The Volokh Conspiracy - What an Odd Concern:

The New York Times reports more on the recent face transplant. "Among the most disturbing aspects of the debate," the Times writes, "are conflicting reports from doctors about whether the transplant was the result of two suicide attempts, one successful by the donor, and one failed by the recipient." The donor had apparently hanged herself; the recipient's injuries were inflicted by her dog, but there's reason to think that this happened when the recipient deliberately took an overdose of sleeping pills, trying to commit suicide.

Now there are interesting ethical problems about how we should ration health care between those who apparently don't much want to live and those who do want to live. One could argue that the subjective value of the benefit to the suicide victim is less than to others; or one could argue that there's a substantial chance that the patient will try committing suicide again soon and this time succeed, so all the investment of money and effort will have been wasted. (Query, though, how applicable these arguments are, even if they're sound, to experimental procedures in which the major social benefit comes from learning about the surgery.)

Yet these don't seem to be the main problems that the Times is focusing on. Rather, the first concern, as best I can tell, is that:

If Ms. Dinoire's disfigurement resulted from an attempted suicide, it would raise questions about her emotional stability and her ability to consent to such a risky operation.

Surely many people who try to attempt suicide are emotionally not entirely unstable -- yet they're generally not fools or lunatics. They can understand the costs and benefits of the procedure as well as others. They can understand that their current state is very grim. Are patients generally disqualified from making such judgments just because they've attempted suicide? I'm not suggesting there's nothing to this concern; perhaps the doctors should also have asked the woman's relatives or some specially designated patients' guardian, though query whether it's appropriate to limit suicide attempters' autonomy in making medical decisions (other than perhaps suicidal medical decisions) this way.

But the second concern utterly perplexes me:

Reports that the donor committed suicide also have implications for Ms. Dinoire's future, because if true, and if the transplant is successful, it would mean that for the rest of her life, she would see in the mirror the nose, mouth and chin of a woman who herself met a brutal end.

Does it really seem likely that the beneficiary of a face transplant operation would be that upset by this? I can certainly see why she might be upset at seeing what will at first look like someone else's face (though probably less upset than seeing her own mangled face). But why should it matter to her that the donor had committed suicide?

After all, the donor must have died somehow, and probably not in her sleep of old age. Could have been a motorcycle accident. Could have been early onset cancer. Could have been a rare early heart attack (probably the least unpleasant death of the lot, but not that likely). Or could have been a suicide. I like to think that if I had needed a transplant and had gotten the transplant, I'd be grateful, and wouldn't be that troubled by the face's provenance. Or am I mistaken?

	[Eugene Volokh, December 15, 2005 at 2:01pm] Trackbacks What an Odd Concern: The New York Times reports more on the recent face transplant. "Among the most disturbing aspects of the debate," the Times writes, "are conflicting reports from doctors about whether the transplant was the result of two suicide attempts, one successful by the donor, and one failed by the recipient." The donor had apparently hanged herself; the recipient's injuries were inflicted by her dog, but there's reason to think that this happened when the recipient deliberately took an overdose of sleeping pills, trying to commit suicide. Now there are interesting ethical problems about how we should ration health care between those who apparently don't much want to live and those who do want to live. One could argue that the subjective value of the benefit to the suicide victim is less than to others; or one could argue that there's a substantial chance that the patient will try committing suicide again soon and this time succeed, so all the investment of money and effort will have been wasted. (Query, though, how applicable these arguments are, even if they're sound, to experimental procedures in which the major social benefit comes from learning about the surgery.) Yet these don't seem to be the main problems that the Times is focusing on. Rather, the first concern, as best I can tell, is that: If Ms. Dinoire's disfigurement resulted from an attempted suicide, it would raise questions about her emotional stability and her ability to consent to such a risky operation. Surely many people who try to attempt suicide are emotionally not entirely unstable -- yet they're generally not fools or lunatics. They can understand the costs and benefits of the procedure as well as others. They can understand that their current state is very grim. Are patients generally disqualified from making such judgments just because they've attempted suicide? I'm not suggesting there's nothing to this concern; perhaps the doctors should also have asked the woman's relatives or some specially designated patients' guardian, though query whether it's appropriate to limit suicide attempters' autonomy in making medical decisions (other than perhaps suicidal medical decisions) this way. But the second concern utterly perplexes me: Reports that the donor committed suicide also have implications for Ms. Dinoire's future, because if true, and if the transplant is successful, it would mean that for the rest of her life, she would see in the mirror the nose, mouth and chin of a woman who herself met a brutal end. Does it really seem likely that the beneficiary of a face transplant operation would be that upset by this? I can certainly see why she might be upset at seeing what will at first look like someone else's face (though probably less upset than seeing her own mangled face). But why should it matter to her that the donor had committed suicide? After all, the donor must have died somehow, and probably not in her sleep of old age. Could have been a motorcycle accident. Could have been early onset cancer. Could have been a rare early heart attack (probably the least unpleasant death of the lot, but not that likely). Or could have been a suicide. I like to think that if I had needed a transplant and had gotten the transplant, I'd be grateful, and wouldn't be that troubled by the face's provenance. Or am I mistaken?