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Noted Bioethicist: “Give Face Transplant Woman Option of Assisted Suicide”

LifeSiteNews.com

 By Thadddeus M. Baklinski

CLEVELAND, Ohio, December 22, 2008 (LifeSiteNews.com) - Dr. Arthur Caplan, Chair of the Department of Medical Ethics and Director of the Center for Bioethics at the University of Pennsylvania in Philadelphia, was quoted by the Associated Press as saying that the woman who was given an near-total face transplant recently should be offered the option of killing herself if the operation proves unsuccessful.

"The biggest ethical problem is dealing with failure — if your face rejects. It would be a living hell," said Caplan. "If your face is falling off and you can’t eat and you can’t breathe and you’re suffering in a terrible manner that can’t be reversed, you need to put on the table assistance in dying."

The patient, whose name and age were not released, underwent a 22 hour procedure at the Cleveland Clinic that reconstructed 80 percent of her face after she suffered an undisclosed trauma.

Francis Papay, chair of dermatology and plastic surgery at the Cleveland Clinic explained the surgery at a news conference held last week.

"We transferred the skin, all the facial muscles in the upper face and mid-face, the upper lip, all of the nose, most of the sinuses around the nose, the upper jaw including the teeth, and the facial nerve."

The face transplant was the fourth done worldwide, with two having been done in France, and one performed in China.

The procedure raises the ethical questions of not only what to do in the event of failure of the operation, but also the source of the face used in the transplant and how it was acquired.

Unlike transplants involving vital organs like the heart or liver, face reconstruction is done to improve quality of life, not extend it, and the recipient still runs the risk of life-threatening complications and must take immune-suppressing drugs for the rest of their lives; but this may be the first time a medical ethicist has publicly stated that a transplant recipient should be offered assisted suicide in case of organ rejection.

The AP report indicated the tissue used for the reconstruction was taken from "a female cadaver." The hospital’s bioethics chief, Dr. Eric Kodish, said the circumstances and procedures followed for the donation and transplant were “beyond reproach.”

The ethical question of the harvesting of organs for transplant and the contentious concept of “brain death" was raised in the controversy over the first-ever face transplant surgery conducted in France in 2005.

Dr. Iain Hutchison, an oral-facial surgeon at Barts and the London Hospital, told the BBC concerning the procedure carried out in France: "The transplant would have to come from a beating heart donor." Hutchison, who is chief executive of Saving Faces - the Facial Surgery Research Foundation, explained, "So, say your sister was in intensive care, you would have to agree to allow her face to be removed before the ventilator was switched off."

According to Dr. John Shea, medical consultant for Campaign Life Coalition, "there is no general agreement that brain death is death."  He explained that the "criteria for establishing ‘brain death’ vary from England to the US and through the other countries of Europe."

The fact that the face used in the Cleveland Clinic operation had to come from a live donor - heart beating and still breathing - in order to be transplanted has not been addressed by University of Pennsylvania ethicist Dr. Caplan.

Read related LifeSiteNews article:

First Ever Face Transplant - Face Came from Live Donor
http://www.lifesitenews.com/ldn/2005/dec/05120907.html

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