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Face it: fiction becoming reality


Let’s face it.

Medical advances are occurring faster than our ability as a species to understand their full implications.

Last week in London, a plastic surgeon announced that transplants of faces will be medically feasible within six months.

Dr. Peter Butler told a meeting of the British Association of Plastic Surgeons the expertise and techniques are almost ready to perform the operation. Several variations will be possible, Butler told his colleagues. Transplants could range from a single feature of a face -- such as a cheek, nose or ear, for someone who was born disfigured or sustained serious facial injury or illness -- to an entire face.

The full facial transplant would have two variations. One is the mere removal of a deceased donor’s skin, which would then be fitted onto the recipient’s existing bone structure. In theory, the new skin wrapping around the recipient’s existing bone structure would result in an appearance similar to what the recipient would have naturally.

The other variation is the one that has medical ethicists -- and soon the general public -- concerned. It will be possible, Butler said, for a donor’s entire face, including underlying bone structure, to be transplanted to a recipient.

If you saw the 1997 movie “Face/Off” with John Travolta and Nicolas Cage and thought the premise was science fiction, be prepared for fiction to meet fact. In that movie, Travolta and Cage play an FBI agent and a terrorist, respectively, who exchange faces. Travolta, playing the agent, learns that Cage has placed a bomb somewhere in Los Angeles which will kill a substantial portion of the city’s population. With Cage’s character in an apparent coma after a battle with the law, the FBI decides that Travolta can infiltrate Cage’s organization if their faces are surgically switched. But the terrorist unexpectedly comes out of his coma with a new face, escapes custody, and things get rather complicated from there.

Again, prepare for fiction to become fact.

“It is not, ‘Can we do it?’ but ‘Should we do it?’” Butler said. “The technical part is not complex, but I don't think that's going to be the very great difficulty. ... The ethical and moral debate is obviously going to have to take place before the first facial transplantation.”

Indeed. There are two identity traits that each person owns that make him or her unique and identifiable -- a name and a face. Seeing someone’s back sets the brain in motion to identify a set of people who the person may be, based on gender and physique. But once the person turns and his or her face can be seen, who the person is or is not becomes crystal clear.

Science is now on the verge of being able to transplant the one physical feature that gives every person a unique identity. Internal organs are transplanted, but because they help to sustain life, the procedures are accepted. People who lose limbs or digits can receive prosthetic devices and they are generally viewed as courageous. Chemicals and surgical procedures are available to people who want to change a certain aspect of their bodies. But after such procedures, it’s still evident that it is Jane who had breast augmentation or John who used chemicals to add muscle mass.

But when Jane has Jan’s face? We’re in uncharted territory.

“It may seem an extraordinary concept, but it comes from a desire to help those who have to live with very serious deformities,” Butler said. “If the reasons behind this are explained fully to the public, they may overcome their revulsion.”

Much like acceptance of people with prosthetic limbs or transplanted organs, the reaction to people who benefit from donor facial parts will probably be overwhelmingly positive. Replacing a disfigured nose, a genetically misshapen jawbone or a shattered cheekbone would certainly be seen as someone’s right to be able to look in the mirror and not be reminded of his or her injury or deformity.

Like donated hearts, donated faces would be taken from people very recently deceased. It raises the possibility of the spouse and children of a deceased person walking around town and seeing the face of their late loved one on a person who probably didn‘t even know him or her. And the Travolta-Cage movie already explored some of the ways an identity transplant could be used for nefarious purposes.

What if Osama bin Laden could get a face transplant, and move around freely, maybe even on the streets of the United States?

Human cloning has been declared illegal in the United States and many other countries, due to the many ethical and medical questions which are still unanswered. Replacing a portion of a disfigured face seems, on the surface, to have reasonable medical and psychological benefit for the recipient. But full face replacements have too many ethical and psychological questions unanswered for them to be accepted in this country, or anywhere on the planet.

Even though they can, they shouldn’t.

This column was written November 30, 2002, and published in several print publications across the country.

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