Vulnerability and the Ethics of Facial Tissue Transplantation

Abstract

Two competing intuitions have dominated the debate over facial tissue transplantation. On one side are those who argue that relieving the suffering of those with severe facial disfigurement justifies the medical risks and possible loss of life associated with this experimental procedure. On the other are those who say that there is little evidence to show that such transplants would have longterm psychological benefits that couldn’t be achieved by other means and that without clear benefits, the risk is simply too great. Ethicists on both sides have called for more analysis of the link between the face and personal identity in order to get a better grasp on potential gains and losses. This paper responds to that call by looking at contemporary philosophical analyses of the relation between organ transplants and personal identity and between the human face, human dignity, and human vulnerability. It is argued that the face matters not because it is the unique marker of our identity, but because of its role in the intersubjective constitution of moral identity and human dignity.

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Notes

  1. 1.

    Guoxing is reported to have stopped taking the immunosuppressive drugs in favor of herbal medicines, though the circumstances that led to his actions are unclear. “Chinese face transplant Li Guoxing dies,” Available at: http://www.news.com.au/story/0,27574,24829166-23109,00.html (accessed on 25 March 2009).

  2. 2.

    The techniques for inducing tolerance without immunosuppressive drugs will involve, as Jones notes, experimental limb transplants in large animals; however, he makes no mention of the ethical issues associated with large animal research.

  3. 3.

    Carson Strong makes a similar point: “If we assume... that the three-year graft survival for face transplants would be equivalent to the best success rates [for solid organ transplants] according to the most recent UNOS data—that is approximately 80 percent—this would imply that, at best, one in five facial transplant recipients will lose the graft within three years” (Strong 2004, 14). In fact, these numbers reflect the current state of facial transplant (with one loss of graft and loss of life out of 4 transplants since the inception of such surgeries in 2005). It must be noted, however, that hand transplant numbers are better and may be a better source of comparison with facial CTA.

  4. 4.

    The ontology of being-with that Nancy later develops in Being Singular Plural (and is still on the way to developing when Corpus is written) thinks bodies as the spacing between, the border or line of separation that allows beings to appear as distinct from one another but that equally serves as the point of their connection and contiguous existence. Bodies, for Nancy, do not have limits, they are limits. Moreover, every body is multiple limits: every body divides and relates to itself and to others along multiples borders.

  5. 5.

    The French committee’s report likewise emphasizes that facial disfigurement from accident or disease can severely disrupt one’s sense of identity and ability to relate to others and sees this point as directly relevant. They note that risk of graft rejection is likely to be downplayed by recipients who desperately desire a more functional face, while the event of failure will invariably leave recipients worse off than they were before transplantation.

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Correspondence to Diane Perpich.

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Perpich, D. Vulnerability and the Ethics of Facial Tissue Transplantation. Bioethical Inquiry 7, 173–185 (2010). https://doi.org/10.1007/s11673-010-9236-4

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Keywords

  • Face transplants
  • Risk-benefit analysis
  • Vulnerability