Suskin Zaev D, Giordano James J
Harvard Medical School Center for Bioethics, 641 Huntington Avenue, Boston, MA, 02115, USA.
Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, 20057, USA.
Philos Ethics Humanit Med. 2018 Jul 13;13(1):10. doi: 10.1186/s13010-018-0063-2.
Neurosurgeon Sergio Canavero proposed the HEAVEN procedure - i.e. head anastomosis venture - several years ago, and has recently received approval from the relevant regulatory bodies to perform this body-head transplant (BHT) in China. The BHT procedure involves attaching the donor body (D) to the head of the recipient (R), and discarding the body of R and head of D. Canavero's proposed procedure will be incredibly difficult from a medical standpoint. Aside from medical doubt, the BHT has been met with great resistance from many, if not most bio- and neuroethicists.Given both the known challenges and unknown outcomes of HEAVEN, several important neuroethical and legal questions have emerged should Canavero be successful, including: (1) What are the implications for transplantology in the U.S., inclusive of issues of expense, distributive justice, organizational procedures, and the cost(s) of novel insight(s)? (2) How do bioethical and neuroethical principles, and legal regulations of human subject research apply? (3) What are the legal consequences for Canavero (or any other surgeon) performing a BHT? (4) What are the tentative implications for the metaphysical and legal identity of R should they survive post-BHT? These questions are analyzed, issues are identified, and several solutions are proposed in an attempt to re-configure HEAVEN into a safe, clinically effective, and thus (more) realistically viable procedure.Notably, the permissibility of conducting the BHT in China fosters additional, important questions, focal to (1) whether Western ethics and professional norms be used to guide the BHT - or any neuroscientific research and its use - in non-Western countries, such as China; (2) if the models of responsible conduct of research are identical, similar, or applicable to the intent and conduct of research in China; and (3) what economic and political implications (for China and other countries) are fostered if/when such avant garde techniques are successful.These questions are discussed as a further impetus to develop a globally applicable neuroethical framework that would enable both local articulation and cosmopolitan inquiry and oversight of those methods and approaches deemed problematic, if and when rendered in more international settings.
神经外科医生塞尔吉奥·卡纳韦罗几年前提出了“HEAVEN手术”,即头部吻合术,最近他已获得相关监管机构的批准,将在中国进行这种异体头移植手术(BHT)。BHT手术包括将供体身体(D)连接到受体(R)的头部,同时舍弃受体的身体和供体的头部。从医学角度来看,卡纳韦罗提出的手术将极其困难。除了医学上的疑虑之外,BHT还遭到了许多生物伦理学家和神经伦理学家(即便不是大多数)的强烈抵制。鉴于“HEAVEN手术”已知的挑战和未知的结果,如果卡纳韦罗手术成功,就会出现几个重要的神经伦理和法律问题,包括:(1)对美国移植学有何影响,包括费用、分配正义、组织程序以及新见解的成本等问题?(2)生物伦理和神经伦理原则以及人体研究的法律法规如何适用?(3)卡纳韦罗(或任何其他外科医生)实施BHT会有哪些法律后果?(4)如果受体在BHT后存活,对其形而上学和法律身份会有哪些初步影响?本文对这些问题进行了分析,找出了相关问题,并提出了几种解决方案,试图将“HEAVEN手术”重新设计成一种安全、临床有效的,因而(更)切实可行的手术。值得注意的是,在中国进行BHT的许可引发了更多重要问题,重点在于:(1)是否应使用西方伦理和专业规范来指导中国等非西方国家的BHT手术——或任何神经科学研究及其应用;(2)负责任的研究行为模式在中国的研究意图和行为中是否相同、相似或适用;(3)如果这种前卫技术成功,(对中国和其他国家)会产生哪些经济和政治影响。本文对这些问题进行了讨论,以此作为进一步推动制定全球适用的神经伦理框架的动力,该框架将能够在更国际化的背景下,对那些被认为有问题的方法和途径进行本地阐释以及全球范围内的探究和监督。