Once upon a time, novel conceits of humanoid creation were strictly relegated to the world of fantasy or the imagination. Frankenstein’s monster resided peacefully alongside Mr. Hyde and the Headless Horseman in the pages of storybooks, and the Golem remained buried in Talmudic lore. If there was any moralizing, it was – don’t go there. No longer. Last month the Journal of Medicine and Philosophy devoted an entire issue to the ethics and philosophy of head transplants.
What does this recent symposium tell us about our moral and ethical compass?
Theoretically, it is possible to transplant a head – at least in mice. Preliminary steps have even proved effective in humans. The HEAVEN project (Head Anastomosis Venture) investigates how to conquer the great technological hurdles. I can't be sure whether this is an ironic acronym or a hubristic appellation.
“This innovative surgery promises a life-saving procedure to individuals who suffer from a terminal disease, but whose head and brain are healthy.”
Theodossios Birbilis MD,
Dept. of Neurosurgery, University Hospital of Alexandroupolis
"Head transplants are fake news. Those who promote such claims and who would subject any human being to unproven cruel surgery merit not headlines, but only contempt and condemnation.”
Arthur Caplan, Ph.D., Bioethicist NYU
Far from being far-fetched, human head transplantation is theoretically possible and merits an entry in Wikipedia. One neurosurgeon claims this will be a doable procedure by 2030. But “could” is not the same as “should.”
The Journal of Medicine and Philosophy convened a cadre of philosophers and ethicists from Hong Kong, China, and the US to explore the issue – raising a host of unscientific principles in their analyses. The participation of the Chinese, home of the first and so-far only hereditary gene alteration, is perhaps not surprising. However, it is crucial to acknowledge the differing moral structure between Western and Eastern religions and philosophies and be vigilant of their incursion into mainstream scholarly literature, practice, and ethics.
The Journal focuses on two main issues,
- Which donor survives the (transplant) surgery – the head or body?
- Does personal identity necessarily follow the head?
We begin with Jason Eberl, Professor of Health Care Ethics at St. Louis University, who qualifies the issue as a “thought experiment” while acknowledging the possibility of its use:
“A surgical head-transplant technique, HEAVEN, promises to offer significantly improved quality of life for quadriplegics and others whose minds are functional, but whose bodies require artificial support to continue living.”
Jason Eberl, PhD
Because exoskeletons and brain-to-computer interface technologies are becoming increasingly available to aid the life of the person with quadriplegia, Eberl gives far too much credence to the value of head transplants in the medical treatment arsenal . Nevertheless, it does afford him a platform to espouse his personal – and rather idiosyncratic philosophy. While he cites Thomas Aquinas and others, who assert that a human being is not fully separable from his body, he also bases his views on his religious notions of the soul, which he believes requires integration of head and body, a view not necessarily accepted by other Judeo-Muslim-Christian believers.
Next, psychologist Lian Bian and philosopher Ruiping Fan  present a Confucian view. Grounded in the Confucian belief that personal identity is inseparable from one’s family relations, Bian and Fan reject the acceptability of head transplants on social and metaphysical grounds.
Their view of personal identity, dependent on understanding the Chinese notion of lifeforce, or qi, involves social aspects inseparable from one’s intimate familial relationships. You are inseparable from your family; it is the basis for the reverence paid to our elders.
Metaphysically, based on the Confucian concept of a “new you,” Fan and Bian claim the transplant would destroy two people’s identities and personalities by creating a third, new person, providing no benefit to either of the donors. (Who, exactly, this person would be is unclear.) This might be the case, but it is both a highly personal and speculative belief, untethered to any Western ethical, scientific, or legal structure.
Chillingly, Bian and Fan’s article also warn that.
“conservative” cultural forces … cannot be permanently stopped [and] objections to head transplants … are much like “playing God”-objections against germline interventions: such worries or objections will gradually weaken and disappear.”
Ouch. Most mainstream scientists currently oppose germ-line interventions, and those who signal acceptance make me nervous.
The American philosophers, whose views are more nuanced, follow their Eastern colleagues. Mark Cherry, Ph.D., professor of philosophy at St. Edwards University, asserts that personal identity follows the brain because it is the seat of personhood, memories, and psychological connectedness, agreeing with the science. Cherry raises the practical question of whether the brain could fully integrate with a new body, and if so, would the new “person” fully maintain the head donor’s identity over time. Keep in mind, however, that we non-head-transplanted humans also change our identities and cellular constructs over time.
Finally, we have American philosophy professors Ana Iltis and J. Clint Parker , who bemoan the lack of a fundamental emphasis on philosophy to answer complex philosophic questions such as who survives whole-body/head transplants?
Perhaps the most salient article is Dr. Parker’s – regarding society’s view on the extension and enhancement of an aging life and the worthiness of a medical quest to escape our mortality. The entire journal might have focused on that.
The focus on whether our personhood is jointly vested in the body also deflects attention from mainstream science.
From a scientific perspective: the human brain is “the basis of everything we have: our experiences, thoughts, and unconscious processes,” an entirely different view from that portrayed by the philosophers:
“As a neuroscientist, I can say that all of our conscious and unconscious psychological processes begin with the tissue called the human brain.”
Professor Raphael Malach, Weizmann Institute of Science 
What Does Philosophy Offer?
The ability of a new “person” to integrate both a head with its conscience and a new body has, thus far, been the purview of science fiction (the Dax phenomena of Star Trek) and metaphysical literature (e.g., the Dybbuk and the Ibur, evil and beneficent psychic additives, respectively, in mystical Judaism).
The question of being “at home” in one’s new and improved body is also not new and has been dealt with in science fiction . In every literary and metaphysical case, specific themes emerge: if one is going to intentionally create a human with multiple consciousnesses, the new host or housing must be psychologically prepared. Otherwise, the likelihood of evil manifestations must be recognized. It seems that the philosophers have nothing new to offer us here, either.
From a psychological standpoint, such a transformation might be too overwhelming for any individual to acclimatize, as Cherry suggests. However, this notion could be tested using computer simulations and again doesn’t lend itself to philosophical speculation.
The Journal does, however, raise pointed issues that should be addressed:
- The meaning of personhood (especially as it relates to AI creations).
- Mind-body integrity
- The limits of life
These issues arise in the context of individuals who have lost the use of all limbs (cases of quadruple amputation, quadriplegia, severe burns, and congenital limb deformations) and others with significant bodily infirmities that arise with aging. Sadly, these issues are lost by sensationalizing them in the head-transplant format, which raises a host of diversionary and false issues and dilutes key questions:
- Should we go all-out to extend our physical lives?
- How do we address mind-body connections in more medically realistic situations?
More importantly, similar issues arise in the context of the transplantation of body parts from animals to humans, questions that are far more realistic and pressing.
The Journal notes that we need to consider variations in religious, cultural, and secular moral diversity, highlighting the different bioethical communities of the authors. They provide no framework to address these issues, nor do they consider what legal opinion and precedent might say on these issues.
As a legal academic and attorney, I wonder if the law might directly resolve many of our concerns - stay tuned In.
 A head transplant, among other challenges, would require the surgical connection of two spinal cords while preserving crucial blood vessels.
 Fan has previously argued that Confucian ethics accept genetic enhancement of children.
 “The human mind is the basis of everything we have” Jerusalem Post
 Martin Caidin’s ManFac and Cyborg (which served as the basis for television’s The Six Million Dollar Man)
 Ana Iltis, Ph.D., Wake Forest University, and J. Clint Parker, MD Ph.D., East Carolina University