December 5, 2005

Suicide and the face transplant.

The donor in the face transplant case was a suicide: Is this an ethical problem? More significantly: Is it an ethical problem that the recipient came about her need for a face transplant through her own attempt at suicide?

The horrible detail:
Transplant patient Isabelle Dinoire, from Valenciennes, north of Amiens, was reported to have overdosed on pills last May following a row with one of her two daughters. As she lay unconscious, part of her nose, her mouth and chin were bitten off by her Labrador-cross dog, Tania.
UPDATE: The woman's doctor denies that she had tried to commit suicide.

41 comments:

Joe Baby said...

Wow. Time for a dog transplant, too.

Ann Althouse said...

Wow. Bow wow.

Ron said...

Either she really ticked off that dog, or she tasted like ham!

This part of the story adds a whole Seinfeld aspect to the story; George: "...and then the dog tried to eat her face! Unbelievable!"

reader_iam said...

I just can't bring myself to make the obvious and disgusting play on words.

Kim said...

I think that if you've had your nose and lips eaten off by a dog and 9 months later you're still alive and have not attempted to kill yourself, I'd say that's a good sign.

Dave Schuler said...

Other reports I've read (but can't put my hands on now) have suggested that the dog was attempting to rouse her not eat her.

I think that we need to pay more careful attention to the ethical considerations here. There was no informed consent (French law doesn't require one); there was no attempt at reconstructive surgery prior to the transplant. What if the face is rejected? There are no protocols for removing a dead or dying face—the victim would likely just suffocate and might well be in worse shape than before the transplant.

Meade said...

I don't see the ethical problem, except for what may have been a stolen protocol.

amba said...

My first uncensored thought: It sounds like they deserve each other.

This story was grotesque even before those details came out. (They weren't talking about this aspect of it on TV -- only about the movie Face/Off, and whether you'd get a face transplant if you could for cosmetic reasons. Chatty Jeannie Moos stuff.

AJ Lynch said...

Had heard the recipient was mauled by a lab but that story struck me as questionable as her injuries were so severe and so I wondered if she was dead drunk or something.

Now you have told me what was left out of the story I heard....and I ask was she unconscious so long, the dog went unfed and hence the attack?

Ron said...

Isn't that the irony of life? She wanted to kill herself, failed, but the whole time, the dog thought of her as snausages! Who knew?

Mark the Pundit said...

everyone with a dog, PLEASE take note to feed your dog before overdosing on pills.

It will go a long way in avoiding these potential bad scenarios!

Meade said...

I doubt the dog was hungry and bit off and swallowed those body parts. More likely, the dog, in his own way, was trying to revive his companion, first by licking her face, and then, in desperation, began nipping.

knoxgirl said...

You know this story is giving the people at "Fear Factor" ideas...

PatCA said...

Let's not be some caninonormative here! Cats will also eat their comatose/dead masters. They get hungry, they get panicky...

So, yes, remember the kibble if you plan to die young and leave a good looking corpse.

Meade said...

Ironically, the dog's nipping may have been what saved the life of the unconscious suicide self-victim.

Meade said...

The patient was mauled by a pet Labrador in June, leaving her with severe facial injuries that her doctors said made it difficult for her to speak and eat.

The dog was put down. Neighbours said the woman was an animal lover who bought a new dog after the attack - a smaller dog.

Jeanne-Marie Binot, administrator of the local Society for the Protection of Animals, said it was likely the Labrador had passed through her service, though she had no written record of it and did not recall the case.

One of the woman's daughters reportedly told French media that the dog had tried to wake her mother and had no intention of harming her - a scenario that a local dog trainer said was possible.

"The dog undoubtedly wanted to re-establish contact with (its) master, in any way he could," said Pascal Duplouy, who had no contact with the animal in question.

"It's true that when a dog is in a state of panic, it can scratch and scratch and scratch his master's face, to try to wake her, without realising the harm it's doing," Duplouy said. - Sapa-AP

http://www.int.iol.co.za/index.php?set_id=14&click_id=117&art_id=qw1133789760925B216

sonicfrog said...

Mark said,
" everyone with a dog, PLEASE take note to feed your dog before overdosing on pills."

Tooo funy.

I don't see what all the hoopla is about. This was nothing more than a skin graft, when you get right down to it. So much of what we look like depends on the bone structure of the face. This woman's new lips might be a little bigger than the old ones, but hey, that kind of elective surgery is done in Hollywood all the time.

Eli Blake said...

I don't see the ethical problem here. Because she attempted to kill herself, therefore she is undeserving of the surgery? How would one have to do with the other?

DEC said...

No problem. Most people are two-faced, anyway.

Ann Althouse said...

Meade: "Ironically, the dog's nipping..."

Nipping?? Her lips, nose, chin, and parts of her cheeks were eaten off. People who are trying to excuse the dog are being silly. The dog was just being a dog. Don't be so sentimental. That is what dogs do. Face it. (To coin a phrase.)

The ethical problem might be that she did the damage to herself (or by her own intentional, destructive act). But it may also be that she has demonstrated emotional instability and might not be able to deal with the difficulties of the transplant: the emotional blow of having a different face (though anything seems better than having no lips), and the hardship of having to take drugs for the rest of her life.

Meade said...

Where does it say they were "eaten" off? I don't think I'm the one here with a misunderstanding of canine psychology.

Meade said...

And you are just trying to get my goat with that charge of sentimentalism. How about you not being so cold? You know? Put a little love in your heart, as the song goes.

Ann Althouse said...

Meade: Where do you think all that flesh went? Do you think the dog bit off these large chunks of flesh and placed them on the floor somewhere? Why was the dog put down? It's well-known that dogs left with a dead body will use it as a food source. The bizarre thing here is that the woman came to. I'm not being unloving toward the dog. In fact, I love the dog for what he really is. You're in love with your own illusion of the dog. That is not the dog.

Meade said...

Ann: You are the one being silly here. You still can't cite for me where the pieces of the woman's body were "eaten." "Large chunks" of "all that flesh..." you're making that up out your own imagination, not from what was reported here. I am not "in love with" my own illusion of anything and I haven't "excused" the dog's behavior. I've merely tried to explain it. I don't know why the dog was put down and neither do you. Do you? Review this thread of comments and show me where I have expressed sentimentality or silliness.

HaloJonesFan said...

Why would a hungry animal go for the face? It's a thin skin. The rear end is much softer, meatier, and easier to access.

Eli Blake said...

HaloJonesFan:

But that could be risky. She was apparently lying face up, so the dog would have had to dig down and probably suffocate in her clothes (no word on how tight fitting they were). Or it could chew through them, but it would still have to chew all the way down through her to get to the buttock. Or it could try and pull her off the couch but if she is heavy, she might fall on the dog and crush it to death. Or, it could to for a meatier area that is on top, but that might be too fatty.

Meade said...

Eli, please -- stop being so sentimental.

reader_iam said...

Bow wow--that pooch peeled her face like bark from a dogwood.

There, I said it (but held off for hours).

I'm not normally like that--this thread is actually seriously grosses me out. I, unlike what I've gathered about our host, am a squeamish sort.

Seriously, though, whole idea of a face transplant fascinates me, from a psyche perspective.

Not to go on too long, but I'm wondering what affect it has on one to go the mirror and see someone who no longer looks like your particular someone? (Now, obviously, that'd be better then seeing the results of being mauled.)

I mean, aren't our visions of what we look like, what we expect to see, deeply and unconsciouly embedded in our minds?

And there are all sorts of, again, unconscious reference points to family and heritage, and all that.

I mean, I don't think about it much, but if I look consciously at myself in the mirror I can note that my upper lip is my mom's, the lower my dad's; my nose is again a combination of both; my eyes remind me of my paternal grandmother's in their color and quickly changing expressiveness, and my mother's in their shape; my cheekbones belong to my maternal grandmother ... and so on and so forth.

While these are things I don't generally ponder, I have certainly been aware of them for most of my life. How would one's whole self image be affected with such a profound change?

I also know someone who has worn glasses since around age 5 and who, as a byproduct medically necessary eye surgery, needs them no longer. Yet she found it so disconcerting to look at herself in the mirror without glasses that she's taken to wearing them again--with non-prescription lenses. I know that I myself (glasses since 7), the few times I've tried contacts, ended up doing my make-up entirely differently--and it actually felt weird.

Ann Althouse said...

I love the way everyone's trying to answer the ethical question posed.

LetMeSpellItOutForYou said...

Offering a complex new surgery to this woman might be unwise and arguably unethical if she later succeeds in committing suicide, since surgeons would lose out on valuable follow-up data. What if you were the second person being offered the surgery with no useful information on whether the first one's face had been rejected?

LetMeSpellItOutForYou said...

If there's a good chance she commits suicide, I guess there's also a question of why waste valuable resources on her to begin with. Like why give a heart transplant to an inmate on death row in Texas? It might make her more guinea pig than human by elevating the value of the surgery as experimentation over any honest plan to improve her life.

Oh and by the way: Woof Woof!

reader_iam said...

Re: "Might lose valuable follow-up info" and "wasting resources"

To treat this superficially, it seems we think the recipient has a lot of responsibility to the greater "us" (the former") but on the other hand, we should limit our responsbility to her because she's not the perfect test case.

Ick. Ethics can be a cold proposition. Especially the utilitarian brand.

We don't know everything about this person. But I'm personally uncomfortable with the proposition that because someone tried to commit suicide, that that's somehow on par with a "bad lifestyle" choice, and therefore it's ethically OK to say she's not worth the effort of helping.

If, for example, she's been clinically depressed--which is often a CHEMICAL thing, not a choice--and that contributed to her decision, does that make a difference?

(By the way, I personally don't think that "bad lifestyle choices" should necessarily be the overwhelming determining factor, either, for various reasons I won't go into right now.

Unless you have a very stark, immediate choice to make--such as, say one liver that matches both a 45-year-old drug addict and a 15-year-old, otherwise in perfect health kid who happened to contract hepatitis--in which case the choice is clear.)

I was attacked and mauled by a dog as a pre-schooler, necessitating three plastic surgeries before age 6 to repair facial and head damage. If, rather than having been the victim of an unprovoked attack, I had been one of those kids who are dog-kickers and otherwise mean to animals, would it have been a waste of resources? Would I then have "deserved" to go around with more visible scarring?

Meade said...

If, rather than having been the victim of an unprovoked attack, I had been one of those kids who are dog-kickers and otherwise mean to animals, would it have been a waste of resources?

No, not at all.

Would I then have "deserved" to go around with more visible scarring?

Only if you couldn't learn your lesson and kept kicking innocent dogs and being mean to animals and inanimate lime green Volkswagen Beetles.

lindsey said...

It's only a matter of time before some crazy person has someone whose face they want knocked off. A black market in beautiful faces. Watch out, Angelina Jolie!

miklos rosza said...

"Les Yeux sans Visage" directed by Georges Franju, 1960 or so, is a classic, extremely scary, stylish film which addresses this question in great detail. (The title is usually translated as "Eyes Without a Face.")

A scientist's beautiful daughter loses her face in an automobile accident. Hence, he attempts to repair this by luring replacement candidates to his chateau.

The daughter (who usually wears a featureless white mask) is not necessarily wild about the experiments conducted on her behalf.

There are some bad dogs here as well.

Daryl Herbert said...

joe baby, the "dog transplant" line is apt:

Before the surgery, she largely kept to herself and wore a surgical mask to hide her face while walking her new pet, they said.

Ann: It's true she told a British tabloid that she tried to kill herself, but you shouldn't believe her words because she was high on pills at the time.

To answer your question:

It's so terrible that they took advantage of an emotionally vulnerable woman to use as a test subject? I don't think that's what went on at all.

Would scientists really be more "ethical" if they let this woman suffer grotesque organ failure because she wasn't the perfect test case? It's not enough that maybe she tried to kill herself, now we have to cut her off from any chance of having a normal life?

Have you considered that no normal person could be considered emotionally capable of facing the horror of life as a deformed freak, with people gasping and averting their eyes and children screaming and whispering? She's neither blind nor deaf.

Who would want to love her? Who would stop to chat--oh, wait, she couldn't chat, because she didn't have a functioning mouf.

If she's such a terrible person for wanting to kill herself, why do you care what's done to her? If she's such an innocent victim, why would you want to victimize her further by preventing her from having a chance at normal life?

What's the ethical case against? That it's risky? That's not an argument, that's an observation.

CCMCornell said...

No real opinions from me - just writing down some questions I can't answer for myself.

If the patient, before passing out due to the pills, looked at herself in the mirror, she would have seen a depressed, suicidal face. Now, when she looks in the mirror, will she see features of two depressed, once-suicidal faces? How will this affect her recovery? Why weren't the details of the donor kept more of a secret - a practice to avoid such psychologically taxing problems?

Details of the donor left aside: if a face transplant can help improve her appearance and help mask reminders of her suicide attempt so it's not so overwhelming to grow past in mental therapy, doesn't such a procedure benefit her mental health?

Of course, there's the experimental nature of the procedure and the patient's mental history, as raised by the linked article - if the physical recovery, life-long, high maintenance, and unforeseen complications form too much of an emotional burden, could the procedure end up being harmful to her mental health?

Lastly, the experiment, successful or failure, should yield results that will benefit future patients. However, if it fails medically, especially because of the patient's previous mental state, and then brings about a media circus, it could stigmatize any future research in the field.

OK - really lastly: the above humor reminded me of one of my most favorite TV programs: the stand-alone (freak-of-the-week) episode of the X-Files - Clyde Bruckman's Final Repose (s3e4) for which guest star Peter Boyle (the grandfather on Everybody Loves Raymond) won an Emmy playing a man who could foresee the details of anybody's death, including that of his neighbor - a little, old lady with a tiny dog (whom Scully later adopts and who makes a couple of cameos in later episodes until his exit in another great stand-alone episode - Quagmire, s3e22 - wow, a dorky X-Files reference within a dorky X-Files reference.) The last time Bruckman sees his neighbor while taking out her trash, he asks if she needs anything else - like dog food.

vkk1_hypno said...
This comment has been removed by a blog administrator.
docdoc said...

when you are talking about a kidney, a liver, a heart.... YOU DON´T TRANSPLANT a depressed person.

There´s shortage of organs (you don´t have enough organs to transplant everyone who needs it); it´s a very expensive surgery (not only the surgery but also a lot of years on immunossupresive therapy have its cost - how many lives you would be able to save with all that money?); its a danger surgery (the patient might die during the procedure); the patient might die of the immunossupressive therapy (risk of infection, risk of rejection if he doesn´t take the medicines right).

So, you must choose patients to receive a transplat, and you won´t select those who won´t benefit from it (like someone with an advanced neurologic illness that will kill him anyway in a few weeks); someone who are likely to die from it (like someone with cancer that will have a flare of the disease, or someone that have a high risk of not taking the medicines and might have rejection).

However, when it comes to a face transplant its a completely different matter. Your not talking about a kidney, those rules do not apply here. Perhaps bringing her face back might actually save her life (terrible scars on your face, your identity, might bring a ordinary person to a suicidal depression, imagine what it would do to someone who was already on a major depression?)

As long as it is a experimental treatment, if the patient is well informed and agrees with the procedure and the doctor who will perform the surgery agrees with its indication, I don´t see an ethical dilema.

I won´t even comment anything about an ethical someone having someone elses face. It don´t applies in this case (the 3 faces will be different from each other) so I don´t see a medical issue here, its much more a philsophic issue, so its not my business

Lillygirl said...

If you ask me. This face transplant should have gone to someone else. I don't believe this dog did this intentionally to hurt this trashy women. Why did the dogs life have to end? Not the womens? If you ask me she was just a sience project for all these doctors....I hope she get an infection and dies...the crude and rude to say, but its how I feel after doing a lot of reading on this story.

Big Herm said...

I think they should have used a dog face for the transplant. TRUE, she would have had to shave more often, but the fur would conceal the plastic surgery scars, and she could earn decent money exhibiting herself as a living work of art! I understand the French do this all the time.