In recent years transplantation has become a feasible way to treat some facial disfigurement. The process is not without its challenges – both scientific and ethical. This video on face transplantation was made by second year students as an assessed piece of coursework at the University of Leicester, UK.
This video was produced by students at the University of Leicester. The team made effective use of a fictional case study to investigate some of the ethical issues associated with organ trading.
In the fourth part of the BBC 4 Blood and Guts series, Fixing Faces looks at the evolution of plastic surgery. True to form, Michael Mosley presents a graphic account of how brutal attempts to reconstruct patients’ diseased or damaged faces have led to a modern medical speciality which is now believe to be on the eve of the first full face transplant. This episode describes and illustrates the history of this area of surgery: showing the work of the 16th century Italian doctor Gasparis Taliacotii (00:05:06 – 00:18:02); the beginning of the Botox era (00:18:02 – 00:30:00); and the work of Sir Harold Gillies and Sir Archibald Mclndoe, who developed both surgical techniques and the need for psychological support for patients undergoing reconstructive facial surgery (00:30:00 – 00:50:00) (Please see this Student BMJ article – ‘A brief histoy of plastic surgery’).
This episode highlights two main ethical topics for discussion: functional Magnetic Resonance Imageing (fMRI) and Neuroethics (00: 01:54 – 00:05:06); and face transplants or facial allograft transplantation (00:50:00 – End).
Blood & Guts – A History of Surgery: Spare Parts is the third part of the BBC Four documentary series about the “brutal, bloody and dangerous history of surgery” focusing on the development of transplant surgery. The documentary primarily gives a graphic account of the history of transplant surgery, in particular focusing on the work of Alexis Carrel (00:04:24 – 00:22:47), Joseph E. Murray (00:22:47 – 00:45:32) and Sir Roy Calne (00:36:40 – 00:45:32). However both at the beginning (Start – 00:04:24) and the end of the programme (00:45:32 – End) Michael Mosley (Also seen in BBC’s documentary series Medical Mavericks) discusses some of the ethical concerns that may arise from transplant surgery. Mosley meets with two patients who have both had a hand transplant, however only one of the patients is able to keep his new hand as it illustrates the success and failure of the radical surgery.
DNA – The Promise & The Price provides an excellent resource for discussing the ethical implications of advancing genetic research, focusing on; gene therapy, stem cells and cloning. The documentary examines the frontiers of genetic science, revealing how researchers attempt to fulfil DNA’s potential to help cure and prevent disease. It also questions how some aspects of these novel technologies may have significant consequences for individuals and society. Bill Paterson: “Much is promised by genetic science, the manipulation of our genes. But can it deliver? And if it does are we ready to take responsibility for meddling with the very fabric of life itself: our DNA”.
The topics found in DNA – The Promise & The Price include: genetics; genetic diseases; gene therapy; transplantation; stem cells; and cloning can all be found in the UK National Curriculum. Please note all timings mentioned include advertisement breaks – (00:04:51 – 00:08:00, 00:25:31 – 00:28:40 and 00:46:50 – 00:50:00)
The issue of resource allocation in the NHS has cropped up several times in recent programmes (see, for example, Dom’s on the Case regarding the “postcode lottery”. The present post examines the ethical issues implicit in a different aspect of resource allocation in healthcare: the potential for conflict between traditional medical ethics and core NHS values and increasingly prominent views of the individual as both responsible and accountable for their own health status. This tension came to the fore in Just, a recent episode of the BBC drama Holby City (first broadcast on BBC1 at 8.00pm on 20th January 2009), and is captured nicely in one particular quote from the programme in which surgeon Ric Griffin challenges his patient, an obese smoker, “if you can’t be bothered to look after yourself, then why should we?” (00:38:07)
At a military hospital in China, Professor Guo Shuzhong is striving to advance the necessary medical techniques to complete a full face transplant for one of his patients. Celebrated as one of China’s best plastic surgeons, Professor Guo is anxious to improve the lives of people with severe facial disfigurements.
Professor Guo believes that the only way to improve the life of his patients is to build on the well established techniques of plastic surgery and move towards partial and full face transplants. In November 2005 Isabelle Dinoire underwent the world’s first partial face transplant in France (00:12:34 – 00:13:32) (See Face transplant – Horizon). Professor Guo is encouraged by this and hopes that his research can build on the medical breakthrough.
The fourth series of BBC Radio 4’s bioethics programme Inside the Ethics Committee began on August 6 2008, and discussed some of the ethical issues involved in the creation of ‘saviour siblings’ (first broadcast on BBC Radio 4, at 20.00, August 6 2008 and repeated on August 9 2008, at 22.15). Vivienne Parry and a panel of experts discuss the ethical issues around real-life medical cases, on this occasion the dilemma involves a young child, Catherine, and her medical treatment. Previous BioethicsBytes posts have noted the utility of this series (see the post Making tricky decisions – Inside the ethics committee), and this episode is no different.
Shortly after she was born Catherine was diagnosed with Diamond Blackfan Anaemia (DBA). DBA is a rare blood disorder caused by a genetic mutation. In general, its treatment is “gruelling” (00:02:27) and the prognosis is poor. As in several previous cases (notably, the Whitaker, Fletcher and Mariethoz families), Catherine’s parents were offered the option of using preimplantation genetic diagnosis (PGD) for tissue typing alone in order to create a ‘saviour sibling’ whose umbilical cord blood could be used to treat Catherine’s DBA.
Many of the ethical issues involved in this choice have been dealt with in past BioethicsBytes posts (see The Future of Our Families? and the extended commentary that accompanies that post), however this edition of Inside the Ethics Committee brings consideration of these issues up to date. Though the majority of the ethical issues raised are covered in our existing posts, some of the additional details noted here about DBA and the testing procedure introduce new complications into the ethical debate.