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ARTICLES ON BIOETHICAL ISSUES:

Face-off over facial transplants

Problems with Surrogate Mothers

A Reaction Paper

Presented to

Manila Adventist Medical Center and Colleges, Inc.

College of Nursing

Level IV

in partial fulfillment

of the requirements in

Bioethics

Submitted by:

Wilma Cleo Yvonne Dapog

BSN IV-A

August 22, 2011


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Face-off over facial transplantsDoctors prepare for surgery, but key questions remainby Arthur L. CaplanCOMMENTARYMSNBC

A team of doctors at the University of Louisville in Kentucky is moving forward with aplan to attempt the worlds first face transplant. They have applied for permission fromthe Universitys research ethics committee to remove a face from a cadaver andtransfer it to a live volunteer willing to go through with the surgery. If approved, theoperation could take place before the end of this year.

For those who have suffered terrible physical trauma, such as burns or the ravages oforal cancer, and who have been unable to adjust to their disfigurement, this radical newform of surgery offers tremendous hope. However, the ethical question is whether thesesurgeons are really ready to offer this hope.

The reason the team at Louisville believes they are prepared to try this incredibleoperation is that they have already been successful in transplanting hands taken fromcadavers. To date, one of the most difficult tissues to transplant is skin. The bodys firstline of defense is especially sensitive to foreign tissue and, as a result, skin transplantshave limited what could be done with limbs, hands or other external organs. TheLouisville group has developed a powerful combination of drugs that helps prevent thebody from rejecting transplanted skin, allowing for their success with handtransplantation. The team believes they can apply this technique to face transplants aswell.

Patient faces enormous riskThere are apparently many volunteers willing to undergo a face transplant. While somepeople who have endured facial disfigurement learn to adjust, others do not. Theywould gladly take the risks involved in such a surgery for a chance to regain thenormalcy that, in our appearance-conscious society where people undergo multiplesurgeries just to look younger, is difficult to achieve with a severely deformed face.

The problem is that there are a number of very real and serious risks confronting thefirst subject. For example, the drugs used to prevent rejection by the body may fail,leaving the recipient with the nightmare of the transplant being rejected and, with deathlikely to quickly follow, no other options. In addition, the drugs involved are so toxic that

cancer, kidney failure and other problems are likely to eventually occur, even if the initialsurgery is successful.

Even more challenging is the problem of adjusting to a new face. While those withsevere facial deformities might hope for any alternative, a transplanted face that doesnot work right, looks strange or reminds people of someone who is dead, would posevery difficult challenges to anyone who receives it.


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Should donor's family help decide?And how will a donor be selected? Remember -- until you know who your pool ofrecipients is likely to be, you cannot match possible donors for blood type, size andother biological factors. As a result, the decision about who will donate and who willundergo the surgery is likely to be a last-minute one.

Should the pool of possible donors only include those who have signed a donor card orwho sign a document including their face among those organs and tissues they arewilling to give? Or should their families be able to make the decision without a donorcard since they are the ones who will have to live with whatever happens when thesurgery is completed and someone else receives their loved ones face?

These are among the most difficult ethical questions ever to confront the field oftransplantation. Thankfully, the Louisville team is trying to explore and discuss theseissues before they proceed. Lets hope that they -- and other surgical teams in theUnited States, France and Britain who are also gearing up to be the first to perform this

unprecedented procedure -- have the good judgment not to proceed until all of thesequestions have been answered.

Arthur Caplan is director of the Center for Bioethics at the University of Pennsylvania.

Posted: 2004-06-03

Source:http://www.bioethics.net/articles.php?viewCat=2&articleId=64
http://www.bioethics.net/articles.php?viewCat=2&articleId=64http://www.bioethics.net/articles.php?viewCat=2&articleId=64http://www.bioethics.net/articles.php?viewCat=2&articleId=64http://www.bioethics.net/articles.php?viewCat=2&articleId=64


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Problems with Surrogate Mothers

Sometimes couples who are unable to conceive a child on their own choose to use asurrogate mother, in which case another woman carries their child. One method of

surrogacy is when a woman who is not able to carry a child to term, but is otherwisefertile, has her embryos transplanted into the surrogate mother. The eggs may befertilized by the biological father or by artificial insemination if the male has fertilityissues. In other cases, a surrogate mother is actually the biological mother of the childas her own eggs are used to create the embryo.

Legality

In some states, surrogacy is illegal. Even in states where surrogacy is allowed, it can bea complicated process for the non-biological mother to be named as the parent,particularly in cases where the surrogate is the biological mother. The surrogate must

sign away her maternal rights so that the intended mother can adopt the child. If thesperm of the adoptive mother's husband was used to fertilize the egg, the biologicalfather is named on the child's birth certificate. Many states require that a legal contractbe drawn up between the couple and the surrogate and her spouse or partner detailingall arrangements relating to the pregnancy and birth. The parties involved in a surrogacycontract should seek the advice of legal counsel to make certain that all pertinent issuesare addressed and that the contract is in compliance with state and local laws involvingsurrogacy and adoption.

Surrogate's Change of Heart

Sometimes a surrogate mother changes her mind and refuses to give up the child.However, in states where surrogacy is allowed, the biological mother usually does notwin custody or visitation rights. In most cases, both the surrogate and the parents sign acontract to prevent this from happening. Nonetheless, there is always the chance thatthe surrogate mother might win her case.

Breach of Contract

Most surrogacy contracts state what the surrogate can and cannot do while pregnant.But in the end, the parents must trust the surrogate mother to do what is in the bestinterests of the baby. Problems can arise when a surrogate breaches the contract by

smoking, abusing drugs or drinking alcohol while pregnant.

Medical Complications

Like with any pregnancy, there is always the chance for medical or obstetricalcomplications, which could harm the baby or the surrogate mother. For one, there is therisk of transmission of infectious disease to the surrogate when another woman's eggsare transplanted into the surrogate. For this reason, both biological parents must be


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prescreened. If a surrogate develops complications early on that put her life at risk, shemight want to end the pregnancy. Another problem that can occur is if doctors discoverthat the fetus has potential birth defects or other health concerns. In that case, theparents might decide they do not want to continue with the surrogacy. This creates allkinds of legal problems, especially if the sperm is from a donor or eggs other than the

surrogate's were used for pregnancy. The question then becomes who gets to decidewhether to proceed with the pregnancy.

Ethical Issues

Although some people view surrogacy as baby-selling and look down on a woman whois a surrogate, in the recent years surrogacy has become more of an accepted practice.Still the ethical question remains as to whether a woman who is being paid for hersurrogacy is exploiting infertile couples and entering the contract for money. Others seethe infertile couple as exploiting the surrogate's body and taking advantage of a womanwho needs money. Yet despite the many ethical issues at stake, statistics show that

there has been a rise in the numbers of women who act as surrogates. In 2006, theSociety for Assisted Reproductive Technology estimated about 260 surrogate births.However, the number of surrogacies each year is likely to be more, as many fertilityclinics do not report to SART. There are also couples who enter private agreementswith a surrogate in which agencies are not involved.

Author: Amber Keefer, M.B.A.

Article reviewed by M.J. Ingram | Last updated on: 04/30/11

Source: www.livestrong.com/article/117026-problems-surrogate-mothers/


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Summary:

Couples who are unable to conceive a child in a natural way would sometimes

decide over using a surrogate mother to fill-in for their incapacities. There are different

methods of surrogacy depending on the needs of the couple: in one case, a surrogate

mother is actually the biological mother of the child as her own eggs are used to createthe embryo; in another case, she is the non-biological mother when an embryo of a

woman who is not able to carry a child is transplanted into her. In countries where

surrogacy is legal, it is still a complicated process that requires a legal contract between

the couple and the surrogate detailing all arrangements relating to the pregnancy and

birth. Problems arise when a surrogate changes her mind and refuses to give up the

child, or she breaches a contract by smoking, abusing drugs, or drinking alcohol while

pregnant. Like in other pregnancies, there is also a chance of medical or obstetrical

complications, which could harm the baby or the surrogate mother. Although surrogacy

has been an accepted practice in the recent years, still the ethical question remains as to

whether a woman who is being paid for her surrogacy is exploiting infertile couples and entering

the contract for money or the other way around: the couple exploiting the surrogate mothers

body while taking advantage of her need for money.

Reaction:

Surrogacy has been an accepted practice in most countries, including the

Philippines; although we dont have enough facilities, Filipinos go abroad to undergo the

transplantation of the egg or embryo. But still, I am not convinced that it is ethical

because it involves the exploitation of another persons body for the process of

sustaining a newly created life. Furthermore, the dignity of the surrogate mother is atstake because others may look down on her and interpret that she enters the contract

just for money while letting her body be used by other people. The most difficult

situation is when the surrogate changes her mind to give up the child since she also has

maternal rights over the pregnancy. As a nurse, whenever I would encounter a couple

who are contemplating on using a surrogate mother, I would remind them of the

importance of signing a legal contract beforehand to avoid future conflicts and minimize

problems; this will also determine who will have the right of custody over the child.


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Summary:

In 2004, a team of doctors in the University of Louisville in Kentucky had a plan

that attempted to perform the worlds first face transplant. The procedure includes

removing a face from a cadaver donor and transplanting it to a living volunteer who is

willing to undergo the surgery. The team believes that they are already prepared to dothe incredible surgery since they were successful in transplanting hands from cadavers

and they have developed combination of drugs to combat the possible rejection of the

transplant. Many are willing to be volunteers for the surgery because of their own

difficulties in adjusting to disfigurements or theyve suffered burns in the face. But still,

the patient to receive the skin transplant would be faced with real and numerous risks,

such as toxic effect of the drugs to avoid rejection, or worse, failing of the drugs to

prevent rejection of the body, which will eventually lead to death. Numerous difficult

ethical questions have confronted the field of transplant, such as how a donor will be

selected, if the family can also decide on the transplant, and so on. The permission has

not yet been granted by the research ethics committee of the university, and thankfully,

the team is trying to explore and discuss these ethical issues before they proceed with

the surgery.

Reaction:

When I saw the title of this article, the word facial transplants gave me goose-

bumps. Ive only seen this is in a movie (Face-off), and Ive never thought that medical

practitioners would attempt to make it a reality. If benefits of the surgery will outweigh itsrisk, I will not object to this face transplantation. But since the medical team had already

perceived the fatal risks that are possible to happen to the patient, and without enough

assurance that it would be a success, I would oppose to it. I am not convinced that life

can be exchanged with a near-normal facial appearance for life is more than deciding

what to wear and what he/she looks like. Even with a disfigured face, one can continue

living as long as there are people who are there to support and love you just as you are.

Furthermore, there are other alternative treatments that are available such as skin

grafting and cosmetic surgery.

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