Friday, December 02, 2005

The Mirror Has Two Faces: The face transplant in France is stirring controversy among plastic surgeons. Is it a matter of ethics or jealousy?

Doctors who gave a French woman the world's first partial face transplant did not try normal reconstructive surgery first, violating the advice of a French government ethics panel, a surgeon familiar with the case said Thursday.

Dr. Laurent Lantieri also said he was concerned the patient may not be fit psychologically for the operation and its demands.

....Lantieri, who developed his own plans to attempt a partial face transplant, said members of Dubernard's team contacted him last spring, seeking details of his protocol.

According to this story, the patient lost part of her face when the family dog bit it while she was in a drug-induced stupor after a suicide attempt. It isn't clear why a history of severe depression should exclude one from a face transplant. In this video of the press conference (mostly in French, but some English), her surgeon says that her face was so badly injured that the scar tissue was keeping her from being able to open her mouth.

While it's true that having a transplant of any kind runs the risk of tissue rejection, which would be particularly unpleasant on the face, but that's a risk that anyone who undergoes the procedure would face. Wouldn't someone with a history of depression be more likely to suffer from a terrible disfigurement than someone with a healthy psyche? Her entire face wasn't removed and replaced, just a portion of it, frome her lips to part of her nose. (See the video link to the press conference above.) The end result is here.

As ethics go, it's hard to see why this should stir controversy. Compared to, say, embryonic stem cells or euthanasia or abortion, this seems like small potatoes. You have a patient - a consenting adult - making a treatment decision that will affect herself alone and no one else. And in this case, the treatment is being done not to disguise her identity or to answer some yearning for youth, but to repair a terribly disfiguring injury. Few of us could suffer the loss of our faces with equanimity. Considering the extent of her injuries, it doesn't at all seem inappropriate to have tried the transplant.

P.S. For an excellent memoir of living with disfigurement, read the book Autobiography of a Face by Lucy Grealy, who, sadly, lost her struggle.

 

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