In his quest for a master race, Hitler has been compared to Mary Shelley’s creation Dr. Victor Frankenstein. Inspired by eugenics and empowered by the rediscovery of Mendel’s genetic work with peas, Hitler’s scientists attempted to rid Germany of presumed inferior genes and promote procreation among those with superior genes. We now know that genetics in the first few decades of the twentieth century was imprecise and many of the eugenic assumptions about improving a nation’s gene pool were both naive and unethical. The Human Genome Project has renewed interest in biological determinism and eugenics, and scientific advances have created possibilities that could only be dreamed of before, such as a head transplant. Reflecting upon her undergraduate research with severed axons and the recruitment of a volunteer for a head transplant by Dr. Sergio Canavero, Monika Pyarali asks, “Where should we draw the line?”
The Making of a Modern Frankenstein: Where to Draw the Line?
By Medical Student Monika Pyarali
Even in the face of declining government funding, the rate of scientific advances has been on the rise since the 1990s (5). This may be due, in part, to the incredible rate of technological advancement during the last quarter of a century. With new developments in technology arising nearly every day, scientists are constantly tempted to push the limits of plausibility. However, experimentation is a double-edge sword. On the one hand, experimentation is what continually enables humanity to progress. For example, Alexander Fleming’s experiments led to the discovery of penicillin, which is still used to save the lives of millions of patients suffering from bacterial infections (1). Similarly, nearly every major advancement in science and medicine can be attributed to clever experimentation.
Conversely, experimentation could also lead scientists to perform unthinkable acts in the interest of gaining knowledge. Perhaps the most infamous examples of a scientist gone astray is Dr. Mengele, known as “the Angel of Death”. Dr. Mengele’s experiments on the prisoners of Nazi death camps ranged from injecting substances in the eyes of twins to attempt to fabricate blue eyes to ripping fetuses from the wombs of their mothers to examine them. Often, experimental subjects were killed to perform autopsies on the bodies and obtain after-death measurements (6). Dr. Mengele and other Nazi doctors involved in prisoner experiments claimed that these studies were done with the interest of learning more about genetics to help purify the Aryan race. Regardless of the purpose, these experiments clearly crossed the boundaries of acceptable harm to the experimental subjects.
While experiments like those conducted by Nazi doctors during World War II would not be plausible under modern standards of ethical research, it is not always clear where to draw the line. In some experiments, the potential harm to the subjects may not be apparent before the experiment is conducted. For example, Dr. Zimbardo’s famous Stanford Prison Experiment was approved by the ethics committee at Stanford because it followed ethical guidelines (9). Retrospectively, however, Dr. Zimbardo’s study is widely recognized as an unethical study in psychology. In other cases, the benefit to be gained from conducting an experiment may be perceived as much greater than the possible harm to the research subject(s). Experiments that could objectively put the research subject at harm may be approved because of their potential benefit for the advancement of humanity. But where should we draw the line?
One specific case of high-stakes human experimentation drew my attention while I was still an undergraduate because of its relation to the research I was conducting. In 2015, an Italian surgeon by the name of Dr. Sergio Canavero proposed to perform the world’s first head transplant. In his article, titled “HEAVEN: The head anastomosis venture”, Dr. Canavero details his surgical procedure and supports his methodology using previous experiments conducted on animals. He notes that the success of his procedure is mainly dependent on two factors: maintaining the donor and recipient under hypothermia and successfully fusing the severed axonal connections (2).
This daring proposal rapidly sparked much interest in the scientific community. Dr. Canavero was invited to universities across the world to speak of his procedure. He was also invited to give a TED talk by an independently organized TED event in Limassol, Cyprus. However, his proposal also sparked many debates about the ethics head transplantation. Dr. Canavero recruited Mr. Valery Spiridonov, a 30-year-old computer scientist who has WerdnigHoffman disease, to volunteer his head for transplant. Critics of the procedure argue that there is a high likelihood Mr. Spiridonov will not survive the procedure. While Dr. Canavero acknowledges this possibility, he refutes that the only way Mr. Spiridonov has a chance at regaining mobility, or even surviving the next couple of years, is if the procedure is successful.
Analyzing the ethics of Dr. Canavero’s proposed procedure is complex because of what the procedure itself entails and the potential outcomes. First we must consider whether Dr. Canavero’s head transplant procedure has the potential to be successful. While the entire endeavor may seem ludicrous to some, it is quite frightening how plausible the procedure might actually be. Dr. Canavero proposes to carry out the first human head transplant in 2017 (2). He reasons that by 2017, the technology required to carry out the procedure will be available. All the methods delineated by Dr. Canavero have independently been supported by research on animals, including some of my own research. As an undergraduate, I was involved in the development of a procedure to fuse severed axons using biochemically engineered solutions of poly-ethylene glycol (PEG). Though our nerve transplantation experiments were successful on rats, these experiments left many unanswered questions regarding potential immune reactions, the viability of the technique in humans, and the underlying biochemistry that resulted in the success of the procedure. Even though PEG research on animals has yet to be fully worked out, using PEG to fuse the donor and recipient spinal cords together is one of the cornerstones of Dr. Canavero’s HEAVEN procedure.
As further support for the plausibility of the procedure, Dr. Canavero cites Dr. Robert White’s experiment on head transplantation in monkeys (2). In the 1970’s, Dr. White was able to successfully graft the head of one monkey onto the body of another (7). While the recipient animal only survived for a short time after the experiment, Dr. Canavero argues that advances in medical equipment since the 1970’s would allow for prolonged survival if this procedure were done on a human (4). While the biochemistry behind Dr. Canavero’s procedure may not yet be worked out, the prior success of Dr. White’s procedure on monkeys suggests that there is a very slight possibility that the HEAVEN procedure might be successful.
The next ethical consideration in analyzing Dr. Canavero’s proposition would be whether the potential benefits to society would outweigh the risks to his research subject. Many argue that the head transplantation procedure Dr. Canavero intends to carry out violates the Hippocratic Oath because if unsuccessful, Dr. Canavero would have caused Mr. Spiridonov harm. This is a viable concern because there is a high risk that Mr. Spiridonov might not survive the procedure. However, it is also arguable that any surgical procedure puts the patient at an equivalent risk. Furthermore, the potential benefit of this procedure, both for Mr. Spiridonov and for the fields of transplantation and neurosurgery, would be great. If successful, this procedure could completely alter the prognosis for spinal dystrophy diseases and provide patients who are immobilized an opportunity of regaining mobility. In volunteering for the procedure, Mr. Spiridonov has made the decision that the risk of failure outweighs the potential benefits. But since this procedure would impact many more people than just Dr. Canavero and Mr. Spiridonov, is this a decision that they ultimately have the power to make?
Since there is a possibility that the procedure may be “successful”, or specifically, that Mr. Spiridonov will survive the procedure, the ethical evaluation of head transplantation must consider the positive result as well. If Dr. Canavero managed to successfully transplant Mr. Spiridonov’s head onto the body of a donor, there is a chance that the results would turn out similar to Dr. White’s monkey experiments – Mr. Spiridonov may not survive very long following the procedure or may be left moribund (4). In this case, the ethical consideration that must be examined is whether it would be appropriate to sustain Mr. Spiridonov alive for as long as possible to observe the results of the procedure or whether euthanasia would be appropriate in his case. In animal research, strict guidelines mandate that animals in severe distress following any experimental procedure should be euthanized. However, euthanasia in humans is considered unethical and in many places, illegal. Conversely, leaving Mr. Spiridonov in a vegetative state and observing until he passes naturally could also be considered unethical and is reminiscent of the practices of Nazi scientists during World War II.
Finally, we must consider Dr. Canavero’s procedure in the rare case that everything works as expected and Mr. Spiridonov survives and regains mobility. If this were the case, ethical considerations arise surrounding Mr. Spiridonov’s psychological well-being and quality of life. The first issue is whether the procedure was a head transplant or a body transplant. Since the head is widely viewed as “the seat of the mind” and contains the person’s memories and thoughts, it can be argued that the procedure would be a body transplant for Mr. Spiridonov (7) However, if the procedure were to be successful enough to allow Mr. Spirinov to have children, the gametes in his body would belong to the donor (3). From an evolutionary standpoint, one might be inclined to say that Mr. Spiridonov’s head is just acting as a control center for the donor’s body that is being kept alive. In either case, this uncertainty could have severe psychological impacts on both Mr. Spiridonov and the donor’s family. Another consideration is whether Mr. Spiridonov’s psychological well-being would be impacted during the procedure itself. Dr. Silver, a colleague of Dr. White who observed his procedures, noted that the monkey who survived the head transplant procedure awoke in a state of “pain, confusion, and anxiety”. While this might have been due to the animal’s lack of understanding of the procedure, it is possible that the procedure itself may have altered the animal’s psychological status. While Mr. Spiridonov may be willing to take the risk because of the potential of regaining mobility, many considerations about Mr. Spiridonov’s well-being in the case that Dr. Canavero’s procedure succeeds may not have been evaluated in making this decision. Additionally, many considerations may not even be evident before the procedure is completed.
We owe all our advancements to the great minds of the past, present, and future who were willing to pursue an idea as an experiment. But in conducting an experiment, scientists must make take into consideration the potential outcomes to determine whether their proposed experiment should be conducted. Retrospectively, it is easy to point out the experiments that were blatantly unethical as well as those who may have been borderline unethical. However, making the decision of whether a future experiment might be unethical is not always clear-cut. The first consideration of whether an experiment should be carried out is its plausibility. Albeit, the success of some experiments could make such a huge impact in the field that they might be worth a try. However, before a risky experiment is attempted, the potential outcomes of the experiment must also be taken under consideration. In this example, each of the potential outcomes of the experiment present an ethical dilemma that must be further thought through, adding to the complexity of determining whether this experiment is worth pursuing. While Dr. Canavero’s experiment has the potential of changing the outlook for patients with limited mobility, it also has the catastrophic potential of ending Mr. Spiridonov’s life, or perhaps worse, creating a modern Frankenstein. Where should we draw the line?