do with identity and the risks of surgery are substantially unknown. What you want for a really risky situation are patients who have their bolts in as tight as possible."

    Many critics contend that the French team cut a few ethical and other corners in order to win the distinction of having performed the first partial face transplant. At the same time, they may have pushed hard on the publicity pedal.

    "They didn't publish it in the scientific literature, but went to the lay press. It puts their credibility at issue," said Dr. David Arnold, an assistant professor of otolaryngology and head and neck surgery at the University of Miami Miller School of Medicine. "This smacks of showboating."

    The surgeons, however, defended themselves at a news conference reported in The New York Times. "We are doctors," said Jean-Michel Dubernard, one of the doctors who led the transplant team. "We had a patient with a very severe disfigurement that would have been extremely difficult, if not impossible, to repair with classic surgery."

    According to a profile in the Times, Dubernard leads a double life as a politician, a former deputy mayor of Lyon, and one of the most powerful members of the French National Assembly. A chain smoker who is no stranger to controversy, Dubernard gained notoriety after he transplanted a new hand to patient Clint Hallam in 1998. It was later revealed that Hallam had lost his hand while in prison, the Times reported.

    Neither hand nor face transplants are technically lifesaving procedures, like receiving a kidney or heart would be. Yet all the procedures require recipients to take immunosuppressant drugs for the rest of their lives.

    "You have to knock down the recipient's immune system, and that's one of the reasons why I can't ever see this working," Arnold said. Hallam refused to take his drugs, and eventually had his donated hand amputated.

    Face transplants occupy such murky territory that the French National Ethics Advisory Committee and the Royal College of Surgeons of England rejected doing them, although the French body left open the possibility of doing partial transplants, the Cleveland Plain Dealer reported. The Cleveland Clinic team worked for more than a year to get approval for their procedure. They are currently evaluating 12 people who have been disfigured, and have fielded dozens of other inquiries from interested patients, according to the Dealer.

    And then there's the issue of the face which, unlike a kidney or lung, is a major component in identity, providing the visual platform from which we interact with the world.

    "It's important to recognize that patients who have very severe facial disfigurement have a suicide rate four times that of the general population and a very poor quality of life," said Dr. Malcolm Z. Roth, director of plastic surgery at Maimonides Medical Center in New York City.

    "If somebody is not a candidate for standard reconstructive techniques, there are very, very rare indications where this might be considered," Roth added.

    And "considered" may well be the operative word.

    "There will always be scarring and the need for medications," Roth said. "It's critical that you select your patients wisely, and make sure that patients understand that this will be a long road, a forever road."


    Have they gone to far?

    ``Victor
     
  2. Faint

    Faint Well-Known Member

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    Of course they haven't gone too far. And why wouldn't these surgeries be ethical? If you believe in a soul, and that this body is temporary, then the face is not a true identity, only a facade. And if having a facade that actually looks decent compared to one that frightens or disgusts people, then yes, I think it is a worthwhile procedure in that it will help you enjoy life in the here and now.
     
  3. jamaesi

    jamaesi To Save A Lamb

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    I don't understand the outrage.

    Your face will be different either way after an injury to it- why not have one that is easier to live with than huge scars?
     
  4. Faint

    Faint Well-Known Member

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    Bingo! Maybe people are just afraid of new things or science in general.
     
  5. Quiddity

    Quiddity UndertheInfluenceofGiants

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    I have a feeling you guys read the title of the thread and responded without reading the article.

    ~Victor
     
  6. Ardent Listener

    Ardent Listener Active Member

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    I think they are as ethical, if not more so, than performing a 'sex change' operation on a transsexual. Of couse, with all such body altering surgeries, the patient's psychological condition should first be determined.
     
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  7. Quiddity

    Quiddity UndertheInfluenceofGiants

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    Bingo!

    ~Victor
     
  8. Ardent Listener

    Ardent Listener Active Member

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    Thank you for the "Bingo" Victor. With all the hot water I have been in lately, I needed a Bingo. :D
     
  9. jamaesi

    jamaesi To Save A Lamb

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    No, I read the entire article.
    ... Which left me with the "buh, I don't understand the outrage."


    People get plastic surgery all the time and no one stops and questions their state of mind. It's their body, I couldn't care less. This is something that is a little more needed than a nose job- it's not nessecary for life, but I sure as hell would have a new face than one that's horrible deformed. I really don't think the fact that some perhaps "mentally unstable" people getting this done is a reason for a blind moral ban on everyone getting it. Half of this is biased on 'WELL SHE MIGHT HAVE BEEN THIS AND THEN THEY MIGHT HAVE DONE THAT." I just don't really get it- and it's not my place to judge. I'll leave it up to the doctors and paitents to judge their cases and motives themselves.
     
  10. angellous_evangellous

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    Many critics contend that the French team cut a few ethical and other corners in order to win the distinction of having performed the first partial face transplant. At the same time, they may have pushed hard on the publicity pedal.

    "They didn't publish it in the scientific literature, but went to the lay press. It puts their credibility at issue," said Dr. David Arnold, an assistant professor of otolaryngology and head and neck surgery at the University of Miami Miller School of Medicine.

    This means that we really don't know what happened. The entire article is based on speculation. They just said, "hey, we're doing a face transplant." Not really knowing what this means, people want to talk about the ethics of it.

    I heard some doctors talking about this on NPR. They didn't know what was going on in France, even after the surgury, particularly because the French doctors didn't tell anyone what they were doing. In America, a face transplantation is simply taking the facial skin off of the donor and put it over the facial musules of the recipient. No identity issues there, and the ethics of organ donorship apply nicely.

    There was some speculation that the French doctors were actually taking the face off of someone and putting it on someone else, which is not really possible considering the complexity and risk of such an operation. The ethical debate in this article is like debating the ethics of creating a clone army.
     
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  11. pdoel

    pdoel Active Member

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    I too read the entire article. To be honest, I'd have to say that those who feel this is unethical, or who are against it, haven't read all the facts.

    They act as if this completely changes someone's identity. Or could possibly almost steal someone elses identity.

    It's not like when this is done, they are going to even resemble the person that the face came from. And after any type of injury where a face is disfigured, your appearance is going to change no matter what!

    And about the whole psyche of the person receiving it. Which is going to be more tramatic for the patient? To wake up after a massive injury horribly disfigured? Or to wake up looking a bit different, but able to go out and public without fear of what others will think when they see the disfiguration?

    Personally, I think it's more unethical to NOT consider something like this.

    We currently allow transplants of hearts, livers, kidneys, eyes, bone marrow, etc. We allow people to have elective surgery to change their appearance, whether it's their nose, chin, liposuction, whatever.

    I'd be more willing to push some counseling before allowing those types of surgery, than I would to help someone in desperate need after having some type of serious disfiguring injury.
     
  12. Valjean

    Valjean Veteran Member
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    I'm a bit mystified by this controversy. Grafts and transplants are as common as flag pins at a Republican convention. What is so medically extraordinary about this particular procedure?
     
  13. angellous_evangellous

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    Because some moron said "face transplant" instead of "skin graft," and interviewed doctors using those terms with hypothetical situations. This isn't real news or real ethics. It is only speculation about stuff that they can't do.
     
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  14. Quoth The Raven

    Quoth The Raven Half Arsed Muse

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    I would consider half the issue with the patient's mental state has to do with the fact they've had half their face chewed off by the family pet or whatever. That's bound to make you a little sparky in the scone for a while.
     
  15. Nehustan

    Nehustan Well-Known Member

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    Not only can they be ethical, I think in some cases they should be compulsory.

    :jiggy:
     
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  16. mohammad singh

    mohammad singh New Member

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    I don't really think that's right... they're not all that ethical for a start, from the site i've seen here they've worked out that it can turn out pretty badly.



    ... and don't think that anyone should have to change the way they look, rather than being happy with what they are.

    mohammad.
     
  17. michel

    michel Administrator Emeritus
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    Mohammad,

    Firstly, about your post;
    With the greatest respect, the lady in question had her face chewed up by a dog....this wasn't a case of 'vanity'.

    Personally, I agree with you when surgery is undertaken simply because someone wished they looked different. This, was, a different kettle of fish altogether..........

    Anyway, Welcome to the forum!

    I would like to invite you to introduce yourself to the other members, by posting on :-
    Are you new to ReligiousForums.com?.

    Please feel free to ask questions, if you have any, and to check out our article with links for our newer members; there is also a link to the forum rules which you ought to look at.

    Have fun, and I look forwards to seeing you around.;)
     
  18. Nehustan

    Nehustan Well-Known Member

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    Mohammad, my dear chap, it was humour, please don't make me explain.
     
  19. michel

    michel Administrator Emeritus
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    remind me, if ever you achieve the distiction of ever being able to be in power of any Country in the future, to avoid that Country like the plague.:p

    Talk about judgemental...oh, and i love the considered proffessional
    Yes Sir!:rolleyes:
     
  20. Nehustan

    Nehustan Well-Known Member

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    Michel - wow I didn't realise he was a pychologist, I better watch what I say...
     
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