Ick, Not Ethics: The Incredible Head Transplant

OK, this looks unethical...

OK, this looks unethical…

I adore stories that clarify ethical distinctions, and this is the third one we’ve had recently. First we had the classic “Awww! Factor” case of the Down Syndrome cheerleader. Then, close on its heels, we got “Downton Abbey’s” finale, which illustrated the ethics fallacy of Consequentialism as deftly as any textbook.

Now we have the startling report of impending head transplants:

The world’s first attempt to transplant a human head will be launched this year at a surgical conference in the US. The move is a call to arms to get interested parties together to work towards the surgery.

The idea was first proposed in 2013 by Sergio Canavero of the Turin Advanced Neuromodulation Group in Italy. He wants to use the surgery to extend the lives of people whose muscles and nerves have degenerated or whose organs are riddled with cancer. Now he claims the major hurdles, such as fusing the spinal cord and preventing the body’s immune system from rejecting the head, are surmountable, and the surgery could be ready as early as 2017.

Canavero plans to announce the project at the annual conference of the American Academy of Neurological and Orthopaedic Surgeons (AANOS) in Annapolis, Maryland, in June.

Predictably, this news prompted a wave of “Futurama” jokes and bad puns. It also prompted dozens of hysterical stories online and in print pronouncing the yet-to-be performed operation as “a terrible idea” and obviously unethical. A Daily Beast “expert” with the trust-inspiring name “Docbastard” condemned the practice with this wisdom:

That’s the funny thing about ethics—it may be impossible to say why something is wrong, but can be easy to see that it isn’t.

Yeah, that is funny. It is also false, and incredibly stupid. If one cannot say “why” something is wrong–you know, things like interracial marriage, interracial adoption, homosexuality, gay marriage, plastic surgery, income tax, integration, eating meat on a Friday…gee, let’s see how far back into cultural history we need to go to get the list up to a thousand! My guess: no further than 1900, if that far—there’s an excellent chance that it only seems wrong because 1) nobody’s bothered to analyze it thoroughly and objectively, and 2) the Ick Factor, which is when we mistake strangeness, shock and surprise, all visceral, emotional reactions, for ethics.

Let’s actually think about the “Doc’s” provocative questions about the theoretical procedure that he seems to think clinch the argument that head transplants are “easy” to identify as unethical. He writes,

Prior to attempting this feat in humans, we would have try it using small animals followed by monkeys. What ethics review board would approve such a thing? Would this not be considered animal cruelty?

1. Of course we would. 2. The same boards that approve other animal experimentation. 3. This is a question about the ethics of animal experimentation, not the procedure.

If the trials were approved and then proved successful, who then would be the first human guinea pig?

I don’t know: who’s going to win the 2017 World Series? An appropriate, consenting subject will be the first human to be subjected to the operation, as with every other new procedure since the beginning of medicine .  Are heart transplants unethical? Were yellow fever vaccine trials unethical?

• What if the head survives the surgery but not the body? What if the body survives but not the head?

Operations fail. That doesn’t make them unethical.

• Are either of those scenarios even possible?

Is the author still vaguely aware of his topic? What does this have to do with ethics?

• How would the person react to someone else’s body on his head when he woke up? The psychological trauma alone would be immeasurable.

I’m sure it can be measured, or at least evaluated. How does someone react to waking up missing a limb? Without a voice box? With a mechanical heart? With breasts the size of casaba melons? Being able to see for the first time? Again, this question, unless the answer is “Screaming in horrible, searing unbearable pain that lasts the rest of the patient’s hopefully brief existence!,”  is a factor in every form of serious surgery with permanent after-effects.

• What if the head is rejected? Would they then try a second body transplant?

Well, if I’m the head, I sure as hell will hope so!

These questions have nothing to do with the ethics of the procedure itself. They are just random concerns, stimulated by the prospect of something unexpected, that show that such a procedure has questions and unresolved problems connected to its development and use, exactly like every other new medical treatment or procedure.

Are there unethical ways such a technique could be used? Of course. So what? You ban those. No stealing bodies. No animal-human hybrids, like in “O Lucky Man!” No such transplants without the head owner’s informed consent. No putting kid’s heads on adult bodies. No using bodies that still have living heads with functioning brains attached. There will be a lot of rules. There are always a lot of rules governing surgery.

The ethics question about head transplants really is simple. If such a procedure can be perfected using ethical means, transplanting a human being’s head whose body is diseased or disabled to the healthy body of a patient who is brain dead and who has previously approved the use of his or her body for that purpose is ethical. One human being is better off than he would have otherwise been, and another is no worse off: he’ll just require a shorter coffin.

That is ethical. The reactions of the hysterical critics, in contrast, are based entirely, and erroneously, on ick.

___________________

Facts: GMA, New Scientist, Daily Beast

61 thoughts on “Ick, Not Ethics: The Incredible Head Transplant

  1. While I agree that the majority of concerns you’ve quoted of critics are non-ethical concerns, I think head transplants would require extraordinary safe guards to prevent abuse. With most organ tranplants, there is usually considerable trauma to parts of the body. Thus the pool of healthy, but braindead, bodies is very small. How does one fairly, distribute these few? Additionally, there is already a considerable black market for organs; what additional steps are needed to keep unlucky living heads attached? While this problem is not unique to head transplants, this new procedure in the wrong hands could dramatically worses the problem if no safeguards are put in place.

    • Again, “the thing could be misused”; “It needs careful monitoring”; etc…can all be applied to guns, lasers, and Groucho glasses. The fact that something requires great care and wisdom cannot make that thing itself unethical.

      • Don’t even get me started. I almost lost my 11-year-old daughter to a pair of those infernal things. For weeks she refused to take them off and insisted that *everyone* call her by her true name, Mr. Kobb. For a while it almost seemed that a head transplant would be our only recourse. With time and patience, we eventually weaned her off the glasses, but Mr. Kobb still makes an occasional surprise appearance.

  2. Seems ok to me. I don’t think we have to worry about this for a very, very long time. Did this guy skip the first year of med school (gross anatomy and neuroscience)? Imagine taking a bundle of computer and phone wires, about 3 feet in diameter, that you find running through an office building, cutting it in half with a chainsaw, then re-proximating them, heating them with a blowtorch, throwing chunks of solder on the mess, and hoping everything works. Sound’s like he’s been huffing the formalin.

    • It’s both better and worse than that.

      Better, because to extend your analogy, the lines each have some self-repair capability. Sever the bundle, butt the two halves together, and they will mostly re-connect, under the right conditions. Only if the gap is too wide will they not. How wide is too wide? It varies, and we can”t predict it. Sometimes nerves re-grow several cm a year. Sometimes even a fraction of a millimeter will prevent it. So much we don’t know… facial surgery is a toss-up, sometimes major nerve damage will heal, sometimes trivial nerve damage will not.

      Worse, because you’re not trying to re-connect the severed ends of the same bundle,but splice two different bundles together, While they may be similar, they’re not identical. The multiplexing problem is non-trivial, and it’s not at all certain that the self-repair capabilities can be guided to do the re-wiring. It may require a prosthetic “patch panel”.

      When I brought up this issue in 1978 in CompSci class, the reaction off the rest of the class was… unenthused. The Ick factor was nearly 100%, I was in a minority of one in pointing out the benefits to quadraplegics etc.Now we know more about the biology, much is obsolete, it was thought at the time that severed nerves couldn’t regrow. Now we know better.

      • Neural regeneration is much, much more likely in the PNS than in the CNS. With facial nerves, regeneration becomes less likely as you get closer to the CNS. Typically, if it’s closer than the trigeminal ganglion, it’s a lot less likely. At this point, before even considering multiplexing, which again is much more complicated in the cord itself, there’s essentially no neurogenesis in the CNS, and no way to reconnect in a PNS-CNS injury. Glial scars, and glial factors such as the axon regeneration inhibitors NOGO, and NI-35 ,put an end to any attempt at even remyelination, let alone resprouting axons, nor does Wallerian degeneration (a prerequisite to regrowing schwann cells, which are needed to produce neurotrophic factors ) occur.

  3. An aside, there was never anything “wrong” with eating meat on Fridays. Indeed, meat is a delicious luxery, and abstaining from its consumption was meant to help remind Catholics of actually wrongs they committed. It was the witholding of something good as a means of builing self control; it was a very different practice than Kosher laws, for example, where certain foods are unclean and forbidden. The rule to perform penance on Fridays has actually never been repealed, only the requirement that the penance take the form of abstaining from meat.

  4. Organ-legging was once illegal in every country EXCEPT Iran. Why is that not surprising? A kidney sold legally for $2000, Red Market for as much as $160,000…How much would a whole body go for? Who could afford it? Donald Trump?

    • Those ayatollas are pretty down-to-earth. This is a country that actually works suffering into their executions, pulling people up by their necks with cranes.

  5. What about having pre-arrangements, like looking for people willing to sell the rights to their bodies should they get into a situation that leaves them brain-dead? I can Imagine people setting up piano wire garrotes across roads, waiting for hapless young motorcyclists to drive by. “That’s MY body; I was here first!”

      • Yes, except you’d go to gyms or online mail-order body shops. You’d get a complete history and physical exam as part of the package, pay monthly incentives in addition to the initial purchase for not smoking, skydiving, playing football, and for wearing seatbelts (not for helmets, though; feel free to not wear a helmet). This is starting to look lucrative. I just might be a body-broker if they can manage to work out the kinks.

        • In the ACT we’ve extended it to bicycles and skateboards.

          But then, we have a national healthcare system, so it’s not just in your best interest not to be brain-damaged, as a taxpayer I have a financial stake in it too.

          Actually that’s true in all societies, it’s just a bit more obvious when I’m directly paying for your health care, and you for mine. In the US, it’s more indirect, less visible, but just the same. Others bad health affects your wealth.

  6. For non-dog lovers everywhere! One Vladimir Petrovich Demikhov, a Soviet surgeon and scientist, transplanted a puppy’s head onto the body of a living adult dog. Both heads functioned though not everything was shared. However, as the story goes, after a relatively short period of time, the puppy’s head was removed and the adult dog supposedly survived. This story came from the 1950’s but I would hate to have been the puppy! Is this what we humans have to look forward to? I thought I was tough but this story sent chills down my spine.

    • Is that true?

      The Soviets were also known for reporting massive wheat surpluses, abundance of luxury items, and happy throngs of commoners across the land…

      • There is no way that it’s true. This must be like the Soviet Sleep Experiment story. That actually brings to mind yet another JoeD story. I was awake for just over a month and a half back in 1993. This was in prison, and I had two things going on; they didn’t have a medication I needed, and they were giving me a medication that was supposed to be treating a movement disorder, but actually made it far worse. It was a 24/7 state of literal torture that words can’t convey. I would have rather been skinned alive if it would have ended this. Among other things, I had this horrible twisting tension in my body that manifested itself in an incessant twitching in my legs. This tension in my body and legs completely and utterly prevented sleep, for over 6 weeks. I could barely move. I was sleeping on the floor, lacking the energy needed to get into bed. I was so unkempt, I looked like the Unabomber. After I finally figured out what was going on by accidentally missing a dose of the aggravating med, I got my first hour of sleep. It was heaven. Then, a few weeks later, a couple hours a night, and so forth until I was back to “normal”, more or less, about 6 months later. There have been people who said that this was impossible, but I’m telling you that it is. For the longest time, I thought that I might have established some sort of record, but I eventually found a reference to someone who reportedly was awake for about a month longer, if I remember correctly. So, this is my long-winded way of saying that, though I think it’s extremely unlikely, this is one situation that convinces me that there are unrecorded situations that defy conventional knowledge. The above ordeal is true, on the souls of my children. That is an oath I do not make lightly, I promise you.

      • Speaking of standing in lines for turnips, I saw a brawl at our local Costco just before Christmas at one of those little foodstands that they set up to get you to impulse buy. If we ever had a great depression, it would be more like a great culling.

      • The Soviets were actually very good at basic research. Where they fell short was in putting that research into practical use.

  7. Actually, Vladimir Petrovich Demikhov was a real person, and youtube has a film about him and his surgery. There was also a Robert J. White who supposedly transplanted the heads of monkeys. But, like Jack said, “Ick”.

  8. This post gave me the best laugh I’ve had in days. Maybe even weeks. And the best thing about it is that it’s actually a serious topic. I love it when reality becomes so surreal there’s nothing left to do but laugh.

  9. Don’t mean to inject a note of rationality into the fun (I’ve enjoyed every deserving word of it), but this head-thing has been coming on like gangbusters for quite some time in this latest of human centuries:
    In 2005 the first face transplant was performed. The first leg transplant took place in 2011 and the first womb transplant — how’s that for ick-factor, hey? — was carried out in 2012.

    People still go queasy at the idea of having a scalpel driven into their eyeball (gotcha, did it?) … that is, until they are going blind from cataracts. (granted, not technically a transplant but having similar ICK factor) The typical surgery — removing the opaque part, replacing with an artificial lens — takes about 10 minutes; getting de-groggied from the sedation could take as long as an hour; then you put on sunglasses and somebody gives you a ride home where you might feel like napping for a few hours. After that: you catch up on a little email, watch your favorite TV show, or take a bath. For the next month, you follow the instructions on the eye-drops bottle while getting your brain around the fact that you see like you ain’t seen in years (if ever, in memory). Worst thing is that you go around hunting for those contacts that are gone, or for the specs that aren’t there anymore — for the rest of your life, habitually poking a callus into that spot where nose meets forehead and the frames used to slide down.
    OR
    You can give in to your ICKidiocy and not have to think about the scalpel in your eyeball … except that you will always …. always …. think about it … til the day you die with the BIG-ICK image of BillieBurke and Br’erHare creeping in with bloody shovels to unearth your sodded bod and make it do the bidding of some oh militant radical leftie illegal-immigrant Muslim homosexual. All because of your ICKity-ness.

    Note: The safest transplant is a hair transplant. The worst thing about hair transplant is not that a scalpel makes holes in your head, but that it is not covered by insurance.

      • There’s been much talk on Trans fora about this.

        “If we only could
        Make a deal with God
        And get Him to swap our places….”

        There’s many trans women and trans men who would go for that.

        However.. I’d give it at least a century before benefits outweighed risks.

        • Actually, it occurs to me that this is a TERRIFFIC alternative to sex-change procedures. Like you, I think it will be many years coming but it would sure simplify things.

            • And while we’re at it… this one has a special meaning to Trans and Intersex people. Two of those in it are 46,XY, but while one is the standard factory model male, another is a woman with Complete Androgen Insensitivity Syndrome (CAIS). Being “immune” to male hormones, such women often become supermodels, more female than most girls.

              Now listen to the lyrics. I don’t think you’ll be able to see this song in the same light ever again.

              • Yeah, Kate Bush was something. My favorite female vocalist from that era is Elizabeth Fraser from the Cocteau Twins, though.

            • Beautiful! My ex-wife was an aspiring ballerina, and managed to instill in me an appreciation for the dance. Thank you.

  10. > he’ll just require a shorter coffin.

    Understatement of the year. 🙂

    On a more serious note, what if consciousness is not localized to the brain? Say it is evenly distributed through the nervous system. Then it gets interesting.

    • Consciousness is apparently very localised.

      Thinking – including processing we’re not self-aware of – is not.

      An obvious example is reflexes. Hard-wired actions sensory nerve->spine->control nerve with the “message” only arriving at the brain later.

      Those of us who make spaceflight avionics etc use both techniques, localised hard-wired quick-reaction to simple unambiguous situations in parallel with far more complex processing involving pattern-matching from multiple inputs (that takes a lot longer)

        • Depends – Fedsat used some hardwired gate arrays for the reflexes, an ESA developed space-qualified processor whose name escapes me (triply redundant) for the high end, with FPGAs for some tasks.

          So it was much like a biological brain, the Field Programmable Gate Arrays provided neuroplasticity.

          Possibly about as intelligent as a cockroach or spiny lobster. More so than a worm. Not remotely as bright as any vertebrate.

          • The processor was an ERC-32. A space qualified SPARC processor. Took me a while to retrieve that memory, it wasn’t in cache but archive.

          • Reason I ask is that at one point, I read a story describing the processors in either the Hubble or the shuttle as “advanced 286-based processor” and I nearly fell out of my chair.

            • The smaller the components, the more they’re susceptible to SEUs (Single Event upsets) and physical damage from errant cosmic rays.

              In the relatively benign environment on the Earth’s surface, it’s relatively easy to make VLSI components with a high yield and high reliability. As long as you don’t put them inside nuclear reactors or other hostile environments, nor subject them to -100 to _200C temperatures – or worse, one and then the other.

              The ERC-32 sacrifices processing power for durability and reliability. It uses three chips to process a modest 10 million instructions per second and two million floating-point operations per second – less than 1 per cent of a Pentium 4’s capabilities.

              The pay-off is reliability: the ERC-32 uses concurrent error-detection to correct more than 95 per cent of errors.

              Power-hungry microprocessors such as the Pentium 4, which runs a standard office PC bought off the shelf today, would be an intolerable burden on the solar-powered satellite. The ERC-32 consumes less than 2.25 watts at 5.5 volts.

              Designed to survive extreme radiation bursts from solar flares, the ERC-32 can tolerate radiation doses up to 50,000 rad. This is 100 times the lethal dose for humans.

              Low-Earth-orbit is “a cruel place to put a computer”, says software engineer Alan Brain, who is responsible for FedSat’s data-handling system.

              It will orbit at about 803 kilometres above the Earth’s surface and will circle the planet every 100 minutes.

              “The radiation will cause random bit-flips and can even fry components,” Brain says. “The vacuum boils the volatile gasses out of normal chips, making them useless and coating everything nearby with conductive gunk. In the Earth’s shadow, temperatures make Antarctica look balmy, and in the sun’s glare it’s hotter than the Simpson Desert. On the way up, the vibration of the rocket would shake most normal circuit boards to pieces.”

              Spaceflight avionics software development is not for the faint-hearted either.

              “The question for software developers is not, ‘Are you paranoid?’, the question is, ‘Are you paranoid enough?’ ” Brain says. “Every software module, every function, procedure or method has to assume that information coming in may have been spoilt by a malfunction and be prepared for the worst. The system must be ductile – bending, not breaking – when things go wrong. In space no one can press Control/Alt/Delete.”

              http://www.theage.com.au/articles/2002/08/24/1030052995897.html

              That was from 2002. I had no idea that 3 years later I’d have the puberty I’d missed out on before then. But that’s another issue.

              Interestingly, one of the other scientists working on the project recently transitioned – in the more usual way, common or garden therapeutically caused, not a natural change.

              • Thanks for the article. I had heard of the ERC-32, but, unsurprisingly, never seen one. Sun Microsystems used to make a processor that they were trying to sell to NASA that SEEMED, from their prop…uh, ads to be a space-survivable processor, but then I turned to other interests. Boy, talk about getting off-track. Sorry, all.

      • Ok. I need coffee. By “use both techniques” I understood as “my nervous system uses both techniques” which made me think the avionics comment was somewhat irrelevant. Of course the replies then made for some interesting read. For a brief moment I thought you were a cyborg.

        May I ask where do you do avionics? I have a friend in the industry working in the Seattle area.

        • Haven’t done it for a while, too busy with PhD and now dealing with TCC – Transitional Cell Carcinoma – in my elderly mother in law.

          But I worked on Fedsat with Auspace in Canberra, and did some consultancy work on the MESSENGER spacecraft via intercontinental telecommute.

          • Cool! My friend is more on the explody side of things, with sensor and control software for the propellant stage (although I’m not sure what he’s doing these days).

  11. Or, as Arthur Dent famously told Zaphod Beeblebrox, “Go bang your heads together, four eyes”!

    Personally, I’d far rather pass away peacefully and with a little dignity than becoming a sideshow freak with someone that I’d soon come to despise.

  12. Thanks for your response to my article. However, in your rush to call my arguments stupid, you seem to have failed to think about a few major problem:

    One: Cost, which would be prohibitive for 99.99% of the population (probably more). So this means that only the fabulously wealthy would be able to afford it, especially when (if) it first becomes available. So when a rich person’s body ran out of fuel, he could just swap it out for a new one, while the hoi palloi who would not be able to afford it would continue to be be stuck with death.

    The second ethical aspect you failed to imagine (and that I admittedly failed to mention) is that other types of transplants are different. One donor can supply 2 kidneys, 2 lungs, intestines, a heart, a pancreas, skin, bones, and corneas to multiple recipients, saving and/or improving multiple lives. Now change that to a full body transplant – one body, with all those organs, going to just one recipient head. What about all the other people potentially dying on the waiting lists who won’t get a liver from the newly-deceased because the rich man got his entire body? Is that ethical?

    And yet another ethical aspect you didn’t think of is that people with diseased bodies who would be candidates for a body transplant aren’t dying. Stephen Hawking, for example, has a devastation disease which will eventually kill him, but he isn’t actively dying. However, people on the liver, lung, and heart transplant list are. Would it be ethical to give an entire body with those 4 life-saving organs to one person who isn’t dying while allowing 4 other people who need those organs to survive to continue to wait?

    And you didn’t mention my most glaring point, probably because you don’t understand the immunology. If there is any rejection, it would be the original head that is rejected, not the body. If that happens and immunosuppressive drugs can’t turn it around, the only thing possible would be to remove the offending body and perform a second body transplant, which would then use a *second* full body while depriving yet more people of its life-saving organs. Would you consider *that* ethical?

    If you’d answer “yes” to those questions, then I’d have to question *your* sense of ethics, not mine.

    • 1. Bad start, Doc. I never called your post stupid, but I did call this stupid:
      “That’s the funny thing about ethics—it may be impossible to say why something is wrong, but can be easy to see that it isn’t.” Ethics is the study of what is right and wrong: if you can’t explain why something is wrong using ethics principles and analysis, then it isn’t wrong. You’re talking about gut, visceral, emotional feelings. Not ethics.

      2. “Cost, which would be prohibitive for 99.99% of the population (probably more). So this means that only the fabulously wealthy would be able to afford it, especially when (if) it first becomes available. So when a rich person’s body ran out of fuel, he could just swap it out for a new one, while the hoi palloi who would not be able to afford it would continue to be be stuck with death.”

      You don’t know what ethics is, so don’t write about it. Cost isn’t ethics, nor price. The topic is the procedure. Expensive procedures are no more unethical than expensive shoes. The question is what policies are put in place to make a procedure as accessible as possible. The policies might be unethical, but unethical policies don’t alter the ethical nature of the procedure itself. Helping rich people live is helping people live, and that’s ethical, per se.

      3.” What about all the other people potentially dying on the waiting lists who won’t get a liver from the newly-deceased because the rich man got his entire body? Is that ethical?”

      Again, a distribution issue and a policy issue, not materially different from the problems involved with any other transplant of a limited supply of organs. If Mickey Mantle unfairly went to the top of the liver donor list, that doesn’t make liver transplants unethical. I can end your dilemma with one provision: the full body donors don’t want their body cut up, and want to stay intact. Body or nothing. End of dilemma.

      4. “And yet another ethical aspect you didn’t think of is that people with diseased bodies who would be candidates for a body transplant aren’t dying. Stephen Hawking, for example, has a devastation disease which will eventually kill him, but he isn’t actively dying.”

      He has a fatal disease! Of course he’s dying. Everybody’s dying. And again, you are mistaking the policies governing the use of a useful, ethical technique that can save lives with the procedure itself. Naming unethical ways anything can be used does not show that thing is unethical. This is not a hard concept.

      5. “…the only thing possible would be to remove the offending body and perform a second body transplant, which would then use a *second* full body while depriving yet more people of its life-saving organs. Would you consider *that* ethical?”

      AGAIN: distribution ethics, not the procedure itself. When this happens with heart transplants, the patient goes back to the end of the list. You essentially see anything that helps rich people as unethical. Grow up.

      If you’d answer “yes” to those questions, then I’d have to question *your* sense of ethics, not mine.

      You don’t have any sense of ethics. You’re completely ignorant of the area. Your post was silly; this comment is sillier.

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