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Face Value: Challenges of Transplant Technology

Published online by Cambridge University Press:  06 January 2021

Rhonda Gay Hartman
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What is the value of a human face? It is a vexing question with no simple answer. The question, however, is no longer fanciful given the trajectory of biomedical science that simultaneously captures our imagination and challenges our essence. Essential to each of us and to the whole of humanity, the face is primal in its individuated image and identity. It is intrinsically connected with us in a way that defied question—until now, given the highly anticipated next step in transplant science and technology, facial transplantation. This Article examines the value of the face in this context, along with a range of related issues.

The human face has rich significance. It is intrinsic and instrumental to the ontology of a person. A portal for emotions and expressions, the face reveals an inner-self essential to identity and is inscribed with an inherent dignity of human life.

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Article
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American Journal of Law & Medicine , Volume 31 , Issue 1 , March 2005 , pp. 7 - 46
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Copyright © American Society of Law, Medicine and Ethics and Boston University 2005

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References

1 Whether physical identity is bound up with personal identity is discussed in BARUCH A. BRODY, IDENTITY AND ESSENCE 49 (1980). Discrete particulars, such as age, occupation, race, gender, sexuality, situation in life, and values, further define us as persons and give us identity. See EDMUND D. PELLEGRINO & DAVID C. THOMASMA, THE VIRTUES IN MEDICAL PRACTICE 87 (1993).

2 See Kuczynski, Alex, A Lovelier You, With Off-the-Shelf Parts, N.Y. TIMES, May 2, 2004Google Scholar, § 4, at 1, available at 2004 WLNR 5560423 (describing Stepford-like prototypes representing conformity to cultural standards of beauty that denigrate personal history and identity); McGregor, Richard, All the Rage in Shanghai: Looking for Career Advancement or a Good Husband? For Many Young Women in China, the Solution is to Go Under the Knife, FIN. TIMES, Mar. 6, 2004Google Scholar (Magazine), at 12, available at 2004 WL 70209594 (chronicling personal choice to undergo procedures in anticipation of attracting professional and personal attention, despite the risk of disfigurement); Cowley, Geoffrey, The Biology of Beauty, NEWSWEEK, June 3, 1996Google Scholar, at 61, available at 1996 WL 9471487 (exploring the link between biological attraction and looking good, along with the value placed on it by society that leads to acceptability and integration); see also Westwood, Matthew, The Ugly Face of Flawless Beauty, THE AUSTRALIAN, May 28, 2004Google Scholar, at 14 (discussing social and cultural “indicators of how pervasive the worship of beauty has become”).

3 See Tannen, Mary, Unnatural Selection, N.Y. TIMES, May 2, 2004Google Scholar, (Magazine), at 78, available at 2004 WLNR 5546599 (detailing the “new and chilling dimension” of class-based aging); see also JPitman, oanna, Pictures No Longer Reflective of Reality, THE AUSTRALIAN, June 10, 2004Google Scholar, at 12 (noting surgical “immunity to aging that is wholly unnatural”); Marrin, Minette, The Misplaced Outrage at Aborting a Disfigured Baby, SUNDAY TIMES (London), Nov. 23, 2003Google Scholar, at 21 (discussing “lookist” society in which aging is considered a disfigurement necessitating surgical treatment).

4 See, e.g., Petit, Francois et al., Face Transplantation: Where Do We Stand?, 113 Plastic & Reconstructive Surgery 1429, 1429 (2004)CrossRefGoogle ScholarPubMed.

5 See Morris, Peter J. et al., Facial Transplantation: A Working Party Report from the Royal College of Surgeons of England, 77 Transplantation 330, 337 (February 15, 2004)CrossRefGoogle ScholarPubMed (“[F]acial transplantation would constitute a major breakthrough in restoration of a quality of life to those whose faces have been destroyed by accident or tumor. It is therefore worthy of study.”).

6 Relevant medical literature has commented on mass media sensation and public clamor related to the prospect of facial transplant. As several surgeons state, “Photographs of potential candidates for a face transplantation have been posted in magazines and on the Internet, their mutilated faces being reinforced by their dreary story revealed with tearful details. This kind of scientific reality show’ with exhibition of patients diminishes the potential value of these procedures.” Petit et al., supra note 4, at 1432.

7 See Siemionow, Maria et al., Prospects for Facial Allograft Transplantation in Humans, 113 Plastic & Reconstructive Surgery 1421, 1421 (2004)CrossRefGoogle ScholarPubMed.

8 See id.; Petit et al., supra note 4, at 1429; see also Devine, Cate, Why We Still Can't Face the Most Sensitive of Issues, THE HERALD (Glasgow), Nov. 22, 2003Google Scholar, at 13 (interviewing facial cancer survivor Christine Piff, who proclaimed, “[T]he thought that there might be a donor out there who could help you be normal again would be an absolute miracle…. Those who feel horrified at the thought of walking around with someone else's face simply aren't aware of what it's like to be blighted.”).

9 See infra notes 234-248 and accompanying text.

10 Petit et al., supra note 4, at 1432; Siemionow et al., supra note 7, at 1427.

11 Sensational articles in the global press have chronicled the progress toward facial transplant. A sampling is found in Hoggart, Paul, The Medical Innovation Revealed in the Human Face, THE TIMES (London), June 25, 2004Google Scholar, at 22 (“the Frankenstein syndrome”); Thinking Out of the Box, NEW STRAITS TIMES (Malaysia), June 22, 2004Google Scholar, at 12 (“get a deceased person's face”); Roan, Shari, The Face as Frontier, L.A. TIMES, Feb. 2, 2004Google Scholar, at F1, available at 2004 WL 55889911 (“dead person's face is recycled for the living”); Laurance, Jeremy, Life Health: Health Check, THE INDEPENDENT (London), Nov. 24, 2003Google Scholar, at 10 (“swapping faces”).

12 See generally MARGARET J. RADIN, CONTESTED COMMODITIES: THE TROUBLE WITH TRADE IN SEX, CHILDREN, BODY PARTS, AND OTHER THINGS (1996); THOMAS GREY, THE DISINTEGRATION OF PROPERTY (1977).

13 Petit et al., supra note 4, at 1432.

14 See Semuels, Alana, Identity Issues: The Looming Possibility of Face Transplant Raises a Host of Moral and Ethical Questions, PITTSBURGH POST-GAZETTE, Jan. 11, 2005Google Scholar, at C1, available at 2005 WL 56719457; Clinic Gets OK for 1st Face Transplant, CHICAGO TRIBUNE, Nov. 1, 2004Google Scholar, at 10; Morris et al., supra note 5, at 330; see also Altman, Lawrence K., The Ultimate Gift: 50 Years of Organ Transplant, N.Y. TIMES, Dec. 21, 2004Google Scholar, at F1, available at 2004 WLNR 14475089 (presupposing “[i]n the near future, face transplants, still a subject of controversy, are likely to become a reality: last month the Cleveland Clinic became the first institution to receive approval for the operation”); Petit et al., supra note 4, at 1430 (observing that “[j]ust a few years ago, the concept of face or any other composite tissue allotransplantation would have sounded like an illusion”).

15 Skin flap transfer from one person to another is an allotransplant. Morris et al., supra note 5, at 331.

16 See Morris et al., supra note 5, at 330 (reporting that “[i]n September 1998, the first human hand transplant was carried out in Lyon, France. Since then, 20 hand transplants, 9 abdominal wall transplants, and a laryngeal transplant have been performed. Most recently [July 2003], the world's first tongue transplant was reported.”); accord Siemionow et al., supra note 7, at 1422; Goldenberg, Suzanne, Medical Miracles: Five Years On, The World's First Hand Transplant Patient is Thriving, THE GUARDIAN (London), Feb. 17, 2004Google Scholar, at 10.

17 See Morris et al., supra note 5, at 337; Petit et al., supra note 4, at 1429.

18 See Petit et al., supra note 4, at 1429; Siemionow et al., supra note 7, at 1422. See also Morris et al., supra note 5, at 330-31 (describing the resulting appearance as a “loss of function with tight scars and lack of facial expression”).

19 Morris et al., supra note 5, at 330-31; Petit et al., supra note 4, at 1430.

20 Petit et al., supra note 4, at 1430; Siemionow et al., supra note 7, at 1422-23. From the standpoint of Jacqui Saburido, a prospective face transplant recipient, “fully working eyelids” enabling sleep “without goggles” would be a relief. Jones, David, Soon I May Have My Life Back, DAILY MAIL (London), June 27, 2004Google Scholar, at 84 (interviewing Jacqui Saburido, who was severely burned in an automobile accident).

21 Siemionow et al., supra note 7, at 1422-24; Petit et al., supra note 4, at 1430.

22 Radford, Tim, Scientists Prepare for Full-face Transplant, THE IRISH TIMES, June 1, 2004Google Scholar, at 56.

23 Siemionow et al., supra note 7, at 1421.

24 See Morris et al., supra note 5, at 337 (noting that the “highly experimental” character of facial transplantation “cannot be overestimated”).

25 Siemionow et al., supra note 7, at 1422-24; Luis Bermdez, Eduardo et al., Experimental Models of Facial Transplant, 110 Plastic & Reconstructive Surgery 1374, 1374 (2002)CrossRefGoogle Scholar; Bell, Ian, Cutting Issues of Corpses and the Controversial Face-Saving Debate, THE HERALD (Glasgow), June 25, 2004Google Scholar, at 23 (review of television program).

26 See infra notes 233-248 and accompanying text.

27 See infra notes 200-232 and accompanying text.

28 National Organ Transplantation Act, 42 U.S.C. §§ 273-274 (1994). See infra notes 126-129 and accompanying text.

29 Uniform Anatomical Gift Act, 8A U.L.A. 19 (1993) (amended 1987) [hereinafter U.A.G.A.]. See infra notes 123-125 and accompanying text.

30 See, e.g., ALA. CODE § 22-19-52 (2004); ALASKA STAT. § 13.50.070 (Michie 2004); ARIZ. REV. STAT. § 36-842 (2004); CAL. HEALTH & SAFETY CODE § 7150.5 (West 2004); MICH. COMP. LAWS § 333.10101 (2004); MISS. CODE ANN. § 41-39-31 (2004); MONT. CODE ANN. § 72-17-101 (2003); N.Y. PUB. HEALTH LAW § 4306 (Consol. 2004); OHIO REV. CODE ANN. § 21.08.02 (West 2004); PA. STAT. ANN. tit. 20, § 8611 (West 2004); S.D. CODIFIED LAWS § 34-26-22 (Michie 2003); TEX. HEALTH & SAFETY CODE ANN. § 692.003 (Vernon 2004); UTAH CODE ANN. § 26-28-3 (2004); see also U.A.G.A., 8A U.L.A. 63 (1993) (providing a table of jurisdictions that have adopted the Uniform Anatomical Gift Act).

31 Throughout this Article, I will nevertheless refer to it as “facial transplant” in keeping with relevant medical literature on the subject. See, e.g., Bosch, Xavier, Surgeon Denied Ethics Approval for Face Transplantation, 363 Lancet 871, 871 (March 13, 2004)CrossRefGoogle ScholarPubMed; Morris et al., supra note 5, at 337; Petit et al., supra note 4, at 1429; Siemionow et al., supra note 7, at 1421.

32 See Petit et al., supra note 4, at 1432 (considering plastic and reconstructive surgeons as “the right doctors to evaluate and be in charge of these kinds of patients”).

33 See Bosch, supra note 31 at 871; Clark, Jocalyn, Face Transplants Technically Possible but “Very Hazardous”, 170 Canadian Medical Association Journal 323, 323 (February 3, 2004)Google Scholar; Kmietowicz, Zosia, Face Transplants Should Not Be Done Without More Research, 327 British Medical Journal 1184, 1184 (November 22, 2003)Google Scholar; see also infra notes 208-229 and accompanying text for a discussion of whether professional self-policing or public oversight is desirable in this context.

34 See infra notes 38-48 and accompanying text.

35 Morris et al., supra note 5, at 336-37.

36 Id. According to England's Royal College of Surgeons, “it follows that any surgeon contemplating performing facial transplantation should regard the procedure as experimental and subject it to the ethical evaluation of an independent committee.” Id. at 336.

37 See ROBERT J. LEVINE, ETHICS AND REGULATION OF CLINICAL RESEARCH (2d ed. 1986).

38 See Morris et al., supra note 5, at 332-37.

39 Id. at 331-32.

40 Id. at 332 (anticipating a recipient to neither resemble the donor nor pre-injury self).

41 The original and disfigured identities constitute the other two. Edmistone, Leanne, Scalpels Poised for World's 1st Face Transplant, COURIER MAIL (Queensland, Australia), May 27, 2004Google Scholar, at 10.

42 Bell, supra note 25, at 23.

43 See Morris et al., supra note 5, at 332-33; see also Petit et al., supra note 4, at 1431 (explaining that “due to its highest antigenicity within all the tissues, skin has long been regarded as a major obstacle to composite tissue allotransplantation”).

44 Petit et al., supra note 4, at 1431-32.

45 Morris et al., supra note 5, at 334; Siemionow et al., supra note 7, at 1425.

46 For example, hand transplant failure is largely attributed to recipient noncompliance with prescribed immunosuppressive drugs. Siemionow et al., supra note 7, at 1424.

47 See Morris et al., supra note 5, at 337.

48 Id. at 334 (estimating further grafts would be “hugely disappointing” in terms of result, and calling for “further research into how to improve the prospects for rejection” before proceeding); see also Bosch, supra note 31 at 871 (stating that failure would worsen the recipient's situation).

49 See Morris et al., supra note 5, at 333-37; Siemionow et al., supra note 7, at 1426 (raising the possibility of human immunodeficiency virus, hepatitis C virus, and hepatitis B virus as possible infectious agents transferred from the donor to the recipient).

50 See Morris et al., supra note 5, at 337 (underscoring surgical obligation for not performing the procedure until it is determined “that the risks are proportionate to potential benefits despite willingness [of persons with facial disfigurement] to incur high risks for the chance of a better quality of life”).

51 Id. at 335-37 (stating that surgeons must not be derelict in their responsibility “for carrying out the procedure in a fashion that conforms to acceptable professional standards”). See generally JAY KATZ, THE SILENT WORLD OF DOCTOR AND PATIENT 165-206 (1984); PHYSICIAN AND PHILOSOPHER: THE PHILOSOPHICAL FOUNDATION OF MEDICINE – ESSAYS BY DR. EDMUND PELLEGRINO 130-149 (Roger J. Bulger & John P. McGovern eds., 2001) [hereinafter PELLEGRINO ESSAYS].

52 See PELLEGRINO ESSAYS, supra note 51, at 99-129; see generally PELLEGRINO & THOMASMA, supra note 1, at 87.

53 See Beecher, Henry K., Ethics and Clinical Research, 274 New Eng. J. Med. 1354, 1355, 1360 (1966)CrossRefGoogle ScholarPubMed (explaining that “consent in any fully informed sense may not be obtainable…[b]ut it is absolutely essential to strive for it for moral, sociologic and legal reasons”); Morris et al., supra note 5, at 336 (emphasizing “extra diligence…so that patients have a good understanding of what will be done to them, why, and with what potential hazards”).

54 See Bosch, supra note 31, at 871 (characterizing consent as “illusory” in this context); see generally Beecher, Henry K., Consent in Clinical Experimentation: Myth and Reality, 195 JAMA 34 (1966)CrossRefGoogle Scholar.

55 As Jacqui Saburido, severely disfigured from an automobile accident, exclaimed upon learning that she might be a candidate for facial transplant, “I want it, I want it – right now! Nobody wants to be ugly, do they? I would like to be better looking! I would like it if people didn't stare at me and little kids didn't make comments.” Jones, supra note 20, at 84.

56 See generally TOM L. BEAUCHAMP & JAMES F. CHILDRESS, PRINCIPLES OF BIOMEDICAL ETHICS (5th ed. 2001); KATZ, supra note 51, at 165-206.

57 Morris et al., supra note 5, at 335-36.

58 See PELLEGRINO ESSAYS, supra note 51, at 99-129; see generally PELLEGRINO & THOMASMA, supra note 1.

59 See Moore v. Regents of the Univ. of Cal., 793 P.2d 479 (Cal. 1990).

60 See Kaimowitz v. Dep't of Mental Health for the State of Mich., 1 MENTAL DISABILITY L. REP. 147 (Mich. Cir. Ct. 1973) (holding that informed consent cannot be given by an involuntarily detained mental patient for experimental psychosurgery).

61 CHRISTIAAN BARNARD & CURTIS BILL PEPPER, ONE LIFE 348 (1969).

62 See Sunstein, Cass R., Social Norms and Social Roles, 96 Colum. L. Rev. 903, 907-08 (1996)CrossRefGoogle Scholar.

63 See Devine, supra note 8, at 13 (interviewing Christine Piff, facially disfigured from cancer, who expressed that the mere thought that someone could help “would be an absolute miracle”).

64 See Morris et al., supra note 5, at 331.

65 Studies have shown that persons with facial disfigurement are generally withdrawn and avoidance inclined. See Newell, Robert & Marks, Isaac, Phobic Nature of Social Difficulty in Facially Disfigured People, 176 Brit. J. Psychiatry 177 (2000)CrossRefGoogle ScholarPubMed. See also Miliora, Maria T., Facial Disfigurement: A Self-Psychological Perspective on the “Hide-and-Seek” Fantasy of Avoidant Personality, 62 Bull. Menninger Clinic 378 (1998)Google ScholarPubMed (studying persons facially disfigured since birth and their tendency toward avoidant personality disorder and to “emotionally hide”); Jones, supra note 20, at 84 (interviewing prospective facial transplant candidate, Jacqui Saburido, who assessed, “If I can make myself more sociably acceptable in the society we live in, then why not?”).

66 See LEVINE, supra note 37, at 55-56; Calabresi, Guido, Reflections on Medical Experimentation in Humans, 98 Daedalus 387 (1969)Google Scholar, reprinted in JAY KATZ, EXPERIMENTATION WITH HUMAN BEINGS 180-84, 855-56, 927-29, 950-52 (1970).

67 Siemionow et al., supra note 7, at 1426 (acknowledging that facial transplant “opens a social, ethical, and psychological debate”).

68 Id. at 1426-27 (estimating that facial transplant, along with life-long immunosuppressive drugs, will be in the “costly” range of a quarter of a million – or more – dollars).

69 Recognizing the moral, social, and policy implications accorded selection, research scientists and surgeons call for multidisciplinary review of selection criteria, along with institutional oversight. See id. at 1426; see also Childress, James F., Ethical Criteria for Procuring and Distributing Organs for Transplantation, 14 J. Health Pol., Pol’Y & L. 83, 103 (1989)Google ScholarPubMed (noting that justice in allocation involves procedural as well as substantive matters).

70 See Phipps, L., Psychiatric Aspects of Heart Transplantation, 36 Canadian J. Psychiatry 563 (1991)CrossRefGoogle ScholarPubMed; Dressler, D.K., Psychosocial Effects of Cardiac Transplantation, 6 J. Intensive Care Med. 126 (1991)CrossRefGoogle ScholarPubMed; see also Mai, F.M. et al., Psychosocial Adjustment and Quality of Life Following Heart Transplantation, 35 Canadian J. Psychiatry 223 (1990)CrossRefGoogle ScholarPubMed (finding significant correlation between pre-operative psychiatric diagnosis and a rating of poor medical compliance).

71 Van Loey, N.E. & Van Son, M.J., Psychopathology and Psychological Problems in Patients with Burn Scars: Epidemiology and Management, 4 Am. J. Clinical Dermatology 245 (2003)CrossRefGoogle ScholarPubMed (detailing problems in coping styles and personality traits prone to shame and lack of self-esteem).

72 Terwee, Caroline B. et al., Facial Disfigurement: Is It in the Eye of the Beholder? A Study in Patients with Graves’ Ophthalmopathy, 58 Clinical Endocrinology 192, 196-98 (2003)CrossRefGoogle ScholarPubMed.

73 In the context of resource allocation and appropriation, “[j]ustice may be defined as rendering each person his or her due, and it includes both formal and material criteria. The formal criterion of justice is similar treatment of similar cases, while material criteria specify relevant similarities and dissimilarities among people and thus determine how particular benefits and burdens will be distributed.” Childress, supra note 69, at 103.

74 See, e.g., Moss, Alvin H. & Siegler, Mark, Should Alcoholics Compete Equally for Liver Transplantation?, 265 JAMA 1295 (1991)CrossRefGoogle ScholarPubMed; Cohen, Carl & Menjamin, Martin, Alcoholics and Liver Transplantation, 265 JAMA 1299 (1991)CrossRefGoogle ScholarPubMed.

75 Jones, supra note 20, at 84 (interviewing Jacqui Saburido).

76 Siemionow et al., supra note 7, at 1422, 1425 (recognizing the disadvantage of skin color or tissue texture mismatch as “a limiting factor in obtaining an acceptable aesthetic reconstruction”).

77 See Section IV, infra notes 156-157 and accompanying text.

78 See Bosch, supra note 31 at 871 (noting that identity was the chief concern of most potential transplant candidates).

79 Sanner, Margareta A., Transplant Recipients’ Conceptions of Three Key Phenomena in Transplantation: the Organ Donation, the Organ Donor, and the Organ Transplant, 17 Clinical Transplantation 391, 397 (2003)CrossRefGoogle ScholarPubMed. See Bunzell, B. et al., Does Changing the Heart Mean Changing Personality? A Retrospective Inquiry on 47 Heart Transplant Patients, 1 Quality Life Res. 251 (1992)CrossRefGoogle Scholar.

80 FRANZ KAFKA, THE METAMORPHOSIS (1915).

81 See KARL R. POPPER, CONJECTURES & REFUTATIONS: THE GROWTH OF SCIENTIFIC KNOWLEDGE (1963). According to post-positivist philosopher, Sir Karl Raimond Popper, knowledge acquisition depends on intellectual revolutions “through new and great ideas.” KARL R. POPPER, IN SEARCH OF A BETTER WORLD: LECTURES AND ESSAYS FROM THIRTY YEARS 91 (1984) [hereinafter POPPER LECTURES AND ESSAYS]. Evolutionary epistemology, as conceived by Popper, transforms the idea of knowledge into a method of inquiry for acquiring it through conjecture, critical examination, and refutation. Thus, knowledge to inform a point – such as risk-to-benefit ratio critical to a decisionmaking process in the context of facial transplant – results from refutability and testability of research questions. That is, knowledge acquisition results from trial and elimination of errors. Id. at 27-39, 47- 83.

82 GEORGE ORWELL, NINETEEN EIGHTY-FOUR (1949). See supra notes 40-42 and accompanying text.

83 See Ginia Bellafante, CULTURAL STUDIES: OUR BODIES, OUR SILICONE, OURSELVES, N.Y. TIMES, Final Edition, May 18, 2003, at 5; see also Langton, James, Makeover Trio to Emerge Transformed from Surgery, THE EVENING STANDARD (London), Dec. 12, 2002Google Scholar, at 14 (reporting about the American television program Extreme Makeover, where self-described “ugly ducklings” undergo extensive plastic surgery to become a “new person” despite many who find the show “bizarre and horrifying”).

84 See Tannen, supra note 3, at 78-83; see also Pitman, supra note 3, at 12 (describing a “wholly unnatural” result of surgery designed to stave off visible effects of aging that makes it “almost impossible to distinguish between face and mask”).

85 See Coull, Fiona, Personal Story Offers Insight into Living with Facial Disfigurement, 12 J. Wound Care 254 (2003)CrossRefGoogle ScholarPubMed; Yu, Bum-Hee & Dimsdale, Joel E., Posttraumatic Stress Disorder in Patients with Burn Injuries, 20 J. Burn Care & Rehabilitation 426 (1999)CrossRefGoogle ScholarPubMed.

86 See BARNARD & PEPPER, supra note 61, at 349 (documenting experiences of heart transplant patients, “[f]or if the present – that is, the new life – was invested with meaning taken from the past, so was his renewed identity determined in much the same way.”).

87 See Confronting Death: Who Chooses, Who Controls? A Dialogue Between Dax Cowart and Robert Burt, 28 Hastings Ctr. Rep. 14 (1998)CrossRefGoogle Scholar; DAX's CASE: ESSAYS IN MEDICAL ETHICS AND HUMAN MEANING (Lonnie D. Kliever ed., 1989). These published writings are based on DAX's CASE: WHO SHOULD DECIDE? (1985), an award-winning documentary about Dax Cowart, who was severely burned over two-thirds of his body in a propane gas explosion.

88 See Christensen, A.J. et al., Effect of Family Environment and Donor Source on Patient Quality of Life Following Renal Transplantation, 21 Health Psychol. 468 (2002)CrossRefGoogle ScholarPubMed (reporting on salutary effects of supportive family setting that include reduced depression and improved social functioning).

89 See Newsome Wicks, Mona et al., Family Caregivers’ Burden, Quality of Life and Health Following Patients’ Renal Transplantation, 8 J. Transplant Coordination 170, 173–175 (1998)Google Scholar (finding significant correlation between family support and self-reported compliance).

90 Teichman, B.J. et al., Factors Associated with Adherence to Treatment Regimens After Lung Transplantation, 10 Progress In Transplantation 113 (2000)CrossRefGoogle ScholarPubMed; Herrick, Colette M. et al., Combined Heart Failure Transplant Program: Advantages in Assessing Medical Compliance, 6 J. Heart Transplantation 141 (1987)Google ScholarPubMed.

91 Jones, supra note 20, at 84 (interviewing Jacqui Saburido, a facial transplant recipienthopeful who was severely burned in an automobile following an accident caused by a drunk driver).

92 See Flor, Herta, Phantom-Limb Pain: Characteristics, Causes, and Treatment, 1 Lancet Neurology 182 (2002)CrossRefGoogle ScholarPubMed (estimating the occurrence to exceed 80% of people who undergo amputation); see also Mortimer, C.M et al., Patient Information on Phantom Limb Pain: A Focus Group Study of Patient Experiences, Perceptions, and Opinions, 17 Health Educ. Res.: Theory & Practice 291 (2002)CrossRefGoogle ScholarPubMed (exploring experiences and perceptions of patients through interviews before and after amputation).

93 Pucher, I. et al., Coping with Amputation and Phantom Limb Pain, 46 J. Psychosomatic Res. 379 (1999)CrossRefGoogle ScholarPubMed; see Ramachandran, V.S., Consciousness and Body Image: Lessons from Phantom Limbs, Capgras Syndrome, and Pain Asymbolia, 353 Phil. Transactions: Biological Sciences 1851 (Nov. 29, 1998)Google ScholarPubMed; Ramachandran, V.S. & Hirstein, W., The Perception of Phantom Limbs, The D. O. Hebb Lecture, 121 Brain 1603 (1998)CrossRefGoogle Scholar.

94 See Bosch, supra note 31 at 871.

95 See Wiggins, Osborne P. et al., On the Ethics of Facial Transplantation Research, 4 Am. J. Bioethics 1, 5 (2004)CrossRefGoogle ScholarPubMed.

96 See W. PAGE KEETON ET AL., PROSSER & KEETON ON TORTS 851-54 (W. Page Keeton ed., 5th ed. 1984); see also Dickerson & Assoc. v. Dittmar, 34 P.3d 995 (Colo. 2001) (name and likeness); Ainsworth v. Century Supply Co., 693 N.E.2d 510 (Ill. App. Ct. 1998) (image); Hetter v. Eighth Jud. Dist. Ct. of State In and For County of Clark, 874 P.2d 762 (Nev. 1994) (name and image); Hirsch v. S.C. Johnson & Son, Inc., 280 N.W.2d 129 (Wis. 1979) (nickname).

97 See Doe v. Chao, 124 S.Ct. 1204 (2004) (referring to Privacy Act of 1974, 5 U.S.C. § 552 (2000), along with 18 U.S.C. § 2707 (2000)); United States v. Stanfield, 360 F.3d 1346 (D.C. Cir. 2004). See, e.g., ALA. CODE § 13A-8-192 (Supp. 2004); CAL. CIV. CODE § 1798.84, 1798.95 (2004); DEL. CODE ANN. tit. 11 § 854 (2003); D.C. CODE ANN. § 22-3203 (2004); FLA. STAT. ANN. § 817.568 (2005); IDAHO CODE § 28-51-101 (Michie 2004); 720 ILL. COMP. STAT. 5/16G-5,15 (2004); IOWA CODE ANN. § 715A.8 (2003 & Supp. 2004); KAN. STAT. ANN. § 21-4018 (Supp. 2003); KY. REV. STAT. ANN. § 514.160, 532.034 (2004); LA. REV. STAT. ANN. § 9:3568, 14:67.16 (2004); MASS. GEN. LAWS ANN. Ch. 266, § 37E (2004); MINN. STAT. ANN. § 609.527 (2003 & Supp. 2004); MO. ANN. STAT. § 570.223 (Supp. 2004); MONT. CODE ANN. § 45-6-332 (2003); N.J. STAT. ANN. § 2C:21-17 (1995 & Supp. 2004); N.M. STAT. ANN. § 30-16-24.1 (2004); N.Y. PENAL § 190.79, 190.80 (Supp. 2005); OKLA. STAT. ANN. tit. 21, § 1533.1 (2002 & Supp. 2005); OR. REV. STAT. § 165.800 (2004); PA. STAT. ANN. tit. 18, § 4120 (West 2004); TEX. PENAL CODE ANN. § 32.51 (Vernon 2003 & Supp. 2004-05); VA. CODE ANN. § 18.2-18.3:1 (2004); WASH. REV. CODE ANN. § 9.35.020 (2003 & Supp. 2005); WIS. STAT. ANN. § 943.201 (Supp. 2004); WYO. STAT. ANN. § 1-1-128 (2003).

98 See Reid v. Pierce County, 961 P.2d 333 (Wash. 1998).

99 See State v. Stalkfleet, 106 Wash.App. 1040 (2001).

100 See Vogelaar v. United States, 665 F. Supp. 1295 (E.D. Mich. 1987) (recognizing claim under Federal Tort Claims Act and Military Claims Act for indignity to name and identity of deceased soldier when the federal government neglected to retract his deserter classification). Harm to reputation uniquely associated with a person is an enhancement under the United States Sentencing Guidelines when the crime for which the defendant was convicted involved a genre of identity appropriation. See U.S.S.G. Manual § 2B1.1 (b)(9)(C)(i) (2004); accord United States v. Melendrez, 389 F.3d 829 (9th Cir. 2004).

101 See, e.g., In re Tri-State Crematory Litig., 215 F.R.D. 660 (N.D. Ga. 2003); Christensen v. Superior Court, 820 P.2d 181 (Cal. 1991); Dufour v. Westlawn Cemeteries, Inc., 639 So.2d 843 (La. Ct. App. 1994).

102 See, e.g., Williams v. Minneola, 575 So.2d 683 (Fla. Dist. Ct. App. 1991); Meyer v. Nottger, 241 N.W.2d 911 (Iowa 1976).

103 See Posthumous Nomination for Nobel, DAILY TELEGRAPH (Sydney), Jan. 31, 2002, at 25 (reporting attempts to nominate deceased for Nobel Prize, despite the award not being given posthumously).

104 See Hecht v. Superior Court, 59 Cal. Rptr. 2d 222 (Cal. Ct. App. 1996). See, e.g., In re Starr's Estate, 170 So. 620 (Fla. 1936); Tr. of Amherst Coll. v. Ritch, 45 N.E. 876 (N.Y. 1897); In re Coddington's Will, 118 N.Y.S.2d 525 (N.Y. App. Div. 1952).

105 David Salisbury, Giving Cannibalism a Human Face, EXPLORATION (August 15, 2001) at http://www.exploration.vanderbilt.edu/news/news_cannibalism.htm.

106 See In re Moyer's Estate, 577 P.2d 108, 110 (Utah 1978) (expressing “sound and wellestablished policy of the law that a person, once buried, should not be exhumed except for the most compelling reasons” due to the “reverent regard” for human remains). See, e.g., CAL. HEALTH & SAFETY CODE § 7980 (West 2004); OHIO REV. CODE ANN. § 517.23 (West 2004); W.VA. CODE ANN. § 61-8-14 (2003).

107 See Moyer's Estate, 577 P.2d at 110. State restraint is rooted in inherent police powers. See, e.g., IDAHO CODE § 54-1101 (Michie 2003); N.Y. PUB. HEALTH LAW § 4200 (McKinney 2004).

108 See 2 WILLIAM BLACKSTONE, COMMENTARIES ON THE LAW OF ENGLAND 429-30 (1766); Tri-State Crematory Litig., 215 F.R.D. at 683.

109 See Williams v. Minneola, 575 So.2d 683, 694 (Fla. Dist. Ct. App. 1991) (finding disrespect or indignity directed at a decedent's body – including any representation of it – constitutes actionable outrageous conduct).

110 See, e.g., IDAHO CODE § 18-7027 (Michie 2003) (desecration or molestation in any way of any portion of any grave, cemetery, headstone, grave marker, mausoleum, crypt, or other place of burial, whether of whole bodies or ashes or other evidence of remains of a deceased human body); UTAH CODE ANN. § 76-9-704 (2004) (abuse or desecration of deceased's interests through disturbance, destruction, disinterment, or dismemberment).

111 See, e.g., TENN. CODE ANN. § 40-13-220 (2004).

112 See, e.g., ALA. CODE § 13A-11-13 (1994); ARK. CODE ANN. § 5-60-101 (2003); COLO. REV. STAT. § 18-13-101 (2003); HAW. REV. STAT. ANN. § 711-1108 (2003); IND. CODE ANN. § 35-45- 11-1 (Michie 2004); IOWA CODE ANN. § 709.18 (2003); KY. REV. STAT. ANN. § 525.120 (2004); ME. REV. STAT. ANN. tit. 17-A, § 508 (West 2003); N.H. REV. STAT. ANN. § 644:7 (1996); OHIO REV. CODE ANN. § 2927.01 (West 2004); OR. REV. STAT. § 166.087 (2004); PA. STAT. ANN. tit. 18, § 5510 (West 2004); TENN. CODE ANN. § 39-17-312 (2003); TEX. PENAL CODE ANN. § 42.08 (Vernon 2003).

113 See Nelkin, Dorothy & Andrews, Lori, Do the Dead Have Interests? Policy Issues for Research After Life, 24 Am. J.L. & Med. 261, 263-66 (1998)Google ScholarPubMed (summarizing historical controversies, including social values and policy considerations pertaining to research on the dead); see also Berg, Jessica, Grave Secrets: Legal & Ethical Analysis of Postmortem Confidentiality, 34 Conn. L. Rev. 81, 83 (2001)Google ScholarPubMed (discussing confidentiality in the context of postmortem interests in personal information).

114 See Statement of Tom Malinowski, Washington Advocacy Director, Human Rights Watch, Senate Government Affairs Committee, Prosecuting Iraqi War Crimes (April 10, 2003), available at http://www.senate.gov/gov_affairs/041003malinowski.pdf.

115 See Donaldson v. Lungren, 4 Cal. Rptr. 2d 59, 61 (Cal. Ct. App. 1992).

116 See, e.g., CAL. HEALTH & SAFETY CODE § 7100.1 (West Supp. 2005); TEX. HEALTH & SAFETY CODE ANN. § 692.003 (Vernon 2004).

117 See CHI. SUN TIMES, Apr. 22, 2004, at 37, available at 2004 WL 63139251; Landler, Mark, A New Spine-Tingler for the Impressario of Cadavers, N.Y. TIMES, Feb. 3, 2004Google Scholar, at A4.

118 See DeVita, Michael A. et al., Research Involving the Newly Dead: An Institutional Response, 31 Crit. Care Med. S385 (Supp. 2003)CrossRefGoogle Scholar (discussing desirability for institutional policy oversight and establishment of the Committee on Research Involving the Dead at the University of Pittsburgh Medical Center).

119 Martyn, Susan R., Using the Brain Dead for Medical Research, 1986 Utah L. Rev. 1Google ScholarPubMed (referring to brain dead bodies maintained on artificial life support for the purpose of medical research or education as “biomorts”).

120 See Kerr, Susan M. et al., Postmortem Sperm Procurement, 157 J. Urology 2154 (1997)CrossRefGoogle ScholarPubMed; Robertson, John A., Posthumous Reproduction, 69 Ind. L.J. 1027, 1030 (1994)Google ScholarPubMed.

121 See, e.g., OHIO REV. CODE ANN. § 2927.01 (West 2004) (outrage common sensibilities); W.VA. CODE ANN. § 61-8-14(b)(2) (2000) (same). See infra notes 245-247 and accompanying text for a discussion related to the roles of repugnancy and outrage intuit to human response in shaping social values and legal policy.

122 See Mahoney, Julia D., The Market for Human Tissue, 86 Va. L. Rev. 163, 173 (2000)CrossRefGoogle ScholarPubMed (explaining how the language of property, for instance, “could diminish our sense of uniqueness and lead to a conception of humans as fungible, interchangeable objects of trade”). Judicious use of language and its influence in policy formulation and regulatory oversight of facial transplant are discussed in Section V, infra notes 230-232 and accompany text.

123 U.A.G.A., 8A U.L.A. 19 (1993).

124 See supra note 30 for state statutes adopting the Uniform Anatomical Gift Act in some form.

125 See PA. STAT. ANN. tit. 20, § 8611(e) (West 2004).

126 42 U.S.C. § 274(e).

127 See, e.g., ARIZ. REV. STAT. § 36-831.01 (2004); MONT. CODE ANN. § 72-17-106 (2003); PA. STAT. ANN. tit. 35, § 10025 (West 2004); TEX. PENAL CODE ANN. § 48.02 (Vernon 2004); WASH. REV. CODE § 68.50.160 (2004).

128 42 U.S.C. §§ 273-274.

129 See id.; U.A.G.A., 8A U.L.A. at 19.

130 Siebert, Charles, Making Faces, N.Y. TIMES, Mar. 9, 2003Google Scholar, § 6, at 34 (reporting that Dr. Peter Butler of the Royal Free Hospital in London surveyed a group of 120 persons comprised of doctors, nurses, and lay people and found a majority would undergo a facial transplant if they were disfigured but “not one” would donate their facial tissue).

131 See, e.g., UNITED NETWORK FOR ORGAN SHARING, Waiting List Deaths and Death Rates: 1995 vs. 2003, at http://www.unos.org/SharedContentDocuments/Waiting_list_deaths_and_rates_1995_2003.pdf; see also Thomas-Lester, Avis, With New Heart, a New Journey, WASH. POST, Apr. 15, 2004Google Scholar, at T18 (profiling a heart transplant recipient and highlighting need for cadaveric organ donation).

132 See Siemionow et al., supra note 7, at 1426 (suggesting that commercially available synthetic materials and silicone masks should be discussed in this regard); Aziz, Tariq et al., Development of a New Poly (Dimethylsiloxane) Maxillofacial Prosthetic Material, 65B J. Biomedical Materials Res. 252, 259-60 (2003)Google ScholarPubMed (noting that synthetic prosthetic materials, such as current formulations of silicone rubber, have inadequate mechanical properties, in particular tear strength).

133 See Weiss, Robin A., Science, Medicine, and the Future: Xenotransplantation, 317 Brit. Med. J. 931, 933-34 (1998)CrossRefGoogle Scholar; Champan, Louisa E. et al., Xenotransplantation and Xenogeneic Infections, 333 New Eng. J. Med. 1498, 1499–1500 (1995)Google Scholar.

134 Verble, Margaret & Worth, Judy, Fears and Concerns Expressed by Families in the Donation Discussion, 10 Progress In Transplantation 48, 53–54 (2000)CrossRefGoogle ScholarPubMed.

135 See generally Richard A. Epstein, Organ Transplants: Is Relying on Altruism Costing Lives?, AM. ENTERPRISE (November-December 1993).

136 See UNITED NETWORK FOR ORGAN SHARING, supra note 131.

137 See, e.g., Calabresi, Guido, Four Approaches of Law and to the Allocation of Body Parts, 55 Stan. L. Rev. 2113 (2004)Google Scholar; Morley, Michael T., Note, Increasing the Supply of Organs for Transplant Through Paired Organ Exchanges, 21 Yale L. & Pol’Y Rev. 221 (2003)Google Scholar; Kolber, Adam J., A Matter of Priority: Transplanting Organs Preferentially to Registered Donors, 55 Rutgers L. Rev. 671 (2003)Google ScholarPubMed; Pellegrino, Edmund D., Life or Death: The Issue of Payment in Cadaveric Organ Donation, 265 JAMA 1302 (1991)Google ScholarPubMed.

138 Developments in the Law: Changing Realities of Parenthood – The Law's Response to the Evolving American Family and Emerging Reproductive Technologies, 116 Harv. L. Rev. 2052, 2068 (2003)Google Scholar. See Ertman, Martha M., What's Wrong with a Parenthood Market? A New and Improved Theory of Commodification, 82 N.C. L. Rev. 1 (2003)Google Scholar; Lyndon Shanley, Mary, Collaboration and Commodification in Assisted Procreation: Reflections on an Open Market and Anonymous Donation in Human Sperm and Eggs, 46 Law & Soc’Y Rev. 257 (2002)CrossRefGoogle Scholar; Sandel, Michael, What Money Can't Buy: The Moral Limits of Markets, in 21 The Tanner Lectures On Human Values 89 (Peterson, Grethe B. ed., 2000)Google Scholar.

139 See Sandel, supra note 138, at 102-103 (noting advertisements in the Harvard Crimson for donor gametes).

140 See Mahoney, supra note 122, at 174 (observing that “markets in human materials are not only thriving but inescapable”).

141 See Dukeminier, Jesse, The Uniform Probate Code Upends the Law of Remainders, 94 Mich. L. Rev. 148, 161 (1995)CrossRefGoogle Scholar (describing futures contracts as “life insurance in the life of another” and evaluating future interests in trusts “certainly no more cumbersome and costly to administer or to value than other nonpossessory interests”); see also COUNCIL ON ETHICAL AND JUDICIAL AFFAIRS, AMERICAN MEDICAL ASSOCIATION, Financial Incentives for Organ Procurement: Ethical Aspects of Futures Contracts for Cadaveric Donors, 155 Archives Of Internal Med. 581 (1995)CrossRefGoogle Scholar (assessing ethical dimensions of using financial incentives to encourage cadaveric organ donation); Cohen, Lloyd R., Increasing the Supply of Transplant Organs: The Virtues of a Futures Market, 58 Geo. Wash. L. Rev. 1 (1990)Google Scholar (calling for a futures market in transplantable organs); Hansmann, Henry, The Economics and Ethics of Markets for Human Organs, 14 J. Health Pol, Pol’Y & L. 57 (1987)CrossRefGoogle Scholar (analyzing advantages and disadvantages of various market schemes for solid organs).

142 See PAUL RAMSEY, THE PATIENT AS PERSON: EXPLORATIONS IN MEDICAL ETHICS 198-215 (1970); see also Robert M. Veatch & J.B. Pitt, The Myth of Presumed Consent: Ethical Problems in New Organ Procurement Strategies, in THE ETHICS OF ORGAN TRANSPLANTS: THE CURRENT DEBATE 173-174 (Arthur L. Caplan & Daniel H. Coelho eds., 1998) (explaining that “one is hard pressed to find any mention of presuming consent, overt or implicit” in laws that presume consent; they “simply authorize the state's taking of the organs without explicit permission”).

143 See, e.g., VA. CODE ANN. § 54.1-2986(B) (2004) (no presumption of consent by donor for organ harvesting).

144 See Cruzan v. Director, Mo. Dep't of Health, 497 U.S. 261 (1990).

145 See MINN. STAT. § 149A.80 (2003); PA. STAT. ANN. tit. 20, § 8611(e) (West 2004); WASH. REV. CODE § 68.50.160 (2004).

146 See Cabrer, C. et al., The Living Kidney Donation Process: The Donor Perspective, 35 Transplantation Proceedings 1631 (2003)CrossRefGoogle ScholarPubMed; RICHARD M. TITMUSS, THE GIFT RELATIONSHIP: FROM HUMAN BLOOD TO SOCIAL POLICY (1970); see also Sharp, L.A., Commodified Kin: Death, Mourning, and Competing Claims on the Bodies of Organ Donors in the United States, 103 Am. Anthropologist 112 (2001)CrossRefGoogle ScholarPubMed (finding that death and body fragmentation are cloaked in ecological imagery signaling renewal and rebirth for people).

147 Arguments have been advanced similarly in the harvesting of reproductive material from the deceased, despite a request from someone for the sperm or ova due to the intimate connection with the decedent and self-interests in procreative decision-making. See, e.g., Kutz, Gail A., Note, Parpalaix c. CECOS: Protecting Intent in Reproductive Technology, 11 Harv. J.L. & Tech. 683, 698 (1998)Google Scholar.

148 See MINN. STAT. § 149A.80 (2003) (permitting disposition of one's remains as expressed orally or in writing through an advance directive).

149 See CAL. HEALTH & SAFETY CODE § 7100.1(a)(1) (West 2004) (requiring “clear and complete” expression by deceased regarding disposition of his or her remains to preclude material ambiguity); see also Gay Hartman, Rhonda, Coming of Age: Devising Legislation for Adolescent Medical Decision-Making, 28 Am. J.L. & Med. 409, 448-49 (2002)Google Scholar for a discussion of the protections afforded to personal wishes by requiring a “clear and convincing” evidentiary standard.

150 See Cruzan v. Harmon, 760 S.W.2d 408, 424 (Mo. 1988). This was affirmed by the United States Supreme Court, which ruled that states may continue treatment of an incompetent person in the absence of the person's prior, competent refusal of treatment without violating the federal Constitution. Cruzan, 497 U.S. at 280-85.

151 Hecht v. Superior Court, 59 Cal. Rptr. 2d 222, 226 (Cal. Ct. App. 1996).

152 Id.

153 Id. at 227.

154 See Woodward v. Comm’r of Soc. Sec., 760 N.E.2d 257 (Mass. 2002).

155 See supra notes 75-77 and accompanying text.

156 Pradel, Francoise G. et al., Exploring Donors’ and Recipients’ Attitudes About Living Donor Kidney Transplantation, 13 Progress In Transplantation 203, 206–208 (2003)CrossRefGoogle ScholarPubMed; Cabrer et al., supra note 146, at 1631.

157 See supra note 75 and accompanying text.

158 Hecht v. Superior Court, 59 Cal. Rptr. 2d 222 (Cal. Ct. App. 1996).

159 Id.

160 See Williams v. City of Minneola, 575 So.2d 683, 690 (Fla. Dist. Ct. App. 1991) (finding tortious disrespect or indignity aimed at a representation of a decedent).

161 Emotional distress engendered by mere knowledge of mistreatment toward the deceased is recognized by the common law. See Christensen v. Superior Court, 820 P.2d 181 (Cal. 1991); see also Verble & Worth, supra note 134, at 52-53 (reporting that fears of procurement are among the “hardest to overcome” in donation discussions).

162 See OHIO REV. CODE ANN. § 2927.01 (West 2004); see also Williams, 575 So.2d at 691 (unauthorized showing of photograph of a dead body constituted outrageous conduct in a careless or callous way that might not be considered tortious in other situations).

163 See, e.g., Reid v. Pierce County, 961 P.2d 333 (Wash. 1998); Smith v. City of Artesia, 772 P.2d 373 (N.M. Ct. App. 1989).

164 See Williams, 575 So.2d at 691.

165 See ARIZ. REV. STAT. § 36-831-01(A) (2004); CAL. HEALTH & SAFETY CODE § 7100.1 (West 2004); N.H. REV. STAT. ANN. § 290:20 (2003); PA. STAT. ANN. tit. 20, § 8611(e) (West 2004); S.D. CODIFIED LAWS § 34-26-1 (2003).

166 See Verble & Worth, supra note 134, at 52-53.

167 PA. STAT. ANN. tit. 20, § 305(d)(2) (West 2004). See CAL. HEALTH & SAFETY CODE § 7100.1(a)(1) (West 2004) (mandating clear and complete evidence of decedent's preferences concerning disposition of his or her body).

168 As discussed in Mahoney, supra note 122, “concerns about the increasing commodification of the human body are not new.” Id. at 169.

169 Moore v. Regents of the Univ. of Cal., 793 P.2d 479 (Cal. 1990).

170 Hecht v. Superior Court, 59 Cal. Rptr. 2d 222 (Cal. Ct. App. 1996).

171 Davis v. Davis, 842 S.W.2d 588 (Tenn. 1992).

172 See, e.g., Mahoney, supra note 122, at 174 (observing that “markets in human materials are not only thriving but inescapable”); Blair, Roger D. & Kaserman, David L., The Economics of Ethics of Alternative Organ Procurement Policies, 8 Yale J. On Reg. 403 (1991)Google ScholarPubMed (assailing market-based systems as more efficient and equitable); Hansmann, supra note 141 (assessing a range of market schemes and arguing that society should consider them despite antithesis to ethical intuitions).

173 See COUNCIL ON ETHICAL AND JUDICIAL AFFAIRS, supra note 141, at 581.

174 See Westwood, supra note 2, at 14.

175 PRESIDENT's COUNCIL ON BIOETHICS, HUMAN CLONING AND HUMAN DIGNITY: AN ETHICAL INQUIRY 18 (2002) [hereinafter HUMAN CLONING AND HUMAN DIGNITY].

176 See, e.g., Davis v. Davis, 842 S.W.2d 588 (Tenn. 1992); Moore v. Regents of Univ. of Cal., 793 P.2d 479, 494 (Cal. 1990); Pierce v. Proprietors of Swan Point Cemetery, 10 R.I. 227 (1872). But see Rekosh v. Parks, 735 N.E.2d 765 (Ill. App. Ct. 2000) (finding no property right in a dead body); Cornelio v. Stanford Hospital, 1997 Conn. Super. LEXIS 1928 (1997) (refusing to recognize any proprietary interest in a pap smear specimen for maintaining a replevin action).

177 Davis, 842 S.W.2d at 588.

178 Hecht v. Superior Court, 59 Cal. Rptr. 2d 222 (Cal. Ct. App. 1996).

179 See, e.g., Rao, Radhika, Property, Privacy, and the Human Body, 80 B.U. L. Rev. 359 (2000)Google ScholarPubMed; Gaines, Jane, The Absurdity of Property in the Person, 10 Yale J. L. & Human. 537 (1998)Google Scholar; Steinbock, Bonnie, Sperm as Property, 6 Stan. L. & Pol’Y Rev. 57 (1995)Google ScholarPubMed; Stephen R. Munzer, An Uneasy Case Against Property Rights in Body Parts, in PROPERTY RIGHTS (Ellen Frankel Paul et al. eds., 1994); Bourianoff Bray, Michelle, Note, Personalizing Property: Toward a Property Right in Human Bodies, 69 Tex. L. Rev. 209 (1990)Google Scholar; Murray, Thomas H., On the Human Body as Property: The Meaning of Embodiment, Markets, and the Meaning of Strangers, 20 Mich. J.L. Ref. 1055 (1987)Google ScholarPubMed; Andrews, Lori B., My Body, My Property, 16 Hastings Ctr. Rep. 28 (October 1986)CrossRefGoogle ScholarPubMed; Jane Radin, Margaret, Property and Personhood, 34 Stan. L. Rev. 957 (1982)CrossRefGoogle Scholar; RUSSELL SCOTT, THE BODY AS PROPERTY (1981); GREY, supra note 12.

180 See, e.g., Jaffe, Erik S., Note, “She's Got Bette Davis[’s] Eyes”: Assessing the Nonconsensual Removal of Cadaver Organs Under the Takings and Due Process Clauses, 90 Colum. L. Rev. 528 (1990)CrossRefGoogle Scholar.

181 See, e.g., Hecht, 59 Cal. Rptr. 2d at 227; Moore, 793 P.2d at 494; see also Kutz, supra note 147, at 688-89 (extrapolating the special nature of reproductive material as forcing courts to declare an intermediate status of property as “somewhere between a piece of inheritable property and an actual life”).

182 See Mahoney, supra note 122, at 201 (explaining that “human tissue that has been or can be separated from its source has attributes traditionally associated with property: It is definable, defensible, and divestible.”). For a position advocating that treating bodily parts as commodities does not imply treating the whole body as a commodity, see Resnik, David B., DNA Patents and Human Dignity, 29 J. L. Med. & Ethics 152, 159 (2001)Google ScholarPubMed. For a position that personal interests in the body are “more properly conceived within privacy, rather than property law,” see Rao, supra note 179, at 359. For a position querying the purposes and uses of bodily property, see LEON R. KASS, TOWARD A MORE NATURAL SCIENCE 281-284 (1985).

183 This conception of property should evolve in due course with biomedical endeavor to give expression to what is precisely at stake for each of us, which merits protection for all of us. See, e.g., JOSEPH WILLIAM SINGER, INTRODUCTION TO PROPERTY (2001). By giving expression to individuated identity and dignity, the law protects meaning in these interests for the whole of humanity, and serves as a constant reminder of what it is we value as vital to humankind. See Mahoney, supra note 122, at 202 (emphasizing the flexibility inhering to property as “not an all-or-nothing” concept).

184 Margaret Jane Radin, What, if Anything, is Wrong with Baby Selling?, Address at the McGeorge School of Law (March 4, 1994), in 26 PAC. L. J. 135, 143 (1995) (drawing on her earlier published work). See, e.g., Jane Radin, Margaret, Market-Inalienability, 100 Harv. L. Rev. 1849 (1987)CrossRefGoogle Scholar; Radin, supra note 179, at 957.

185 Radin, 26 PAC. L. J. at 143.

186 Id. See Radin, supra note 179, at 961-70.

187 SINGER, supra note 183, at 13-14.

188 Id. at 2.

189 For thorough treatment of the expressive role of law and its function in shaping social norms and values, see Sunstein, supra note 62. See also Sunstein, Cass R., On the Expressive Function of Law, 144 U. Pa. L. Rev. 2021 (1996)CrossRefGoogle Scholar; Section V, infra notes 211-227 and accompanying text for an examination of law's expressive function in biotechnology generally and facial transplant particularly.

190 A French court, for example, rejected an argument that sperm is tangible, movable property giving rise to ownership in a case involving cryogenically preserved sperm of the deceased that the spouse wanted released from the Center d’Etude et de Conservation du Sperme for insemination. Rather than defining property in a way that protects the interest at stake – namely Alain Parpalaix’ surviving interest in that which is linked in a constitutive sense to his identity and dignity – the court styled that intangible interest as part of liberty in personal decision-making about procreation, preand postmortem. Parpalaix c. CECOS, T.G.I. Creteil, Aug. 1, 1984, 2, pan-jurisp., 560. See Kutz, supra note 147, at 683.

191 B.F. Skinner has underscored the time-honored recognition for public protection accorded dignitary interests. “The literature of dignity identifies those who infringe a person's worth, it describes the practices they use, and it suggests measures to be taken.” B.F. SKINNER, BEYOND FREEDOM AND DIGNITY 54 (1971).

192 See Mahoney, supra note 122, at 174.

193 JOHN LOCKE, AN ESSAY CONCERNING HUMAN UNDERSTANDING (Alexander Campbell Fraser ed., 1894).

194 IMMANUEL KANT, GROUNDWORK OF THE METAPHYSICS OF MORALS (James W. Elligton trans., 1981) (1785).

195 See LOCKE, supra note 193, at 303-305.

196 See generally JOHN LOCKE, TWO TREATISES ON GOVERNMENT (Peter Laslett ed., 1988)(1690).

197 See BRODY, supra note 1, at 20-23.

198 See Vickery, Lindsey E. et al., The Impact of Head and Neck Cancer and Facial Disfigurement on the Quality of Life of Patients and Their Partners, 25 Head & Neck 289, 294-95 (2003)CrossRefGoogle ScholarPubMed (highlighting significant impact on others closely associated with a person who is facially disfigured).

199 See supra notes 168-198 and accompanying text.

200 Annas, George J. et al., Protecting the Endangered Human: Toward an International Treaty Prohibiting Cloning and Inheritable Alterations, 28 Am. J.L. & Med. 151, 170 (2002)Google ScholarPubMed.

201 See KASS, supra note 182, at 113 (cautioning that “[o]ur society is dangerously close to losing its grip on the meaning of some fundamental aspects of human existence”).

202 A.Z. v. B.Z., 725 N.E.2d 1051, 1055 (Mass. 2000). The scant federal regulatory and state statutory guidance focus primarily on parentage status and concomitant rights and responsibilities, including intestate succession, rather than oversight for developments in reproductive science. See Additional Protections Pertaining to Research, Development, and Related Activities Involving Fetuses, Pregnant Women, and Human In Vitro Fertilization, 45 C.F.R. § 46.201-211 (1989). State statutes vary considerably in relation to the means for assisted procreation. See, e.g., D.C. CODE ANN. § 16-401 (2004) (surrogacy parenting contracts); FLA. STAT. § 742.13 (2004) (parentage determination in context of in vitro fertilization); LA. REV. STAT. ANN. § 9:126 (2004) (ownership of sperm and ovum, along with parentage determination in context of in vitro fertilization); N.H. REV. STAT. ANN. § 168-B (2004) (surrogacy); N.J. STAT. ANN. § 3B:5-8 (2004) (intestate succession); OHIO REV. CODE ANN. §§ 3111.02, 3705.09 (West 2004) (parentage determination in context of in vitro fertilization); TEX. FAM. CODE § 160.204 (Vernon 2004) (presumption of paternity when using reproductive science for procreation); VA. CODE ANN. § 20-156 (2004) (status of child on assisted conception).

203 Cloning through nuclear transfer extends asexual procreation by eliminating altogether the use of human gametes. Robertson, John A., Human Cloning and the Challenge of Regulation, 339 New Eng. J. Med. 119, 119 (1998)CrossRefGoogle Scholar.

204 See HUMAN CLONING AND HUMAN DIGNITY, supra note 175, at 255 (concluding that supporting “valuable research while preserving moral standards is the challenge that confronts the federal government and the American public in the matter of cloning,” and that banning cloning-toproduce- children and regulating cloning for biomedical research “offers the best means of achieving that goal”); see also Baylis, Francoise, Canada Bans Human Cloning, 34 Hastings Ctr. Rep. 5 (2004)Google ScholarPubMed (discussing Canada's Assisted Human Reproduction Act that prohibits human cloning, creating in vitro embryos for any purpose other than assisted conception, and payment for gametes, in vitro embryos, or a surrogate mother's services).

205 Annas, George J., Why We Should Ban Human Cloning, 339 New Eng. J. Med. 122, 123 (1998)CrossRefGoogle ScholarPubMed. But see Robertson, supra note 203, at 121 (advocating for attention to ensuring cloning is done well rather than to prohibiting all uses of it); Sunstein, Cass R., Is There a Constitutional Right to Clone?, 53 Hastings L.J. 987, 1004 (2002)Google Scholar (exploring the constitutional, rather than policy, issue of a cloning ban and concluding that “bans on cloning are constitutional, not that they are a good idea”). Accord FACTS AND FANTASIES ABOUT HUMAN CLONING (Martha C. Nussbaum & Cass R. Sunstein eds., 1998).

206 For thoughtful commentary on the issues related to trans-specie research, see, e.g., Kopinski, Nicole E., Note, Human-Nonhuman Chimeras: A Regulatory Proposal in the Blurring of Specie Lines, 45 B.C. L. Rev. 619 (2004)Google Scholar; Annas et al., supra note 200; Iwasaka, Ryan M.T., Note, Chakrabarty to Chimeras: The Growing Need for Evolutionary Biology in Patent Law, 109 Yale L.J. 1505 (2000)CrossRefGoogle ScholarPubMed.

207 Kopinski, supra note 206, at 653-54.

208 See PELLEGRINO ESSAYS, supra note 51, at 191-200; see also Morris et al., supra note 5, at 335 (suggesting a measure of coercion and conflict created by desperate patients and their relatives on the surgeon to proceed with a risk-laden procedure); Moore, 793 P.2d at 484 (finding fiduciary obligation by physician to disclose personal interests unrelated to patient care that may impair judgment).

209 See PAUL C. WEILER ET AL., A MEASURE OF MALPRACTICE: MEDICAL INJURY, MALPRACTICE LITIGATION AND PATIENT COMPENSATION (1993). The tort system aims to prevent harm by deterring substandard professional conduct. KEETON ET AL., supra note 96, at 1-6.

210 See Morris et al., supra note 5, at 336-37.

211 See Sunstein, supra note 62, at 908-13.

212 See generally CONN. GEN. STAT. § 14-227a (2003); DEL. CODE ANN. tit. 21, § 4177A (2004); D.C. MUN. REGS. tit. 50, § 2201.05 (2004); R.I. GEN. LAWS § 31-27-2 (2004); VA. CODE ANN. § 18.2-266 (2004).

213 See Jones, supra note 20, at 84 (describing television public service announcement about the consequences of drunk driving where Jacqui Saburido, a drunk driving accident victim, speaks from behind a blown-up picture of herself before the accident – then slowly lowers it to reveal her disfigured face).

214 See NAT’L HIGHWAY TRAFFIC SAFETY ADMIN., U.S. DEP't OF TRANSP., NHTSA 38-04, States’ Progress Drops Drunk Driving Deaths to Lowest Level Since 1999 (Aug. 25, 2004), at http://www.nhtsa.dot.gov.

215 See Sunstein, supra note 62, at 908 (stating the importance of seeing “whether shifts in social norms, brought about through law, might operate to save lives and otherwise improve human well-being”). See generally Sunstein, supra note 189, at 2021.

216 See Moore v. Regents of the Univ. of Cal., 793 P.2d 479 (Cal. 1990).

217 See generally Gregg Bloche, M., Trust and Betrayal in the Medical Marketplace, 55 Stan. L. Rev. 919 (2002)CrossRefGoogle Scholar; Iglehart, John K., Congress Moves to Regulate Self-Referral and Physicians’ Ownership of Clinical Laboratories, 322 New Eng. J. Med. 1682 (1990)CrossRefGoogle ScholarPubMed.

218 See Bosch, supra note 31, at 871 (reporting that “attempts to perform the world's first face transplant were thwarted by the French National Ethics Advisory Committee, which ruled that inherent risks of the procedure make it unethical”); Morris et al., supra note 5, at 336 (calling for oversight through ethical evaluation by an independent committee).

219 See supra note 97 and accompanying text.

220 See, e.g., Miller, W.B., Reproduction, Technology, and the Behavior Sciences, 183 Science 149 (1974)CrossRefGoogle Scholar; Marx, J.L., In Vitro Fertilization of Human Eggs: Bioethical and Legal Considerations, 182 Science 812 (1973)Google ScholarPubMed.

221 Bray, supra note 179, at 238 (noting the public policy of upholding a transplant patient's individuality).

222 Cate, Fred H., Human Organ Transplantation: The Role of Law, 20 J. Corp. L. 69 (1995)Google Scholar (measuring the success of organ transplantation by lives saved and improved).

223 See UNOS, supra note 131.

224 See supra note 137.

225 Cf. Hansmann, supra note 141, at 72-73.

226 See Tannen, supra note 3, at 78-83 (discussing analogous issues, whereby outward signs of aging are worn less by those who can afford to pay for cosmetic procedures).

227 JOHN RAWLS, A THEORY OF JUSTICE 261 (1971); see also Childress, supra note 69, at 103- 104.

228 42 U.S.C. § 273 (1984). See supra notes 126-129 and accompanying text.

229 See Bach, Fritz H. et al., Ethical and Legal Issues in Technology: Xenotransplantation, 27 Am. J. L. & Med. 283, 286-89 (2001)Google ScholarPubMed; Vanderpool, Harold Y., Critical Ethical Issues in Clinical Trials with Xenotransplants, 351 Lancet 1347, 1349 (1998)CrossRefGoogle ScholarPubMed; Clark, Margaret A., This Little Piggy Went to Market: The Xenotransplantation and Xenozoonose Debate, 27 J.L. Med. & Ethics 137 (1999)CrossRefGoogle ScholarPubMed.

230 See POPPER LECTURES AND ESSAYS, supra note 81, at 83-92 (advocating a position that clarity in language and intellectual honesty provide integrity to the learning process and to a search for the truth).

231 See supra note 11.

232 See WILLARD VAN ORMAN QUINE, WORD AND OBJECT 19-20 (1960) (urging simplicity as a way to more easily “keep relevant considerations in mind”).

233 But cf. SKINNER, supra note 191, at 56 (explaining that a drawback to mind-boggling advancements in biomedical science, however, is the reduction of any “need to suffer in silence and the chance to be admired for doing so”).

234 See Parry, Vivienne, Health: A Matter of Life and Death, THE GUARDIAN (London), July 6, 2004Google Scholar, at A10.

235 Id.

236 RAWLS, supra note 227, at 261-64.

237 See PRESIDENT's COUNCIL ON BIOETHICS, REPRODUCTION AND RESPONSIBILITY: THE REGULATION OF NEW BIOTECHNOLOGIES (2004), available at http://www.bioethics.gov/reports/reproductionandresponsibility/index.html.

238 Spanbauer, Julie M., Breast Implants as Beauty Ritual: Women's Sceptre and Prison, 9 Yale J.L. & Feminism 157, 183 (1997)Google Scholar (noting cosmetic surgeons have created psychological ailments).

239 HUMAN CLONING AND HUMAN DIGNITY, supra note 175, at 187.

240 See Marrin, supra note 3, at 21 (discussing cultural obsession with beauty that contributed to couple's decision to abort fetus when they discovered it had a cleft palate).

241 See Spanbauer, supra note 238, at 183 (describing the creation of a cosmetic condition to denote breast size).

242 See Partridge, James, Facial Disfigurement: Both Counselling for Patients and Education for the Public are Necessary, 315 Brit. Med. J. 120 (1997)CrossRefGoogle ScholarPubMed. On behalf of Changing Faces, a charitable organization in England devoted to persons with disfigurement, James Partridge (himself facially disfigured) advocates for “more empowerment and a more informed social climate” that could negate any need for facial transplant. James Partridge, FIN. TIMES (London), November 29, 2003 (noting that facial disfigurement is protected under the 1995 Disabilities Act). According to Partridge, it is possible “to acquire self-esteem to live a successful life with a disfigurement.” Devine, supra note 8, at 13 (interviewing Partridge).

243 See Abraham, Kenneth S. & Weiler, Paul C., Enterprise Medical Liability and the Evolution of the American Health Care System, 108 Harv. L. Rev. 381 (1994)CrossRefGoogle Scholar; WEILER ET AL., supra note 209.

244 See Marcus, Leonard C. & Marcus, Eugenia, Nosocomial Zoonoses, 338 New Eng. J. Med. 757 (1998)CrossRefGoogle ScholarPubMed.

245 Leon R. Kass, The Wisdom of Repugnance, in THE ETHICS OF HUMAN CLONING 17-24 (Leon R. Kass & James Q. Wilson eds., 1998); cf. Sunstein, supra note 205, at 987 (averring that “[b]y itself, repugnancy should not be in principle, an adequate justification for law”).

246 Kass, supra note 245.

247 OHIO REV. CODE ANN. § 2927.01 (West 2004). See generally Sunstein, Cass R., Outrage, 2002 Utah L. Rev. 717Google Scholar.

248 “Suicide on a grand scale: suicide of the species” is how Paul Ramsey put it when noting our “propensity for the destruction of the parameters of human existence.” PAUL RAMSEY, FABRICATED MAN: THE ETHICS OF GENETIC CONTROL 160 (1970).

249 See supra note 14.

250 See Petit et al., supra note 4, at 1429.

251 See GUIDO CALABRESI & PHILIP BOBBITT, TRAGIC CHOICES 157-158 (1978) (assailing historical perspective for mapping of society's confrontation with a tragic choice “by showing how a society has dealt with the dilemma previously, we are made aware of the perimeters of future choices, most especially those adaptations which are necessary just because other attempts have preceded”).

252 C.S. LEWIS, THE ABOLITION OF MAN 83-84 (1947).