Month: December 2005

Guest blogger Ron Belgau writes:

I read your blog post today on face transplants, and it provoked a tangential train of thought.  It’s not one I’d want to endorse, but thought I’d send it along for your enrichment (if that is the right term).

Two things caught my attention: first, the prohibition on brain transplants due to the fact that the brain is the seat of the personality, and second, the statement that brain death may be a legitimate criterion for death.

It seems to me that, based on those two considerations, one could make an argument for brain transplantation, with a twist.

Suppose that A receives a gunshot wound to the head which causes brain death (we will assume brain death of a sort that would be acceptable to the most pro-life physician, not just medical community vulture brain death), but leaves his body undamaged.  Meanwhile, B is in a very serious car accident in which his body is damaged beyond all repair, but his brain is undamaged.

It seems to me that within the framework you have offered, one *could* argue that, if it were technically feasible, it could be morally justifiable to transplant B’s brain into A’s body.

In any case, the proper description for this situation would be to say that A had died, and that B was alive in A’s body.  Although from the medical perspective, it probably makes sense to say that we transplanted B’s brain into A, from the moral perspective, what we would want to say is that we had transplanted A’s body to B.

I’m not sure what I want to say about a case like this.  It seems like it could be justified, on the grounds that if we don’t do it, both A and B will die (assuming brain death is a legitimate criterion for death, which *seems* legitimate if we say that the brain is the seat of the personality), while doing it will allow B’s personality to live on, and potentially live a long and productive life.

At the same time, the personal and social identity issues with this case are far more problematic than those involved in the face transplant issue.  One can also imagine a number of particularly ugly ways that this kind of technology could be abused: criminals seeking a new identity, aging Hollywood stars and starlettes looking for the ultimate makeover, etc.

No, you’re quite correct. IF "brain death" (suitably defined and verified) is an adequate criterion for death then you could do PRECISELY this kind of full-body transplant.

Under the scenario you describ you could also snip off both their heads and sew B’s head onto A’s body.

This is one of the things that causes me and others to have significant questions about whether "brain death" in an adequate criterion for somatic death. While the death of the brain may be a necessary condition for the death of the body, it isn’t clear to me that it’s a sufficient condition for the death of the body. I kinda want the rest of the body to die, too–as a whole. I’m not talking about fingernail beds and hair follicles and minor systems like that. I kinda want overall systemic failure before I say that the system of the body is dead, not just the technologically irreversible cessation of brain or higher brain function.

I also think that what counts as technologically irreversible cessation or brain or higher brain function is going to look VERY different once nanotechnology comes online over the next 20-30 years, making our present understandings of what counts as brain death JUST AS INVALID as the cessation of heartbeat definitions of death that were used a hundred years ago.

If you started cutting someone up back then just because their heart stopped beating 20 seconds ago then you would be cutting up someone who was really not yet dead.

People back then weren’t dead the moment their hearts stopped beating. More has to happen to the heart for death to occur than just a cessation of its activity. If it can be jumpstarted then the person simply was not at the point of death, even if his heart could not THEN have been brought back online due to lack of technology.

In the same way, just because a person’s brain has ceased functioning does not mean he’s dead if it turns out that there’s a technology 30 years from now that will jumpstart his brain.

If nanotechnology has the promise that it seems to at this point and we use brain death as a criterion then half a century from now we are LIKELY to find out that we’ve been cutting up people for parts who were STILL ALIVE, we just didn’t have the ability to bring their brains back online yet.

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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