Doctors in Cleveland have performed the first American face transplant. In a 22-hour operation they replaced 80% of a woman's face, transplanting bone, teeth, muscle and nerves. The patient had suffered such severe trauma that she had lost an eye and much of her nose and upper jaw. She was unable to breathe, smell, taste or smile properly. The surgeons at the Cleveland Clinic gave no details about the woman, how she was injured, or the donor. It was the world’s fourth face transplant.

Some bioethicists wondered whether the ethical implications of this complicated and risky surgery had been fully explored. “Not to downplay the difficulties of having a facial disfigurement, but one can live a long life and be disfigured,” Stuart G. Finder, Cedars-Sinai Medical Center in Los Angeles, told the New York Times. However, the benefits of this procedure are not just cosmetic. “The repair of the face can also have significant social consequences like the ability to speak, or the ability to eat that can be replaced because of having lips.”

Professor Arthur Caplan, of the University of Pennsylvania, asked if what would happen if the new face were rejected. Although medical science has progressed far enough to guarantee a good chance of success, life without any face at all might be a torment too difficult to bear for some people.

Consequently, he believes that a surgical team must leave euthanasia open as an option: “The only humane response to the courage it takes to be the subject of a face transplant is to be ready to help that person in any way necessary, including assistance in dying. The idea of assisted-suicide for tragic transplant failures pushes right up against the law, but insisting on life with no face, as opposed to a horribly disfigured one, is too daunting a prospect to proceed ethically — if death is not an option.”

Dr Finder called for caution. “We’ve done this, so we now know it’s technically possible,” he said. “We probably shouldn’t be going wholeheartedly, guns blasting away, down the road to do this. Now we need to pause and say, ‘Is this the right thing to do?’” ~ New York Times, Dec 17; Reuters, Dec 17