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  • Writer's pictureSociety of Bioethics and Medicine


Updated: Jul 21, 2020


Where is the line? What happens if we cross it? These questions are not unique to medicine, but perhaps what’s unique is the question, “If we cross the line who do we become?” When Dr. Joseph Murray performed the first organ transplant, he and most other people felt the effect of this Herculean step in medicine. Incongruously enough, 57 years later, at the same hospital, for the first time in the history of the United States, a facial transplant is successfully completed. Certainly, if Dr. Murray had been alive, he would have been overjoyed to see the legacy of the medical innovation he had started continue into the new generation. But as Winston Churchill memorably put it, “The price of greatness is responsibility.”

Beyond trying to address the possibility of the veritable ship of Theseus paradox that arises from the ability to swap out our broken parts, we answer nothing. The actual answer is left to society and the law, as the medical field is more interested in making these philosophical ideas into actual practical question, and only after can we address the issues that might arise. While interesting, this thought experiment pales in comparison to the dilemma about our identity and who we are that arises when discussing our ability, and willingness to change our actual genetic makeup. For now, we have arbitrary lines in the sand that dictate what we are allowed to do. But are these lines permanent? While some call these interventions playing God, others call them progress. Here, it is a medical versus cosmetic intervention line. This is fuzzy in the best of times, and gets all the more complicated as “necessary medical intervention” gets harder to define.

With plastic surgery procedures on the rise and new surgeries being developed constantly, we, as a human species are not far from making facial transplants an accessible, and viable, option to those wishing to undergo an extreme transformation. But will that make the procedure popular? Will our definition of “necessary” change?  As medical technique improves, our morals about what is socially acceptable inches along with it. Don’t we pride ourselves on our unique intelligence as well as our morality? Funny it is, that we perceive ourselves as human by distinguishing ourselves as a gifted and morally righteous animal, yet the minute a new innovation appears, we’re all too willing to modify our views of what is right and wrong. Are technological limitations the only boundary upon which we structure our morals? And if it is, what does this say about us? Can we even rely on our own judgments at this point?

So far, face transplants have only been used by people who have suffered traumas that have left them with disfigured and nonfunctional faces. Although this is an inherently cosmetic procedure, the medical necessity still is obvious. This procedure has allowed Mr. Norris, in his own words, to go from constantly wearing a “surgical mask, living as a recluse” to being able to smell “freshly cut grass” that he “hadn’t been able to smell for 15 years.” However, when — not if — that arbitrary “medical necessity” line inches so far along that it no longer is about a chance at a normal life, but rather, a better life with a more attractive face, is that still acceptable? Can we, in 2018, even firmly draw our line at accidents and disfiguration?  That line is bound to shift even in our lifetime, and then when we’re far along enough to see it happen, will we just disapprovingly shake our heads?  Or would we become okay with this? Should we not be?

The benefits of being attractive cannot be disregarded even today.  It’s obvious how this procedure can be used to indulge people’s superficiality and further enhance our culture’s obsession with looks. But as far as necessary intervention is concerned, that is not the medical field’s fault. We would only be solving a problem that society created.

There is some part of this new phenomenon that gives hope about humanity’s future. Katie Stubblefield, the youngest person to date to have undergone a facial transplant, met with her donor’s grandma after completing her surgery. Surprisingly, the grandma thought the recipient didn’t look like her granddaughter even though she had the actual face of the donor. Perhaps our appearance and even our personal manifestation come from a much deeper part within us, not just tied to our physical looks, rather a give and take.

Mr. Norris our other facial transplant recipient, experienced a similar phenomenon. The transplant allowed him to go from not recognizing the figure in the mirror, to finally seeing himself in the reflection staring back at him. In Mr. Norris’ words, “After the transplant, I started to see myself.” So much of our identity seems to be tied to our faces especially since we spend a lot of time examining and cosmetically enhancing it, yet Mr. Norris could see himself perfectly even though he had a different face on. Again, the idea that our identity and even raw appearance are shaped by more than just physical features is affirmed.

Dr. Sheila Jowsey-Gregoire echoes this sentiment when she asserts that a facial transplant recipient “remains the person that they’ve always been,” and that these patients have a “core personality that remains the same.” Much more than that, Katie Stubblefield is taking this new chance at life to help others by “teaching, counseling or raising awareness about suicide prevention.” She is fully committing herself to be there for people who are going through a similar rough patch to what she went through. So even if we shop around for new faces, perhaps we’ll use our new assets to help and strengthen others? It is up to the new generation to decide where to draw that imaginary line in the sand. Maybe our moral compass will dip towards the superficial side, or maybe we’ll arrive at a totally unpredictable compromise of the two extremes. In spite of everything, it is comforting to know that regardless of the face we have on, who we are still arises from a place deep within where no scalpel can reach.

Perhaps Mr. Norris put it best, “I don’t think I really had an identity crisis, because I lived so long disfigured. You go from looking like a very normal person, to one day you wake up and you’re completely disfigured and you don’t look nothing like you did before.” Norris says, “That’s when the identity crisis really starts. Every time I looked in the mirror, I didn’t see myself. After the transplant, I started to see myself.” So maybe no matter how hard we try to escape ourselves, our core personality will still be there, somewhere deep, regardless of what our face looks like.


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