You would feel uncomfortable if your face is ‘photoshopped’ onto someone else’s body. How about if you wake up one day and found your head stuck onto a body from unknown origin?

While advancing medical technologies introduce the possibility of life prolongation, it also implies that doctors are more likely to face controversial issues on a daily basis. In Italy, doctor Sergio Canavero’s idea of full body transplant – grafting a living person’s head onto a donor body – ethical and psychological issues have arise.

Firstly, it often violates the principle in medical ethics of caring for the patient as an individual. Not only should a professional physician care for patients’ health, their psychological well-being should also be safeguarded.

Unlike specimens, human beings have cognitive faculties. Therefore, they should be given informed consent. However, given the time-critical nature of surgeries, and the unconsciousness of patients, informed consent and consultation is often neglected. A physician’s role is to be supportive, not judgemental towards patients’ decisions.

According to Dr Katerina Deligiorgi, Reader of Philosophy in University of Sussex, “Transplantations are not in obvious ways connected to our ordinary moral lives, unlike cheating or being cruel. Even though we all have immediate reactions for or against such radical transplant operations, I do not think these are either decisive or particularly informative about the ethics of the case”.

Dr Deligiorgi highlights the possible result of significant alienation – that the operation brings about conflicting self-identity. Throughout history, many patients were confused about their new appendages and had them removed, because of the unbearable psychological burden.

While some scientists believe brains are the most important body part which holds all mental faculties together, philosophers consider psychological continuity essential to personal identity. This is shaped by “memories, beliefs and desires”, Dr Deligiorgi says. A heartbeat or rumbling stomach can also influence our will power, emotions and language.

French philosopher Jean-Luc Nancy, in his book L’intrus (The Intruder) published in 2000, referred to his own experience of heart transplant as a surgery that turns a body into a “montage, an assembly of functions”. To have a body that looks visually different and feels alien must be harder to accept.

Nancy points out that the influence of viruses and bacteria exacerbate as the body gets imposed to and invaded by the strangeness of a transplant because the immune system needs to be artificially weakened to allow the intrusion of the alien organ. 

To become available for this operation, the age of the donated body must be sufficient – an adult brain cannot fit into a skull which has not reached its full growth, which occurs at age 9–12 years. 

In the UK, joining the organ donation register would not automatically allow your body to be used. “If a person needs something not specified on our forms, we would ask a potential donor’s family to consent,” says an NHS spokesperson. “We would only approach a family if the planned procedure had ethical approval.”

Given the ethical difficulty of the demand of bodies, Dr Tanja Staehler, Head of Department of Philosophy in University of Sussex, raises the following questions: “Who decides, and according to what criteria?  If the experience is potentially so alienating that they might not want to keep living afterwards, was it the waste of a body?”

Concerns are raised regarding resource allocation and the use of people for their organs either for profit or to save a siblings.

According to Dr Deligiorgi, “our minds are not just in our skull”. All the material we use to extend our cognitive capacities, from jotting down shopping lists, as support for our memory, to using a calculator, count as part of our mind. If you add to this embedded view of cognition to the view that our experience are directly related to the bodies we have, it explains that the self of the transplanted person would be irrecoverably lost or severely disturbed.

Another challenge is that human beings are not just passive recipients of our experience, we are actively organising them. Our sense of self is inextricably linked with this active self-awareness. If something were to damage this ability to order our experiences it would damage our sense of self. This might stem from a drastic neurological procedure like body transplantation.

As the society evolves, doctors’ role has also changed to fit its members’ needs.  But they should always uphold the principle of doing no harm to patients.  In order for this to endure, doctors should utilize their professional judgement to treat their patients as individuals, considering not only their physical needs, but psychological concerns.

Yim Hoi Heng Dorothy

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