Speaking of the news coverage, I don’t like the operation being referred to as a “face transplant.” That makes it sound like the patient is going to wake up looking exactly like the donor, like in some horror movie. All it is is some skin from part of the donor’s face.
Part of a plot from a movie.
Oops, sorry. I could have sworn it was from 24.
I’m not sure how this differs from what I was saying. Dubernard was not an opponent of the procedure, he had initial reservations. Good for him. Personally, I would not want to be under the care of a doctor who does not have initial reservations. I would want every less-invasive procedure considered first, and the new experimental treatment only as a last resort. And that was the case here.
As for the panel going by “what we’re always supposed to do”, good for them. Strict policies in hospitals are good things. They make sure the hospital doesn’t become a house of butchery. They make sure that doctors are accountable for the work they do. They reduce lawsuits. They’re better for the doctors, better for the patients, and better for the bottom line. Win/win/win.
As for the ethics–there is a very real and significant concern that infection or rejection of the transplanted tissue can cause complications leading to death, as well as the fact that the patient will have to take immunosuppressant drugs for the rest of her life which greatly reduce the ability to fight off viral and bacterial infection and increase one’s chances of developing cancer. In other words, there are very signifcant risks to a procedure versus a quality of life issue that is not life threatening. Given that the patient no doubt suffers no small degree of social ostracism and attendant mental anguish, she may not be making what objectors feel is a rational assessment between the dangers of the procedure and ongoing risks and the benefits.
Personally, if I’d had my face ripped off by a dog, I think I’d rather take the risk, or even the certainty, of long-term health consequences for at least some semblence of a normal life and interaction; I can’t see that as an unhealty or irregular attitude, even with respect to an experiemental and possibly flawed technique. Even if she is less than objective regarding the risks (and with one’s face missing, who wouldn’t be?) it is, in my mind, strictly her risk and her decision. But as with the opponents of longevity, theraputic cloning research, and chronic illness treatments such as Leon Kass (of the President’s Council on Bioethics) the objectors are people who feel that their own personally held moral issues or emotions on the issue should override the perrogatives of others in the decision whether to accept the risks and morality of said treatments. Anyone who opposes, say, a gene therapy cure for progressive diabetes, whether on moral grounds (let the weak die?) or on alleged risk-vs-reward based concerns (better to live a long but miserable existance on dialysis than suffer complications on a therapy that could correct the issue permenantly) clearly has never lived with the disease or had a loved one suffer from it.
If bioethicists had the kind of pull that the beginning of the last century as they did at the end of it and on to the present day, we’d still be suffering from smallpox, polio, unremediated carcinomas, and any number of other chronic, debilitating, or lethal illnesses which have been eliminated or effectively treated by what would today be highly risky techniques to develop and test. A review of radiological and chemological cancer treatments alone would be enough to throw a bioethicist into a nervous spasm, and the development of the polio vaccine would have them institutionalized.
Stranger
I have no argument with the doctor. Intial reservation are indeed sensible and responsible.
I was talking about the panel of ethicist (as was ratatoskK) who are saying:
"Dr. Laurent Lantieri, an adviser to the French medical ethics panel, said the surgeons violated the panel’s advice because they failed to try reconstructive surgery first.
The panel had previously objected to full face transplants but said partial ones could be considered under strict circumstances, which included first trying normal surgery. "
They are saying other surgery should have been required, even though it didn’t make medical sense in this case, because that’s what the policy called for. That doesn’t seem sensible, it seems shortsighted.
It ended up win/win/win, apparently because the doctor went against the panel.
Hmm. I still don’t see it as all that Pitworthy. At worst, the panel was a bit rigid in their thinking. Even then, according to the wording of what you quoted, what they handed down was not a strict order, but advice. As in, a suggestion. And it looks like they never censured or otherwise punished the doc.
How familiar were the panelists with the case? Did they actually see the patient. That part isn’t clear to me.
You mean this one?
From the news stories I saw, it’s more than the skin – it’s the actual underlying bone structure, as well. And the concerns I heard about it were as much about possible rejection issues as ethical issues.
Actually, I heard an interview on NPR yesterday, and it IS just the skin – no bone or muscle. But even if it included bone or muscle, that would be for medical reasons, so I see nothing wrong with it.
Interesting. Because the story I saw (sorry, I forget where, one of the national news media, though) clearly discussed transplanting the underlying bone structure as well, which would mean if rejection occurred, she would be left with no face at all, as opposed to her currently disfigured one.
If you’re talking about the woman from Cleveland (and boy, she sure didn’t SOUND like she was from Cleveland) she talked about the skin a bunch because it’s apparently ‘special’ skin on the face…but did she ever specifically state that it was just the skin?
Because I don’t remember that. Either way.
-Joe
I was driving, I don’t recall exactly where she was from, but she was very clear about it being only skin and no bone or muscle. Perhaps the confusion is in the fact that she also received some bone marrow transfusion to help with anti-rejection.
There’s a movie (based on a true story) about this very kind of reconstructive surgery Why Me?. As I recall her injuries were more extensive (I think she lost most of her lower jaw) requiring more than 30 separate surgeries, most of which were to give her face a more normal appearance. Her surgeon Dr. James Stallings resorted to using labial tissue to create her lips, which was depicted as being equally cutting edge, and questionable by “ethicists” at the time.
1 or 2 surgeries or 10 to 20, which would you pick?
Again, I’ve forgotten where I’ve heard it, but I have heard this as well. It essentially means that rejection of a ‘full’ face transplant would likely result in the patient’s death, or extreme measures would be required to keep them alive until a new transplant occurred. This seems to be part of the moral debate in some cases (not this one) – is it worth it to risk death to avoid disfigurement?
I remember seeing something on TV a while back (some sort of “amazing medical stories” thing) about people with massive facial injuries who got special facial prosthetics built. These things were made of some sort of plastic and snapped right onto the face thanks to metal bits that were screwed into the bone underneath.
I can’t help wondering why they didn’t try something like that with this woman instead. Immunosuppressive drugs are pretty harsh on the system - I’d think that this kind of transplant would really be a last resort.
Antigen, I saw that, too. IIRC, the subjects were patients who had either oral cancer or cancer of their facial bones. The prostheses were designed for cosmetic purposes–none of them could replace a jaw, for instance.
In that case, what about the German man who had a jawbone grown for him using his own bone cells? If rejection, especially of bone tissue, is such a concern, would it make more sense to grow the bone from the patient’s own tissues, and then overlay that with muscles/skin from a donor?
So far, nobody has mentioned the Nick Cage/John Travolta objection to facial transplants.
Isn’t that the patient’s decision to make, and not some self appointed “ethics experts” ? People risk death to one degree or another all the time.
Hear, hear! If someone objects to a certain medical procedure, they can just not have it done. The docotro’s communicated the risks to the patient, and she has accepted them. The “bioethicists” would rather condem her to a life of extreme disfigurement? If the doctors says that more conventional procedures won’t work, and that opnion has been reviewed by the appropriate staff at the hospital (which I am sure it has), than that’s something the patient and the doctor can work out. The objections are silly.
If you took your car into a mechanic’s shop, and the mechanic examined your car and said “Wow! Normally, we’d repair this sort of damage, but your engine block is so badly cracked, it’ll need to be replaced, or your car will never run again.” You can chose to get a second opinion, but what right does someone have to run in and loudly declare that getting your engine block replaced is unethical, and that the mechanic is ethically obligated to repair it first (at your expense) and then if the engine fails (which it might on the highway, possibly killing you), only then should you have the option of getting it replaced?
Lunacy.