Is Face Transplant an Identity Transplant?
John Lantos, MD
December 18, 2008
A few weeks ago, surgeons at The Cleveland Clinic performed “a face transplant.” News reports of this remarkable technological achievement almost always include comments from bioethicists who, as bioethicists tend to do, urge caution, worry about consequences, and wonder about the patient’s autonomy.
Perhaps it might be more appropriate to urge awe and wonder about our interconnectedness.
Certain ethical issues accompany all medical innovations. Nobody really knows the long term risks or benefits. Great hopes might be dashed by unforeseen complications. Progress has inherent perils. The first patients can be harmed rather than helped. All this has been true for prior pioneering transplantations of heart, liver, kidney, and intestine.
It has also been true for cancer chemotherapy, immunizations, and other medications. What, then, is really new and different about face transplantation?
The face is visible in a way that internal organs are not. Further, it is visible in a way that is highly associated with one’s individual identity. If we have someone else’s face, are we really and truly our self? Do we become, in some weird way, the donor? Is a face transplant really an identity transplant?
The relationship between transplanted body parts and transplanted identities has always been a concern. Fiction writers have explored this territory more than have scientists.
John Irving’s novel, The Fourth Hand, imagines a hand transplant in which the recipient gets not only the physical hand but much of the life of the donor. Robert Heinlein’s I Will Fear No Evil imagines a brain transplant, and one in which the brain of an old man is transplanted into the body of a young woman.
Both novels deal with the scintillating concerns that a transplant can never be simply of tissue, that when we put bodies together, we also put souls and psyches together. Tabloid newspapers get it. (The Daily Mail, in the UK, had a recent headline, “I was given a young man’s heart – and started craving beer and Kentucky Fried Chicken.”)
Even transplant surgeons themselves worry. Anthropologist Margaret Lock quotes a surgeon who was a little queasy about the possibility of obtaining organs from death row prisoners, “I wouldn’t like to have a murderer’s heart put into my body. I might find myself starting to change.”
The fact is that transplantation of body parts creates a strange and unique bond between donor and recipient. A gift has been given that is like no other – a gift of self that crosses the boundary between life and death. The families of donors often cling to a belief that their loved on “lives on” because a body part is still alive. Recipients often talk of being reborn, or of not being the same person that they were before.
Face transplants differ from other transplants in degree, not kind. All transplants, all use of the body parts of other people, reflect the subtle ways in which we are interconnected and almost interchangeable with one another.
There is beauty in that, as well as fear and trembling. We shouldn’t shrink from the new responsibilities that our new powers foist upon us. But we shouldn’t minimize or simplify those responsibilities, either. We should never do things simply because we can, but neither should we avoid doing things simply because they raise frightening new ways to think about who we are or who we might become.
We are blessed by scientific breakthroughs that enable us to take care of each other in new, spooky, and miraculous ways. Our interconnectedness should generate in us a sense of awe, wonder, and, ultimately, responsibility.
We can harm each other. We can take care of each other. We can choose. The surgeons, the bioethicists, the patient and the families of the donor and recipient all chose to improve life in a way that was only possible through extraordinary human interconnectedness. They have taken risks for us.
They have done a brave and good thing.
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First U.S. face transplant completed at Cleveland Clinic, USA Today, December 16
Transplanting a Face: The Ethical Issues, New York Times, December 17
Is face transplant worth risking patient's life?, Arthur Caplan, Ph.D., December 17