Face Transplant Surgery Raises Ethical Questions

When we think about the people in our lives, regardless of the nature of our connection, it’s their faces that we imagine. The face is the outward representation of who we are, a reflection of what lies within, the part of us that we present to the world. Faces are the means by which we recognize others. Faces are such an intrinsic part of our identity that we even conjure into being the faces of people we have yet to meet – for example, I’m certain that I know what my colleagues here at Blogcritics look like, because I’ve imagined them all, in spite of not having met any of them – face to face, as it were. Who among us reads a book without drawing a mental portrait of the characters inside? When we look into our mirrors, who do we see?

We lavish a great deal of attention on our own faces. Men shave theirs, or tend carefully groomed beards and moustaches. Women moisturize, exfoliate and paint theirs, and often, when gravity and time begin to exert their effects, seek surgical intervention to repair the ravages of age. We fix our chins, our noses and our eyes in order to make them conform, for better or worse, to some ideal.

There are many colloquialisms involving faces – we have our poker faces for those times when we choose to keep our feelings to ourselves, and we have moments when our emotions are vividly etched upon our face, which is then said to be “like an open book.” We have game faces for when we need to psych ourselves up; we put on a happy face when we might not feel so happy; we save face when we try to avoid embarrassment; we face off with our adversaries; we reserve some face time with people we want to connect with in person; and we face the music when we need to own up to our misdeeds. We read each other’s faces to divine character and intent; we fixate on the faces of our loved ones. We are haunted by the faces of the dead.

Given the personal and social significance of this part of the human anatomy, it’s not surprising that the news of the world’s first face transplant, which took place last week in France, was met with mixed emotions by many in the medical community. The patient, a 38-year-old woman who had been irreparably disfigured by a dog attack, received the nose, lips and chin of an unidentified donor. Amidst criticism that they failed to try traditional reconstructive surgery first (which is one of the ethical guidelines established for this procedure), the French surgical team which performed the transplant has defended its actions on the basis of the severe nature of the woman’s injuries, claiming that traditional reconstructive techniques would not allow for the muscle repair that would have restored the woman’s ability to eat and speak normally. Although surgeons have had the technical capability to perform such transplants for quite some time, the procedure is considered to be fraught with ethical considerations, not the least of which is the psychological impact that such an operation might have on the patient. There is also a risk, common to all organ transplants, that the transplanted tissue will be rejected by the recipient’s immune system, which necessitates a lifelong regimen of immune-suppressant drug therapy, which is itself not without consequences. The possibility of rejection raises the issue of having to deal with the reality of that scenario, which would have both physical and psychological ramifications for the patient and the patient’s family.

If you’ve seen the John Woo thriller, Face/Off, in which John Travolta and Nicolas Cage swap identities via a seamlessly (and unrealistically) perfect face transplant, you might be thinking that this type of surgery results in the recipient looking exactly like the donor. Surgeons are hoping that in the case of the French woman, her own underlying skeletal form will eventually shape the features of the transplanted facial musculature so that she will look somewhat like herself. Ethical guidelines for facial transplant warn against transplanting an entire face, presumably to lessen the impact of a total transformation of a patient’s appearance.

Facial disfigurement due to injury or disease certainly alters the life of the person so afflicted. We instinctively recoil from the sight of facial disfigurement, much more so than we do from the sight of other injuries such as amputated limbs. The possibility of a more normal appearance would obviously have great appeal to these patients on many levels, and restoring both appearance and function seems a worthier use of surgical skill and training than does breast augmentation or cosmetic surgery done for the sake of vanity.

Advances in technology often require the careful balancing of risk and benefit, and as medical science continues to push the boundaries of what is possible, it must also be mindful of the possible consequences of every breakthrough. The psychological consequences of face transplant surgery for patients, their families, and the families of donors are as yet unknown. Certainly the question of who we see when we look into the mirror is not a trivial one for most of us – it has even more of an impact for those whose faces have been altered beyond their original appearance, whether by the hand of fate or, now, that of science. For now, the French woman is recovering, at least in the physical sense; the rest remains to be seen.