Monday, September 19, 2005

Should this be permitted?

Doctor Pushes for First Face Transplant

Sep. 17, 2005 - In the next few weeks, five men and seven women will secretly visit the Cleveland Clinic to interview for the chance to have a radical operation that's never been tried anywhere in the world....

They will smile, raise their eyebrows, close their eyes, open their mouths. Dr. Maria Siemionow will study their cheekbones, lips and noses. She will ask what they hope to gain and what they most fear.

Then she will ask, "Are you afraid that you will look like another person?"

Because whoever she chooses will endure the ultimate identity crisis.

Siemionow wants to attempt a face transplant....

The "consent form" says that this surgery is so novel and its risks so unknown that doctors don't think informed consent is even possible.

Here is what it tells potential patients:

Your face will be removed and replaced with one donated from a cadaver, matched for tissue type, age, sex and skin color. Surgery should last 8 to 10 hours; the hospital stay, 10 to 14 days.

Complications could include infections that turn your new face black and require a second transplant or reconstruction with skin grafts. Drugs to prevent rejection will be needed lifelong, and they raise the risk of kidney damage and cancer.

After the transplant you might feel remorse, disappointment, or grief or guilt toward the donor. The clinic will try to shield your identity, but the press likely will discover it.

The clinic will cover costs for the first patient; nothing about others has been decided.

Another form tells donor families that the person receiving the face will not resemble their dead loved one. The recipient should look similar to how he or she did before the injury because the new skin goes on existing bone and muscle, which give a face its shape....

It took more than a year to win approval from the 13-member Institutional Review Board, the clinic's gatekeeper of research. Siemionow assembled surgeons, psychiatrists, social workers, therapists, nurses and patient advocates, and worked with LifeBanc, the organ procurement agency she expects will help obtain a face....

Despite its shock factor, it involves routine microsurgery. One or two pairs of veins and arteries on either side of the face would be connected from the donor tissue to the recipient. About 20 nerve endings would be stitched together to try to restore sensation and movement. Tiny sutures would anchor the new tissue to the recipient's scalp and neck, and areas around the eyes, nose and mouth.

"For 10 years now, it could have been done," said Dr. John Barker, director of plastic surgery research at the University of Louisville, where the first hand transplant in the United States was performed in 1999.

Several years ago, these doctors announced their intent to do face transplants, but no hospital has yet agreed. They also are working with doctors in the Netherlands; nothing is imminent.
The article is a bit longer than what I quoted here, and very interesting, especially considering doctors have been able to do this for a decade now. This is nothing like "Face-Off" with Nicholas Cage and John Travolta, with its implausible (insofar as our current medical technology) premise that requires reshaping facial muscle and altering the underlying bones, not just the entire facial skin graft that Dr. Siemionow plans to do.

I cannot find any reason that a medical body or government can or should prevent the doctor from performing such surgery on a consenting patient, using facial skin obtained from a cadaver with the deceased's survivors' consent. The consent form should be extremely frightening because of its sheer uncertainty: "We don't even know what could happen to you," in essence. That should make a potential patient very wary, and Dr. Siemionow's personal interviews will weed out those she believes harbor secret doubts.
The care of every man's soul belongs to himself. But what if he neglect the care of it? Well, what if he neglect the care of his health or estate, which more nearly relate to the State? Will the magistrate make a law that he shall not be poor or sick? Laws provide against injury from others, but not from ourselves. God Himself will not save men against their wills.
What Thomas Jefferson said applies more to my immediately preceding entry on the market solution to obesity, but the last two sentences do apply here. No one is being coerced into this highly experimental procedure, and to some it may well be worth the risk (and any medical costs once Dr. Siemionow starts charging for it). Any medical boards and governments that deny a voluntary procedure to patients are simply deny people the freedom to assume risks for themselves, in a perfectly voluntary transactions that harm no one else.

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