Saturday, April 11, 2009

This week in modern medicine

by Christina DiGasbarro

It goes without saying that modern medicine is a wonderful thing—life expectancy wouldn’t have risen by 20 or 30 years in places like the U.S. over the past century without improvements in medicine. There have been several interesting stories this past week attesting to the scientific advances of our time. Still, we need to assess the state and use of modern medicine from time to time, assuming we don’t want to get carried away by our medical prowess.

This week the Washington Post profiled women who choose to undergo double mastectomies. These women, however, have not been diagnosed with breast cancer: they are having these surgeries in order to avoid ever getting breast cancer, and that’s why the story seems unusual, because the double mastectomy is not strictly necessary. These women, though, have seen their loved ones suffer and die from breast cancer, or have found that they carry the BRCA1 or BRCA2 genes that predispose them to breast cancer, so any way to avoid getting breast cancer seems like an attractive option, and rightly so. Still, it takes an enormous amount of courage for a woman to decide to get both her breasts removed, even if she already has breast cancer. It’s an emotionally fraught decision for two reasons: in the first place, no one wants to lose part of their body because our bodies are extremely important to us; in the second place—and this is unique to these cases—our culture’s standard of beauty places a premium on a woman’s breasts. While reconstructive surgery is an option after a double mastectomy, and women are taking advantage of that, the fact remains that silicone implants are not the same as one’s own breasts. Women who undergo double mastectomies to avoid getting cancer deserve a great deal of respect for their willingness to put aside conventional beauty norms (at least temporarily) for the sake of something vastly more important: their health.

CNN also reports the completion of a second partial face transplant in the U.S. Since 2005, when Frenchwoman Isabelle Dinoire received the first successful face transplant, there have been a few stories of other face transplants. Each time a team of doctors completes a face transplant successfully, they learn to improve the procedure and develop their skills, which they can share with others through teaching. For victims of maulings, freak accidents, burns, birth defects, tumors, etc., the prospect of a face transplant is surely heartening and offers the chance at an easier or more satisfactory life. Not to be alarmist, but I do think it’s important, as face transplants become easier and safer to perform, that we not allow people to elect unnecessary face transplants, and such limitations need to be considered now, pre-emptively. The fact that faces would have to come from cadavers or brain-dead people is reason enough to limit face transplants only to those who need a new face in order to properly eat, drink, speak, breathe, etc.—waiting for an organ is bad enough when you know that the people ahead of you on the list need the organ just as much as you do; imagine how much worse it would be if someone got a face transplant ahead of you simply because he or she wanted to, while you are missing half your own face and unable to communicate verbally. Furthermore, we would not want face transplants to become another option in the array of voluntary cosmetic procedures available to men and women with excess vanity and money (as for those lacking vanity and money, psychological counseling would probably be more productive than cosmetic surgery). There is something very important about faces and identity—for one thing, faces are important tools for recognition—and we ought to consider that very carefully when contemplating the prospects of face transplants.

Lastly, a Texas woman has harvested the sperm of her dead son, intending to save the sperm and find an egg donor and surrogate mother so that her son may posthumously father children. She plans to do this because, while her son lived, he expressed a strong desire to have children. While it is a tragedy that this woman has lost her son (he was only 21 and was killed in a fight), seeking to replace him, or replace the children he might have had, offers many ethical problems. In the first place, the effects on the resulting child need to be considered. Sooner or later, it would come out that the child’s biological father died before the child’s conception, and the child would presumably not know his or her biological mother, as the would-be grandmother plans to raise the child(ren) potentially conceived from her dead son’s sperm; there are bound to be psychological ramifications from learning this. The situation also brings up the same old questions about egg donation and surrogacy and the reduction of women merely to their reproductive organs and roles.

All of these stories raise questions about ethics, beauty standards, and the proper use of our bodies. It’s important to remember all of these things as medicine continues to advance. Whenever we come to a point where we know we can do a thing, it is vital to ask whether we should do that thing. Where should the line of permissibility be drawn?

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