Face Planters Do Face Plant?

Recently a reader e-mailed me regarding the ethics of face transplants, such as the one recently done in France.

I haven’t had a chance to fully research the facts of that case–and researching them is apparently somewhat difficult since there is considerable (and MOUNTING) dispute over what the facts in the case actually are.

Let me give what I think are some general principles, though:

1. Any part of the body–except the brain as a whole (since it is the seat of the personality)–is in principle transplantable provided (a) that you don’t kill the donor and and (b) that you don’t do more OR EQUAL harm to the donor than the benefit that the recipient will derive and (c) that the donor’s wishes aren’t violated and (d) there isn’t an acceptable alternative to transplantation–though let’s ignore this criterion for the moment.
2. If you were to transplant a face from a deceased person then (a) and (b) are taken care of, leaving you with (c). If the donor donates his face after his death, I don’t presently see a fundamental moral barrier to the procedure (ignoring condition [d]).
3. If the person is not "dead" but only "brain dead" then the question of whether (a) and (b) are met depends on whether you consider "brain death" an adequate criterion for "death." John Paul II expressed openness (in a document whose level of magisterial authority is not fully clear, though it certainly is not infallible) to using brain death as a criterion of death, but many Catholic moral theologians, physicians, and others (including myself, Bishop Fabian Bruskewitz, Bishop Robert Vasa, Fr. Benedict Groeschel,
   Charles Rice, Paul Byrne [past president of the Catholic Medical Assn.]) have significant reservations about this, both on a theoretical and practical level. On the theoretical level, is "brain death" really an adequate criterion for somatic death? On a practical level, the medical establishment has been infected with an anti-life ethic whereby numerous physicians have sought to expand "brain death" via loosey-goosey criteria that make it a declaration of brain death untrustworthy for practical purposes. If, though, you view "brain death" in the current environment as an adequate criterion of death then this case becomes equivalent to (2), above. If not, it becomes equivalent to (4), below.
4. If the donor is not dead and transplanting the face can be done without killing him (which is possible if fatal infection can be prevented) then condition (a) is satisfied. If the person also does not object to his face being transplanted then condition (c) is satisfied. That leaves us with condition (b). Here we run into a HUGE problem. While faces are non-vital organs (you CAN potentially live without them, as some accident victims can attest), it is difficult under normal circumstances to see how the removal of one person’s face so that another may have it would not constitute an immoral MUTILATION of the first person. While one person can sacrifice a good in order to provide a greater good for someone else, mere exchange of one face for another does not does that. It’s sacrificing one bodily good for (at most) an equal bodily good, which seems to be an impermissible mutilation of the donor.
5. To avoid the problem in (4), some have suggested removing faces from donors who are in a "persistent vegetative state." The argument, presumably, would be something like, "Hey, the donor isn’t using his face anyway, so why shouldn’t the recipient have the benefit of it? This way the good to the recipient outweighs the harm to the donor." This seems like an extraordinarily problematic course of action. First, a declaration that a person is in a PVS is another one of those things that–in the present, anti-life medical environment–is notoriously unreliable due to loosey-goosey criteria. Second, the fact that someone is in a persistent vegetative state does not mean that the person is in a permanent vegetative state. There is a chance (that will GROW WITH TIME as medical technology advances over the next few decades as nanotechnology comes online) that the person will recover from their "vegetative" state. Because of this possibility, it is not clear that the benefit to the recipient will outweigh the harm to the donor. How would you like to wake up and find that your face had been given to someone else?
6. One could say, in response to the concern that a patient might wake up and find his face gone is that, as medical technology advances we could also build him a new face. But this sword cuts both ways. As medical technology advances we could ALSO build a better face for the recipient WITHOUT a transplant. And we can do that NOW. This brings us back to the ignored condition, (d). True, an artificial face is not as good as a natural one, but it is a REAL POSSIBILITY. We can get skin and cartilage and bone–OR SUBSTITUTES FOR THEM–from a variety of sources that don’t require transplanting someone’s face. An artifically constructed face may not be as good as a natural one, but it may be "good enough" given the need for the harm done to the donor not to equal the benefit to the recipient.

It therefore strikes me that the prospect of face transplants is beset by extraordinary difficulties, even if a categorical rejection of it (per point [2]) is not immediately clear.

While the face may not be a vital organ, it is nevertheless a part of the body to which humans naturally attach ENORMOUS significance, and this puts it in a special category.

We might propose a taxonomy of body parts ranging from (1) the seat of the personality [the brain] to (2) unique vital organs [the heart, the liver] to (3) unique crucially important organs [the face] to (4) non-unique vital organs [lungs, kidneys] to (5) non-unique, non-vital organs [corneas, patches of skin, volumes of blood]–with it being progressively harder to have morally legitimate transplants as one moves up the scale, with it being impossible to transplant from a live person by the time one hits (2) and impossible to transplant from any person by the time one hits (1).

To point to the elephant in the living room: We naturally feel a profound sense of horror and revulsion at the idea of transplanting a face, particularly from a non-dead person, and we should GO WITH THAT FEELING.

I am reminded from the scene in Jurassic Park where Jeff Goldbulm says, "You were so preoccupied with whether or not your COULD that you didn’t stop to think if you SHOULD!"

That sounds very much like the current situation in France.

Many research-oriented doctors today are so concerned with trying out new techniques and being the first to do something that they totally ignore moral considerations such as those expressed above.

As the current French situation seems to be illustrating.

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Author: Jimmy Akin

Jimmy was born in Texas, grew up nominally Protestant, but at age 20 experienced a profound conversion to Christ. Planning on becoming a Protestant seminary professor, he started an intensive study of the Bible. But the more he immersed himself in Scripture the more he found to support the Catholic faith, and in 1992 he entered the Catholic Church. His conversion story, "A Triumph and a Tragedy," is published in Surprised by Truth. Besides being an author, Jimmy is the Senior Apologist at Catholic Answers, a contributing editor to Catholic Answers Magazine, and a weekly guest on "Catholic Answers Live." View all posts by Jimmy Akin