Ethics

Invasion of the face snatchers

A face transplant could change a disfigured person's life. But is it ethical to take someone else's identity?

By Dr Mark Bernstein

THE DILEMMA
Your brother Nick's face is horribly disfigured after a house fire. But there's hope: face transplant technology is now sufficiently advanced and the success rate is high. A cadaveric donor who has graciously donated his face and other organs is found. The operation is successful and Nick comes home to start life anew. He walks through the front door wearing a face that you recognize from somewhere. Your memory clears and it hits you � it used to belong to a neighbour down the street who recently died from a heart attack.

A new twist to Night of the Living Dead? No � reality has again proved to be stranger than fiction. Facial transplantation is now possible and could be coming to a clinic near you. A transplanted heart or kidney is invisible, but a face? Talk about seeing dead people.

The disturbing mystique of facial transplantation has been graphically depicted in movies like Face/Off. The medical profile of this new technology was recently discussed in a report published in the February issue of the journal Transplantation, in which a working party of the Royal College of Surgeons of England addressed medical and non-medical aspects. Apparently physicians in the US and France are chomping at the bit to give it a shot and are just waiting for the go-ahead from government regulatory bodies.

THE DELIBERATION
There are two ethical components to be considered when assessing whether facial transplantation should become an acceptable medical procedure � the risk/benefit ratio and the psychosocial impact.

For the risk/benefit ratio, it's clearly difficult for a person to live with a disfigured and scarred face. However, a face transplant recipient could have surgical complications such as poor wound healing and may require more surgeries. And even in the event that the surgery goes smoothly, a patient would need a lifetime of immunosuppressive medications, which in itself can cause many complications and shorten life span. The psychological harm of having a face that's not your own is unimaginable, but we can safely assume it could be substantial. A facial transplant could almost qualify as identity loss for the recipient.

When it comes to the psychosocial impact, it could be profound. Even if the donor has given consent, this alone doesn't make a medical intervention ethical. Isn't it disrespectful for a donor's likeness to be associated with another person? And how devastating would it be if someone recognized the face of a deceased spouse or child on another person? There would be no foolproof way of preventing such unthinkable situations.

Is it ethical for the recipient to assume a likeness that belies his or her true identity? You could argue that radical plastic surgery is not substantially different than a facial transplant. But a fundamental difference is that the face, the one definitive, unique identification of an individual, is more than altered � it used to belong to someone else!

And what about the slippery slope argument? Without a doubt, people of all ages dissatisfied with their looks will be lining up to get a new face. Members of the British royal family likely wouldn't think it's a bad idea � and the rest of us would be hard pressed not to agree.

THE DECISION
In the final analysis, after all the arguments are weighed, this issue may come down to that important yet rather non-scientific phenomenon known as 'the yuck factor.' Most people will likely feel a shudder when pondering this issue. It just doesn't seem right to use a face twice! Can humanity tolerate an assault on something most people hold sacred � the individuality and uniqueness of the human face?

There are no easy answers here. Being facially disfigured is an unspeakable tragedy. Fixing it by borrowing someone else's, however, could be an even greater one.

Dr Mark Bernstein is a neurosurgeon with a strong interest in ethics. Readers are invited to submit ethical challenges for his consideration. Please write to [email protected]