Guest Post: Michael S. Dauber, MA
* Note: this article is being cross-posted at the Practical Ethics blog.
In 2015, Sergio Canavero announced that he would perform a therapeutic head transplant procedure on a human subject by December 2017. Since then, he has recruited the assistance of surgeon Xiaoping Ren and switched from Valery Spiridonov to an anonymous Chinese patient whose medical condition remains undisclosed. The procedure, which consists of removing the patient’s head and attaching it to a decapitated donor body, is expected to be carried out in China, will cost tens of millions of dollars, and will require dozens of surgeons. The procedure returned to international attention this week when Canavero announced he had successfully performed the procedure on a human cadaver, and said that the announcement of an official procedure date was “immanent.”
The medical community has resoundingly asserted that the procedure is extraordinarily unethical, given the current state of our medical technology and the unforeseen effects such a procedure might have on the patient, assuming the patient survived at all. While Canavero claims to have performed the surgery successfully in animals and, most recently, on a human cadaver, there is currently no accepted method for fusing the spinal chord and regenerating nerve cells well enough to control a donor body. While Canavero has widely reported that he has used a special solution to accomplish the feat in animals, he has not provided enough evidence to satisfy the rigors of academic research, raising serious doubt about his results. The evidence he has provided, which includes photographs and ambiguous footage of a dog jumping around with limp paws and a suspicious line of discolored fur at the base of its neck, is anything but conclusive, and he may very well kill his patient.
While these are certainly serious issues, the real problem with this picture is with international regulations: none of the laws and policies designed to protect patients and human research subjects have been able to stop them Canavero and Ren, nor are they likely to do so.
There are several internationally renowned ethics documents that combine to forbid dangerous therapies and experiments. In research ethics, the Belmont Report, The Nuremberg Code, The Declaration of Helsinki, and The Council for International Organizations of Medical Sciences (CIOMS) International Ethical Guidelines for Biomedical Research Involving Human Subjects each urge researchers to respect patient autonomy and to only perform experiments for which there is a reasonable prospect of benefit. The Nuremburg Code, specifically, arose in response to the abuses of Nazi surgeons who performed gruesome experiments on involuntary subjects in concentration camps during the Holocaust, including experiments aimed at re-attaching severed body parts. Similarly, the Hippocratic Oath and many traditional formulations of medical ethics urge clinicians to offer therapies that are likely to provide benefits that exceed any possible harms.
Unfortunately, none of these documents are legally binding. Many countries do have their own laws based on these documents. For example, in the United States, 45 CFR 46, known as “The Common Rule,” legalizes the provisions of the Belmont Report and provides specific institutional and legal mechanisms for regulating research and preventing experiments like human head transplantation. Alongside Institutional Review Boards, which regulate research on humans, most Institutional Animal Care and Use Committees would likely even forbid head transplant experiments in animals.
While laws in many countries force research and medical practice to adhere to commonly accepted ethics literature and human rights documents such as the Universal Declaration of Human Rights, the Nuremburg Code, and the Declaration of Helsinki, not all countries are required to do so. Even worse, there are no mechanisms in place to prevent these abuses in countries that do not have these ethics standards, nor to punish those who violate them.
It is telling that Canavero and Ren have not and will not perform their work in a country like the United States, in which the research regulations and medical malpractice laws reflect international ethics documents and the human rights discourse adopted by entities like the United Nations. Instead, he will perform the first human head transplant procedure in China, a country that has a history of taking positions on bioethical issues that diverge from most commonly accepted conceptions of medical and research ethics. For example, there is strong evidence that Chinese institutions have engaged in forced organ donation from prisoners. On the research side, while most countries have been hesitant to fully explore certain kinds of stem cell and genetic editing techniques (most recently, CRISPR) due to ethical concerns, Chinese policy has been much more permissive. Other countries can strongly urge China and other countries whose ethical discourse differs from most widely accepted standards to reconsider their stances, but there is no legal mechanism to stop abuses or dangerous experiments from occurring.
Sergio Canavero will likely kill his patient, either in the course of the procedure or during the indefinitely long “recovery period” that will follow. Medical experts and bioethicists have vociferously argued that the procedure is unethical and should not be performed. But the really controversial issue is the need for strong, international mechanisms to prevent unethical medical research and therapies from occurring. Politicians, lawmakers, and the general public have often been hesitant to “legislate morality,” especially when such laws would apply to people from a variety of cultural backgrounds. As a result, most of our human rights regulations and international doctrines are largely open to interpretation or do not give any substantial enforcement power to any legally recognized entities. But while it is important to allow different countries and cultures to base their bioethical systems on their own perspectives, it is also crucial to cede some ground to the reasoned opinions of medical experts and bioethicists when there is overwhelming consensus that a proposed action is dangerous and unethical. If a researcher can simply travel to another country to perform techniques widely condemned by leading experts in their field, we need to seriously question whether or not our societies take respecting human value seriously.
Michael S. Dauber is a bioethicist who has served as a clinical ethicist and a member of an institutional review board. He has written about the ethics of human head transplantation for The American Journal of Bioethics: Neuroscience and Global Bioethics Initiative (GBI).