The news that Sergio Canavero, an Italian surgeon, and his colleague, Xiaoping Ren of China, plan to perform a ‘head transplant’ with an intention of ‘execution’, surfaced in 2017. Albeit, the pair now state that the procedure is imminent.
The procedure (above) involves taking the head of an individual, unable to use their own body (i.e a quadriplegic) and transplanting it onto the body of a brain dead donor, enabling the recipient usage of a fully functional body.
However with such an extreme proposal, a number of questions need to be answered to ensure ethical consideration.
We can transplant a heart, why not a head?
Although advancements in the medical industry are subject to tight safety regulations, it is leaps of faith from innovators like Canavero that have made the medical industry as powerful as it is today.
A step back in time
The first successful organ transplant of a kidney back in 1954 faced similar backlash as we see today. Despite the protests, and claims of ‘playing god’, Dr Joseph Murray successfully prolonged the patient’s life a further eight years.
Despite the previous failures and lack of medical approval, had this risk not been taken, Richard Herrick (the world’s first organ recipient) would have died in the months following. This breakthrough paved the way for organ transplants as a collective, saving the lives of over 100,000 people annually. With great risk comes great reward, so could there be method to the doctors madness?
A step in the right direction
Unfortunately, we live in a world where unjust diseases exist that restrict an individuals life. If we focus on the outcome of an improved quality of life for those in need (utilitarianism), there’s no reason that the push for a head transplant shouldn’t be enabled.
The act of goodwill alone (Kant): to push the boundaries of modern medicine, to strive for cutting edge procedures and give those wishing for a chance of a normal life – could be argued reason enough, as motivation for Canavero to continue. Who are we to prevent the wishes of consenting adults for chance of a better life?
Complexities of consent
The issue of informed consent, especially in the early preclinical stage, is of major concern for both pros and cons of the ethics involved. Regarding the ethics of care, four major areas must be examined, ensuring both recipient and donor are able to make sound judgement on the procedure:
Valery Spiridonov, who suffers from Werdnig-Hoffman disease (a form of spinal muscular atrophy often leading to low life expectancy), volunteered to take part in the first ever procedure, despite its risks.
This willingness to hazard survival for a chance of a better life is concerning, but ultimately relies on the attentiveness, responsibility, competence and responsiveness of the patient. Ethical practice could be reinforced, perhaps with an overseeing judgement from a medical professional.
After all is said and done, it may be the case that the issue boils down to a single question.
“What would a virtuous person do in the same circumstances, providing consent and the attention to the ethics of care?”
The answer however, may be more difficult than what we would expect.
Heading in the wrong direction
Despite these arguments, a vast amount of crucial scientific and ethical considerations exist, unaddressed by Canavero, which question the plausibility and foundation of the procedure.
Feasible or just fantasy?
The procedure’s chance of success is questionable as most documented “successes” are only claimed by Canavero, with little evidence.
Michael Beattie, an established professor of neurology at UCSF, denies the claims stating that “The genes in a mature mammalian central nervous system (CNS) that control regeneration are repressed”. Meaning “no matter how much you treat the spinal cord with polyethylene glycol and electrical currents”, the CNS will not regenerate in humans.
It falls to the ethics of care to answer whether or not it is equitable for physicians to control lives with such ambiguity?
One vs. Many
The brain is considered to be an integral aspect of an individual’s identity. Therefore, if the entire body is donated, who technically ‘dies’ in the exchange? Is the recipient considered deceased and given the legal rights of the brain donor or vice versa? It’s a breach of the donors human rights in a grey area unconsidered by Canavero.
When there are currently around 6000 people on the UK transplant waiting list, it begs the question of why one recipient should receive the entire body of the donor. This procedure would just further increase this number and prolong the waiting list, taking potential donations away.
One body has the potential to donate organs capable of treating eight recipients, alongside tissues and blood. But with the proposed procedure, other organs cannot be donated. In regards to the principle of beneficence, with organ donations often vital for the recipient to survive (i.e heart transplants), is it fair to improve the quality of life for a single person over eight?
Dancing around the issue
A peer review would examine whether the potential benefits justified the risks, with established evidence to back the decision. Canavero is intentionally avoiding this, by looking for funders not requiring IRB or peer reviews.
He plans to conduct the surgery in a location where the regulations governing medical practice or research are minimally enforced. The complete disregard in his obligation as a medical health practitioner raises alarm bells for the ignorance of possible ramifications (consequentialism).
Additionally, Canavero would likely face criminal prosecution as intentional decapitation treads dangerously between medical care and murder – especially due to the unreliability of the surgery. The procedure would involve several dozen surgeons and take over 24 hours, so one simple mistake could prove disastrous, personally and ethically. The negligence in this “experimental” surgery opposes the intrinsic moral values that make up the deontological theory.
We are against.