Face Graft Following Euthanasia of the Donor
A world first is causing quite a stir: In Barcelona, a total face graft (the 54th in the world) whose donor is a person who underwent euthanasia. Numerous media prefer to state that the donor “benefited from assistance in dying”. Since the first (partial) face graft, received by a French woman: Isabelle Dinoire in Amiens in 2005, the procedure has of course made progress. The first total face graft was conducted in 2010.
The recipient in Barcelona was suffering from a serious microbial infection. Her face was necrosing, preventing her from eating and hampering her breathing. We know no more about the donor apart from her “choice to die, and her decision to donate her organs. The only mention of a psycho-ethical aspect of the transplant, is the presence of “mental health specialists” among the hundred medical staff involved and the assertion that the two women never met, in compliance with the Spanish legal framework.
The recipient added that such absence of any direct contact provides a safeguard against any “particular attachment which, in the long term, would have been unhealthy”. Carme – which is her first name – however expressed considerable gratitude to the donor, whose first name has not been revealed.
Euthanasia increases the likelihood of success
However, although this medical prowess has been widely documented and commentated on, we cannot hide our discomfort on hearing that euthanasia increased the likelihood of success of the transplant, through its anticipation. It indeed enabled extensive checks to ensure the compatibility between the donor and the recipient, with 3D measurement of each of their faces, preparation of millimetric sections, through the use of “digital models”, and the removal under optimum vascularisation conditions, which could not be achieved in the event of an unplanned death, whether following an accident or disease. How can one not fear the possible promotion of a euthanasia for utilitarian purposes?
A few principles regarding post-mortem organ donation
In the field of organ transplants, in the event of a patient discontinuing treatments at their end of life, ethics demand that the treatment team of the patient and the team involved in the transplant must be different and physically separated, in order to avoid any pressures, even unintentional or unconscious, which in consequence could accelerate the dying of the patient. The risk is the temptation to initiate the transplant earlier, in order to benefit from better quality organs. Moreover, the treatment team must be able to decide freely to discontinue the treatments of a patient. The discussion on the collection of organs can only legitimately begin afterwards, and with the agreement of the next of kin.
These essential principles are difficult to uphold in the event of euthanasia or assisted suicide since the collection is planned beforehand.
The complexity of a face graft
In itself, the grafting of a face remains an extremely delicate operation, which must be adapted to the cause of the failure of the recipient’s face. The recipient is then subject to anti-rejection treatments for life, together with secondary effects and the Damocles sword of the risk of a brutal rejection, in addition to other complications, some of which may be fatal. Additionally, receiving a face which “is not me” in the words of the first recipient of a face graft, is far from innocuous (Isabelle Dinoire could not bear to look at old photos of herself).
One can therefore only resort to such a graft in cases of absolute necessity. One should add that it is even more complicated to wear the face of a person whose death has been induced deliberately “for the benefit” of the recipient.
Public incitation to assisted suicide
A graft post euthanasia raises other questions. The posthumous praise granted to the donor promotes her as a heroine. In fact, the positive connotation of suicide – irrespective of its form – risks generating a Werther effect, the well-documented effect of the encouragement and contagion of suicide, against which the prevention specialists are particularly concerned. How can one not see in this arrangement an incitation to go through with the act, for people who are suffering and who are hesitating to choose euthanasia or assisted suicide? It provides them with an “altruist” reason for consenting to or even calling for it.
The practical conclusion of the act followed by organ donation shows that it is impossible, from an ethical point of view, to separate the euthanasia from the ensuing organ collection. The patient is truly predisposed to organ donation by all these circumstances; and one should wonder whether the patient still has sufficient leeway, if he/she so wishes, to go back on his/her decision of euthanasia.
The fact that a hundred medical staff are involved in the transplant shows incidentally the extent to which technical performance tends to anaesthetize ethical conscience. A form of utilitarianism privileges efficiency and speed without considering the value of lives in their ultimate stages. Isn’t is the very thing which the West has been for a long time criticizing China for, accusing it of developing – in the name of absolute efficiency – a system of forced organ collections from those under death sentences or even from prisoners and oppressed minorities?
Real medical progress should never be dependent on an ethical regression such as the deliberate administration of death. Rather than inciting a patient to “give a meaning to his/her death”, by provoking it, we are pleading for the patient to be helped to live, until the natural end of his/her life.
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