Among cosmetic procedures, sources say few have generated more ethical discussion than the partial face transplant recently performed on a French patient.
"I don't find anything wrong per se with the idea of a face transplant, particularly if there's nothing else one can do for somebody," says Daniel Callahan, Ph.D., co-founder of the Hastings Center, Garrison, N.Y. In the French case, however, he says, "Some of the reports suggested (the patient) had tried to commit suicide. So the question is, was she competent to have made a decision? That's hard to know from the news stories." Sander Gilman, Ph.D., professor of the Graduate Institute of Liberal Arts, Emory University, Atlanta, says that although many experts have discussed the impact a potential rejection could have on a face transplant recipient, "The answer is not that one doesn't do it because it might be rejected. We have the same debate with heart and kidney transplants."
Dr. Gilman says that the stigma associated with the Down appearance is so substantial that if the child is immediately subject to assumptions about his or her capacity, which varies widely in the syndrome, Dr. Gilman is comfortable with corrective cosmetic surgery.
However, Jean D. Carruthers, M.D., clinical professor, department of ophthalmology, University of British Columbia, Vancouver, says she'd have trouble agreeing to such procedures.
She explains, "This is a person who's perhaps not mentally able to understand the import of what would be done for them. One is really treating the parents rather than the individual."
Gender bending, blending
According to Dr. Gilman, approximately 5 percent to 7 percent of babies are born with ambiguous genitalia. He says that starting in the 1960s, the prevailing belief that sexual identity was essentially acquired drove surgeons to assign such infants gender — as early as possible and nearly always female.
However, Dr. Gilman says that during the late 1990s, "a number of people began making an argument which says sexual identity is, in fact, biologically hardwired." Proponents of this theory believe it's impossible to "make" a child — whose underlying sexual identity is male — into a female, he says.
"There are probably cases in which the learned experience can dominate," and vice versa, Dr. Gilman says. "We've gone ironically from one end of the spectrum — which says that culture dominates — to the other end, which says nature dominates. But my sense is that over the next decade, there will be a much more nuanced view of surgical sexual reassignment — that (gender) has to be reassigned is an assumption of our society," he adds.
Going to extremes
Out on the fringe are patients who desire extreme body modifications such as giving a feline appearance, or implants and full-body tattoos suggestive of scales or leopard spots.
Transplant raises questions
Dr. Carruthers says, "There is the famous case of the 'cat woman' in New York, who was married to her plastic surgeon. But it's pretty risky surgery. And someone who wants to look like a lizard probably needs counseling more than surgery."