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facial transplantation and identity

Newspapers recently showed pictures of two people, a man and a woman, who underwent facial  transplantations after serious accidents disfigured a large part of their faces. Both recipients were satisfied with the result, and they hope they can now resume a normal life, just like the first woman to receive this kind of transplant five years ago.

However, it has been suggested that this kind of intervention is immoral and should not be allowed because the recipient will have a completely different face, and, since face is strongly connected to personal identity, this kind of transplantation could change patients’ self perception of identity or even their identity itself.

The concept of personal identity is very controversial. In this case, where we are talking about the very specific issue of identity in relation to facial features, I will argue that this kind of objection is irrelevant and based on wrong assumptions.

If we want to assume that personal identity changes along with facial or bodily changes, then we will have to clarify some concepts.

As human beings, our faces are subjected to constant changes, for example through aging or, in some cases, through cosmetic surgery. Who can easily identify the face of his eighty years old grandfather  in a photo in which he was a child? Or who is able to recognize Michael Jackson in pictures taken in the years before before his cosmetic surgery?

Facial features change: there is nothing new or exceptional or immoral in this. What makes the  case of  face transplants unique and different is that this change is  radical, an unwanted and sudden change which occurs after tragic events. I think the problem is a matter of degree and  circumstances, not a fundamental problem with changing the face itself.

To me, it is obvious that the identity of that person understood as an identity connected to those specific somatic and physical characteristics is not lost as a result of the transplant, but lost long before, when the original accident deprived the victim of the somatic features she believed important to identify herself as that specific and unique individual. So claiming that facial transplantations are immoral as they change the identity of a person, is inappropriate, since the change, if it has happened, has happened before the transplant.

It is hoped that we will soon be able to use stem cells to rebuild and reshape individual faces so that they are as similar as possible to their appearance before the accident. Until that time, face transplants are the only good option we have to offer. To object on the grounds of identity is a mistake, and while we have no good alternatives available, if such objections are pandered to, may rob victims of the chance to live a normal life.

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3 Comment on this post

  1. Of course “identity” is changed by a facial transplant, much more than by a face-lift or cosmetic surgery (which after all leaves enough to tell who the person is by relating that person to who the person was before the surgery). By “identity”, I mean social identity — what identifies this persons to others, both as to name and as to those intangibles that we associate with the way the person’s face looks. On the other hand, is it unethical to undertake or undergo this operation?

    To undertake this operation, all the chief surgeon needs to do is to make sure that the subject understands what he or she is giving up and what he or she is gaining. That’s easy, isn’t it, given what the patient has at the time. If the patient does not understand what is going to happen, its costs and benefits, the patient should be given more information and perhaps psychiatric counselling, But, from the point of view of a rational person, I really can’t see any objection unless it is related to some duty to oneself to preserve that person’s personhood. I have a real problem with the concept of a duty to oneself. Kant had to use it as a way of tying up loose ends that otherwise went afray. As to personhood, or the integrity of one’s own (what?), that has been irretrievably damaged by the circumstance that required the transplant.

    To undertake and undergo this operation is ethical if the purpose is ethical — making the patient more acceptable company in the social system — and not fraud. Maybe there is another ethical objection — similar to the objection to breast implants (for other than strippers or breast cancer patients) or serious cosmetic surgery. There are some ills that can’t be cured, and it is unfair to the patient to give him/her the hope that they will be cured by a change of appearance.

  2. It is interesting to read that lay people consider ethical issues in facial transplantation as related to a change of identity.
    Orthognathic procedures (surgical corrections of facial harmony by orthopedic surgery) in conjunction with soft tissue procedures (otoplasty, rhinoplasty, microfatgrafting etc…) are performed on a daily base, do not raise this issue and do not provoke such a fuzz. In contrast, they really do change the structural build-up of a face more dramatically than a facial soft tissue transplant; that can be compared with exchanging the canopy of a bed. Its size, framework and shape do not change.
    Besides, the eyeballs and eybrows (!) have not been exchanged yet in any of the transplant patients. And these are the most importaant features used in facial recognition! There are no reports of mistaken identity in the small series of facial transplants.

  3. Francesca Minerva

    You have to compare with what the alternative is. The alternative is no face at all ( or if you prefer, something even further from what was her face before the accident). What was this person supposed to do? This is the best surgery science can offer at the moment, hopefully in the near future stem cells will allow us to have a better result.

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