Brain transplant: legal and medical ramifications?

Great Debates
1

Robert Heinlein wrote a book called “I Will Fear No Evil” in which a rich old codger named Johann Sebastian Bach Smith cheats death by arranging to be the first successful human brain transplant. As he failed to specify what kind of body he wanted, apart from “young and healthy,” he ended up in the body of a young woman — actually his now-deceased secretary, Eunice.

Since the time of that book, much has been learned about transplant that he glossed over at the time. I’ve undergone kidney/liver transplant myself and the book’s omissions are, to me, quite glaring.

Some of the book focused on the legal hurdles: proof of identity, whether the old man was “dead” and his will should be read, and so on. Many of the points strike me as somewhat old-fashioned. The book is crying out to be rewritten for the modern day.

I’m asking for input and debate here because I’m not sure there’s a right answer. Consider this a thought experiment.

  1. Assume the transplant is possible. I realize that it almost certainly is not, with today’s technology, but Heinlein didn’t worry about it and neither will we. For the sake of argument, the brain is living but the body is cadaveric.

  2. Heinlein’s story featured a rogue ex-pat Australian doctor living in China performing an operation in a private facility. Is this the only realistic way such research would ever be done? Would any traditional medical facilities ever touch such an experimental procedure that may be fraught with such legal peril?

  3. What kind of disclaimers and waivers and guarantees and legal fine print would that hospital use to protect itself? Today’s litigious society almost demands that any facility in the western world line up its ducks before performing such an experiment on humans, lest it face lawsuits for malpractice. Can a patient agree to be a subject for such an experiment and sign away his family’s right to sue in the event the operation fails?

  4. Medically, would this be a brain transplant or a body donation? The patient, identified by his brain, is receiving a body; but the organ, the brain, is what is being transferred. What do you call it?

  5. What about transfer of property ownership? Assuming the courts decide that the brain (the patient’s real self) is the source of identity, the patient/brain would still own, and have access to, all its previous belongings; and none of the body’s. Do you suppose the body’s creditors would be after the patient/brain to pay the body’s old debts? Who else would have a stake in preventing proper proof of identity? And what if the body had had an artificial hip or something, would that be repossessed?

  6. In “I Will Fear No Evil” the patient Johann was declared female by the court, as he had inherited a female body from the operation. But he was also declared to be Johann. There was no legal wrangle for Johann (Joan) to get married. Heinlein made nothing of this can of worms — wouldn’t some Family Marriage Defense Cult object to such a patient having a man’s brain but marrying a man? What would this mean for others?

  7. Suppose for the sake of argument that the body (cadaveric donor) was legally underage (say, 17). What would be the legal status of the patient/brain be, in an underage body? What additional legal hurdles would there be?

  8. What medical complications can you imagine arising from a brain transplant? For instance, the old brain has a new set of eyes with a different balance of rods and cones may experience a shift in color perception. Also… what if the brain were right-handed and the body left-handed?

  9. A body suitable for donation would, in theory, be suitable to be harvested for ten patients to get kidneys, liver, heart/lungs, corneas, long bones, skin, pancreas, etc. A whole body going to a single patient — is this so wasteful that it’d never be done, and would it be preferable to split up those resources? Would somebody sue? Could they sue?

2

I think they would. Really, I don’t think it would be such a big deal, legally. The only exception would be the gender issue as mentioned below, and that hasn’t stopped gender reassignment surgery yet.

They experiment on humans all the time; every new technique has to be tried out for the first time at some point, after all. I don’t think it would be legally any different than, say, signing up to be the first to undergo a novel form of heart transplant.

I’d call it a body donation.

They might try, but I doubt they’d get anything. Brain = ID just seems too clear cut.

I don’t think you can do that even to the orignal owner, much less a third party.

Ohhhhh yeah, they’d freak. But then, they always do over normal gender reassignment, anyway ( or whatever the PC term is at the moment ).

Logically, the brain’s age.

I bet that all that would happen is that the new occupant of the body would shortly make the body right handed, by simple exercise of the former “off” arm. As for other situations, it’s hard to tell. Gender switching might cause problems with balance and coordination; that comes to mind, given that males and females have a different center of gravity and limb proportions.

If the person is damaged badly enough, then they may need the whole body replaced anyway. Until we learn to clone whole brainless bodies, I expect they will decide according to the needs of the patient. Some guy suffering from multiple organ falure and general deterioration would get the whole body, while someone who just needs a new heart would get that. As well, the condition of the body would come into play; I expect that many organ donors have suffered more damage than simple brain death.

3

The two most significant medical complications are, of course that:
-You can’t remove a living brain from a body without causing it massive damage - like a walnut, only more so, it’s just impossible to get out of the shell in one piece, especially if you’re in a hurry, and you will certainly be in a hurry if you’re trying to keep it functioning.
-You can’t implant a brain into another body; we just don’t have anything like the ability to install it properly, connecting up all the necessary bits and bobs (again, which the clock ticks away) - I suppose you could posit some magical nanotechnology - that’s what people normally say.

The visual system is a really weird thing; the eyes are really just a part of the brain that opens on the outside world - the brain is, to a certain extent, custom-wired during development, so even if you were able to join up all the nerves in what appears to be the right configuration, it might not even come close to working; as a possibly useful analogy, take a Windows Laptop and an Apple Powerbook; cut them both in half with a chainsaw and make a new machine out of half the PC and half the MAC; solder together any connections that appear to terminate in more or less the same place and fix anything else up with duct tape. What kind of programs do you think it will support?

I think handedness is almost entirely a brain thing, although after a lifetime of right-handedness, muscles will be asymmetrically toned and developed and joints may be more or less supple on one side than the other.

4

While I couldn’t even begin to postulate any of the moral or legal ramifications of attempting something like this, I just have to say - this is one of the most intriguing threads I’ve ever read.

~Tasha

5

I’m well aware that it is impossible with current technology. See the OP, wherein I set forth the assumption that it does work.

What I mean by medical complications was not in the traditional sense of what can go wrong during a surgery. I gave some examples — call them complexities instead, perhaps — of where the body is accustomed to doing things one way, but the brain a different way. Color perception and handedness came to mind, as does gender. Speech accent is another — is that entirely in the brain, or partially because the motor pathways to the tongue become strongly adapted to certain configurations and atrophy in others? Hormone production also leaps to mind. Food likes and dislikes, photic sneeze response, penmanship, that kind of thing. How much of a person is body and how much is brain, and what if you mix the two?

As far as handedness, I wish I knew more about how nervous system signals are transmitted. Given the idea of phantom limb syndrome, it almost seems as if the nerves have some kind of … I dunno, reflex action, automatically sending signals for things you do routinely.

6

I’m not sure it’s this simple.

For one, if a 65-year-old brain/patient got an 18-year-old body, most company pension plans and Medicare and AARP and other programs would vehemently protest paying retirement/old age benefits to an otherwise able-bodied person.

A bar would certainly not be out of line for questioning an apparent 18-year-old who came into the place with an ID claiming to be 65.

A doctor would be most interested in the patient’s physical body age, for things like routine mammograms or prostate exams, osteoporosis, primagravida, or anything else related to the health of the physical body, and the brain age for things like Alzheimers or cerebral vascular disease.

7

I read this book, too, and the major problem I had with it was its failure to accept that sexual desires, orientation, etc., exist primarily within the brain, not the body. Assuming the protagonist’s male brain were successfully attached to the donor’s female body, he would still think like himself, not in like the now-deceased donor brain. He would not be attracted to males, for example, as the body-donor was. Unless, of course, he was already attracted to males before the transplant. He would have been in the exact state of a transsexual who feels strongly that he is a man trapped in a woman’s body (or vice versa).

Well, that and the whole part about how the donor’s consciousness magically still existed within the donor body and could converse with the recipient. That was just silly.

8

It’s also worth noting that since the brain would still be 65 years old the patient would suffer from all the neurological problems that come with old age such as Alzheimer’s. Regarding the gender issue; what happens if the old-man-turned-young-woman doesn’t want to change their legal gender (it’s not mandatory for transexuals)? He could not only marry a woman, but if he got pregnant (since he’d have all the right parts, unlike a transwoman) would he legally be the father or mother? What if he get’s impregnated with his own sperm from before the transplant?

9

How strongly do we know this is true, given that we have had limited opportunity to test the principle?

I understand the difference in biology between men’s and women’s brains, such as the size of the corpus colossum; and I’ve seen MRI highlights of brain activities that show which part (and how much) of their brains men and women use to perform certain tasks, like 3-D spatial processing, language, listening, etc.

Just a ferinstance, I’ve heard of studies where they have field-reversing glasses that switch up-down or left-right. After a few minutes or hours — so the stories claim — the brain adapts to the new orientation. I don’t know if this is true, but if it is, how great is the brain’s ability to adapt to different signal input?

The part that gets me, as a real-life transplant patient, was that there were no dietary restrictions or post-procedural medications or immunosuppressants.

10

Oops, double-posting again.

Heinlein addressed that last point in the book.

I’ve thought about the mother/father issue, and the best I can come up with is that it’d be a bear to get those procedures billed through the medical bureaucracy if he was still legally male. That wouldn’t be a problem, because no insurance company in the world would dare cover that patient — too many unknowns, wouldn’t you say?

11

To be fair, the transplant killed him in the end.

12

Fair enough; I would stand by my analogy of trying to make a single computer out of half a mac and half a PC though, because. although our nervous systems all conform to a generally similar plan, I believe it’s the case that the detailed interconnection (and the function arising from that) is a custom-build job for each individual, so it’s not necessarily the case that, say, the way your visual cortex is wired/networked would be suitable to receive input signals from my eyes.

13

Heh …

This reminds me of a cod philosophical question that I coined

‘If Clint Eastwood’s brain were transplanted into an Orang Outang, which would be the donor ?’

14

Hmmm. FRDE, are cod really concerned with philosophy?

I agree with most of what Der Trihs has written. The brain is the seat of consciousness, and everything else flows pretty logically from that. Isaac Asimov’s short story “The Bicentennial Man” (and not the awful Robin Williams movie, please) has some good discussion about what makes us human, and it comes down to the mind.

I can’t help but add two relevant quotations; bonus points if you recognize the sources:

“Brain and brain! What is brain?”

“Get that cat outta here!”

15

The notorious “Spock’s Brain” episode.

16

Cod means spoof

  • well in this context
17

The Man With Two Brains.

“I’ll have a Tahitian Lady.”
“Flaming?”
“No, that’s for tourists.”

18

The Man with Two Brains

19

Yeah, but writing a story like “we did a brain transplant and the patient lived but they’re in a permanent state of asensory paralysis because the brain is incompatible” isn’t science fiction, man. :wink: It’d make a pretty dull story.

The interesting parts of the story stem from the speculation of what would happen to society, to laws, to marriage, to culture, if it could work. Heinlein missed a lot of that, I feel, by going exclusively for the gender difference of the character. He acknowledged that the press had a field day with the idea, and that there were those who claimed that Johann/Joan was an abomination, but it never really affected much — it was a one-time miracle done by an unreliable doctor who wouldn’t share his techniques, done at astronomical expense to a man who was already astronomically rich. All of the philosophical discussion was background material and had no depth compared to the intrigue of seeing how many times Johann/Joan could get laid.

I appreciate your viewpoint that it wouldn’t work — I happen to agree that it wouldn’t. That’s not what I’m asking.

I wouldn’t call that a foregone conclusion: look at the Terry Schiavo case. All indications were that her brain was pretty much flatline on the EEG, yet her parents vehemently insisted she was still alive and herself, despite what the brain scans said.

I happen to agree that the brain is where the consciousness is, but there are those would fight that concept in court vehemently, aren’t there? Off the top of my head, wouldn’t some religious organization have a stake in the separation of the concepts of “brain” and “soul?” I mean, defining a unique identity by the presence of absence of an EEG reading would have consequences for abortion law, would it not?

20

That book (or a pretty close equivalent) exists. “Johnny Got His Gun” by Dalton Trumbo.