Ethics Head Transplants and Other Stories of Angels Dancing on Pins (Part II)

Need to catch up? My first article on this topic can be found here.

Many of the issues presented in the Journal were thought-provoking podiums for philosophical meanderings that had little to do with reality, science, or medicine. However, the problems are presented as real and urgent puzzles. Besides the scientific difficulties of connecting two spinal cords and their nerve and vascular connections, there are issues of host transplant rejection and immunosuppression, which are never even raised. Moreover, the value to target such surgery for people with quadriplegia, as some authors do, is contraindicated by the much safer and currently available brain-computer interface technology (exoskeletons, computer-controlled wheelchairs, etc.), making head-body transplants rather wacky idea. So is this even a real problem?

Science, Law, Religion, Philosophy: how do we decide?

Assuming we wanted to discuss the issue – for whatever reason – we would have to agree on a viable, valid and broadly acceptable framework to arbitrate the proposed solutions. Various methodologies can address the morality or ethics of new technologies – but different approaches often lead to different answers, some of which are legally absurd, exemplified by some of the Journal’s authors who draw on Confucianism or early Western philosophy.

Consider an extrinsic example: using philosophy to resolve legal issues arising from other biotechnology issues, such as a robot’s personality and suitability. Ben Franklin, always pragmatic, would surely have been amused: proponents of the philosophy argue that since you can sue a corporation that is not a person, you can also sue a robot. As a lawyer, I suggest that if you want to sue the robot, no one or not, you better have a bank account from which you can collect. (Something no one thinks to mention).

Lawyers, scientists and laypeople alike are swept away by exciting and sexy projects generated by the magic of technology, suspending disbelief at seemingly erroneous claims of feasibility or ownership, in defiance of established scientific or legal principles. This fanciful reasoning is reflected in the Journal’s discussion of head transplants.

The flaws of a mixed philosophical and religious investigation

Philosophy professor Jason Eberl concludes that head transplants should be unethical – Ok, so far. It is his reasoning that sprouts suspicious shoots. It begins by asserting that a human is a living animal by virtue of its soul, a concept with which I wholeheartedly agree. Eberl then says that the soul vivifies the body, which is essential to who we are as humans. To some extent, this is also true. But then he claims that the soul is attached to the body as the basis of his argument.

When you invoke the soul, you invoke religious doctrine. Most religious doctrines state that the soul expires when the breath stops, regardless of the functionality of the rest of the physical body. This belief contradicts Eberl’s premise, illustrating that his view is a rather personal gloss, illustrating the problems of using indefinite philosophical inquiry to make real decisions that require broad buy-in.

Who cares what Confucius says?

Another source of confusion raised by philosophical inquiry are questions concerning the location of the seat of consciousness to determine the ethical property of head transplants, as determined by Confucian thought. Using this philosophy, authors Ruping Fan and Liam Bian claim that the newly anastomosed entity is an entirely different third entity. The newly created organism draws its identity from a mind-body connection, amplified by its social and family identity. Such assertions are independent of the reality of law and science (which undoubtedly holds that the brain is the seat of consciousness, memory, experience and logic, and therefore of personal identity ) and differ from commonly accepted Western thought.

VSOnfucianism espouses a kind of relationalism: human individuals are relational individuals, and the identity of an individual cannot be established without his social relations, especially family, being appreciated.

Extrapolation of nonsense on nonsense, as defined by law:

Worse, perhaps, is that this conception of the family intersection with the new entity becomes the predicate of more complex problems. After asserting the family connection with a new entity, the philosopher Fan and the psychologist Biam fear that the family of the head and body donor will each claim a close family relationship with the post-transplant individual. They claim it would give both families ‘rights’, including medical decision-making and inheritance.

American philosopher Professor Ana Itlis raises similar questions based on mainstream Western philosophy and ethics, drawing on the Belmont Guidelines for Human Research and the UNESCO Universal Declaration on Bioethics and human rights[2]. While lamenting the lack of a fundamental focus on philosophy to answer complex philosophical questions such as who survives full-body/head transplants, she argues that without this knowledge, “we cannot know how to appropriately apply ethical criteria to medical research involving such controversial surgical procedures”. innovation, let alone how to shape public policies to regulate its application.

One wonders if this approach is the right one to use, or to paraphrase a legal maxim, does the approach assume facts that are not immediately credible for philosophical introspection?

“In the case of the whole body/head transplant, which person, whose personal integrity, or whose body is at stake? Who can benefit or be harmed? Who must give informed consent? And who should not be affected if permission is not obtained.

Professor Itlis is right to be concerned about the dignity, respect and integrity of the head and body donors and the newly formed entity. She’s also right to note that “we first need to have a clear picture of who survives the surgery and who that person is.” But like specific arithmetic calculations, the order of the operation defines the outcome, and the question of who survives the surgery – is simple if one relies on science and law – and has a different outcome of the philosophical path.

Before addressing the philosophical questions raised by the new entity, it is appropriate to start at the beginning. First of all.

Who survives the initial surgery, the head or the torso?

The operative question (no pun intended) is not who survives the surgery – but who survives the initial surgery of the three (plural) surgeries in question?. Prior to head or body donation, the issue of informed consent rests with the individual donor. Body and head donors must give their consent. It is the basic law. Then, and only then, can the third surgery, the coupling operation, take place. But at the time of the donation, there is a change in the legal status of one of these parties.

Shortly after the head was severed, the body was legally dead.

According to American jurisprudence and/or religious custom, most definitions of death are based on either brain death or cessation of breathing. Without a head, the body donor would legally no longer be alive. To be clear, the body donor was legally dead before the mating operation began. At this point, only the primary donor, whose brain is “still alive” (i.e. it has brain waves and is hooked up to a heart-lung machine, so it is “breathing” ), has rights and the ability to provide additional informed consent for the coupling operation. (From a practical point of view, consent could be obtained before the decapitation procedure).

Family rights issues are now quickly circumvented by law enforcement: the body donor’s family has none. The family of the body also has no rights to reproduction by the new entity. (This could be resolved before the donation via a contract, as macabre as that sounds). But laws governing the validity of wills and intestates (dying without a will) generally prohibit instructions after death. In short, the laws of the intestate or the law of succession would apply in such cases, not bioethical or philosophical considerations. They would massively favor the brain donor (and his family).

Buried in some articles are discussions transcending head transplants with more universal applications – such as the mind-body connection – which, in a less sensational context, might prove illuminating and helpful. But for now, a word to the wise philosopher – please call your nearest lawyer and doctor before engaging in thought experiments relating to matters with legal ramifications, such as life and death.

[1] The UNESCO Universal Declaration on Bioethics and Human Rights and the Belmont Commission provide detailed and practical principles for assessing comparative rights and carrying out bioethical principles. Building on the American approach, which bases decisions on four principles (autonomy, beneficence, non-maleficence and justice), the UNESCO Declaration contains more than 30 principles.

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