Neuroethics (2016) 9:15–22
DOI 10.1007/s12152-015-9245-4
ORIGINAL PAPER
Head Transplants, Personal Identity and Neuroethics
Assya Pascalev & Mario Pascalev & James Giordano
Received: 5 September 2015 / Accepted: 2 December 2015 / Published online: 18 December 2015
# Springer Science+Business Media Dordrecht 2015
Abstract The possibility of a human head transplant
poses unprecedented philosophical and neuroethical
questions. Principal among them are the personal iden-
tity of the resultant individual, her metaphysical and
social status: Who will she be and how should the
Bnew^ person be treated - morally, legally and socially
- given that she incorporates characteristics of two dis-
tinct, previously unrelated individuals, and possess both
old and new physical, psychological, and social experi-
ences that would not have been available without the
transplant? We contend that this situation challenges
linguistic conventions and conceptual binaries (Bpart-
whole^), and calls into question the major philosophical
approaches to personal identity: animalism and reduc-
tionism. We examine these views critically vis-a-vis
head transplantation and conclude that they fail to pro-
vide an adequate account of the identity of the resultant
individual because both neglect the key role of
A. Pascalev (*)
Department of Philosophy, Howard University, 226 A. Locke
Hall, Washington, DC 20009, USA
e-mail: Assya.Pascalev@bio-ethics.net
M. Pascalev
Bulgarian Center for Bioethics, Gorski Putnik 13A, 1421 Sofia,
Bulgaria
e-mail: Mario.Pascalev@bio-ethics.net
J. Giordano
Pellegrino Center for Clinical Bioethics, Georgetown University,
4000 Reservoir Rd., Bldg D, Rm 238, Washington, DC 20057,
USA
e-mail: jg353@georgetown.edu
embodiment for personal identity. We maintain that
embodiment is central to personal identity and a radical
alteration of the body will also radically alter that per-
son, making her a different person. Consequently, a
human head transplant will result in an individual partly
continuous with the head/brain (in terms of connected
memories and mental events), and partly continuous
with the body donor (in terms of the inputs and regula-
tory patterns afforded by the structure and functions of
the nervous system, and the self-image of this new
embodiment). We conclude that the resultant person
would be different from both the individual whose head
was transplanted and the one to whose body the Bnew^
head is attached.
Keywords Transplantation . Neuroethics . Personal
identity . Neuroscience . Philosophy . Embodiment .
Derek Parfit . Animalism . Reductionism . Metaphysics .
Donor . Recipient . Self . Head transplant . Whole body
transplant . Head-to-body transplant
Recent reports of Italian surgeon Sergio Canavero’s
plans to perform a human head transplant by year
2017 [1, 2], and the subsequent news that the first
volunteer for the procedure, Valery Spiridonov, has
already stepped forward [3], are fostering a number of
neurobiological, philosophical and neuroethical ques-
tions, issues and challenges. Principal among them are
the issue of the personal identity of the resultant indi-
vidual, and his or her metaphysical and social status:
Who will he or she be and how should the Bnew^ person
16
be treated - morally, legally and socially - given that he
or she incorporates characteristics of two distinct, pre-
viously unrelated individuals, and possess both old and
new physical, psychological, and social experiences that
would not have been available without the transplant?
In this paper, we contend that the feasibility of head
transplants challenges the extant philosophical ap-
proaches to personal identity: animalism and psycho-
logical reductionism. We argue that both approaches fail
to provide an adequate account of the identity of the
resultant individual because both misunderstand the role
of embodiment for personal identity. We maintain that
embodiment is central to personal identity and a radical
alteration of the body will also radically alter the person,
making her a different person. Consequently, a human
head transplant will result in an individual partly con-
tinuous with the head/brain donor (in terms of connected
memories and mental events), and partly continuous
with the body donor (in terms of the inputs and regula-
tory patterns afforded by the structure and functions of
the nervous system, and the self-image of this new
embodiment). We conclude that the resultant person
would be a new person different from both the individ-
ual whose head was transplanted and the one to whose
body the Bnew^ head is attached.
The Approaching Feasibility of Head Transplants
and its Challenges for Neuroethics
According to Canavero, the head transplant could be
accomplished successfully in a complex neurosurgical
procedure, which he has called the head anastomosis
venture (HEAVEN). The key to its success is the
GEMINI technique, which entails cooling and cutting
the spinal cords of the recipient and donor in a way that
would allow for anastomosis, with minimal tissue dam-
age, and subsequent axonal fusion that is optimized
through perfusion of inorganic polymers to reduce
gliosis and facilitate connectivity [4]. Canavero bases
the procedure upon prior work of White et al. [5, 6], with
the addition of using particular fusogen/sealants that are
polyethylene glycol (PEG) derivatives, such as PEG-
based polyaxomers, triblock copolymers consisting of
PEG side-chains surrounding a hydrophobic center,
and/or new forms of conjugated chitosan hydrogel.
These are claimed to be non-toxic (at molecular weights
greater than 1000), and highly hydrophilic. The diame-
ter and/or myelination of axons do not appear to
Pascalev A. et al.
differentially factor in the restorative action of these
fusogens, and Canavero asserts that axonal alignment
is also not required for union of donor and recipient
neural tracts [4]. Grey matter interneuronal networks are
posited to remain intact and functional, particularly if
and when transplanted tissue is post-surgically treated
with low level electrical stimulation. Canavero opines
that the ideal operating setting involves a suite that
enables simultaneous conduct of surgeries on both the
body-donor (D) and body-recipient (R - the Bhead^).
Anesthesiologic, thermal, and hemodynamic support is
maintained for both D and R, and suppression of neu-
ronal burst activity is to be achieved through loading of
barbiturate or propofol. Mechanical aspects of decapita-
tion and HEAVEN-GEMINI are described relative to
positioning of D and R bodies, incisions, and the actual
anastomoses (of vascular, meningeal, neural, and mus-
cle tissues). Following surgery, the HEAVEN-Gemini
patient is to remain sedated in a cervical collar under
intensive care, with subsequent physiotherapy instituted
and sustained as necessary to achieve maximal function-
al recovery. Considerations are afforded for post-
surgical central pain (consequential to improper or in-
complete fusion of the spinothalamic tracts), treatment
of which Canavero addresses by reference to his prior
volume on this topic [7]. Absent from the discussion is
mention or address of the complexities and difficulties
of treating and managing central pain (which in some
cases requires neurosurgical intervention).1 According
to Canavero, HEAVEN-GEMINI is seen as viable, and
is proposed as a potentially valuable intervention for a
young patient with B... a condition... devastating the
body, for instance, progressive muscular dystrophies
or... genetic and metabolic disorders of youth... with
no cure at hand^ [4, p. 340].
That Canavero’s proposal represents at least the pos-
sibility of an actual attempt at such an endeavor raises
complex philosophical and ethical issues that have here-
tofore been only the stuff of wild speculation and sci-
ence fiction. However, as the adage informs, yesterday’s
fiction is today’s possibility, and fictional accounts may
serve to at least illustrate the way(s) that head transplan-
tation is regarded in both professional and lay commu-
nities [9]. Importantly, thought experiments, fictional
narratives and metaphors [10–12] facilitate ethical
analysis allowing us to anticipate and evaluate the
neuroethical implications of this procedure and to
1
For an overview, see [8].
Head Transplants, Personal Identity and Neuroethics
consider, before the fact, its moral permissibility (or
impermissibility) and reach conclusions that could in-
form clinical, legal as well as policy discussions. To be
sure, some of the ethical issues of head transplantation
stem from the high risk of the neurosurgical procedure,
the possibility of rejection, the necessity and burdens of
protracted, if not life-long medical care, and the
resulting psychological and economic stress(es) in-
curred. Such concerns are well known, and inherent to
organ transplantation, particularly if and when the pro-
cedure is experimental. While such issues are certainly
crucial, and give rise to important clinical, legal and
ethical protocols to minimize risk, optimize outcomes,
and ensure that procedures are soundly executed, they
are not new. However, other, more explicitly
neuroethical issues arise from the neurobiologic and
neuro-cognitive aspects of the transplant. While animal
studies have shown the relative viability of the
HEAVEN and GEMINI procedure(s), the cognitive in-
tegrative capabilities and experience(s) of the resulting
anastomosis are unknown, given that (1) long-term
manifestations have not been studied (due to the mor-
tality of research subjects to date), and (2) the phenom-
enal consciousness of animals remains inaccessible.
Canavero acknowledges the possibilities of body image
and identity issues, and calls for B... psychiatric assess-
ment and treatment... to prevent adverse postoperative
emotional reaction... related to... new body image^ [4, p.
339].
Indeed, the proposed procedures raise important phil-
osophical and ethical issues, as the principal questions
posed by the HEAVEN-GEMINI scenario concern the
nature of the self and personal identity: What makes one
who he or she is? What makes one the same person over
time? How is one’s brain related to one’s body, mind,
identity and self? Who is the person who survives the
transplantation: the Bowner^ of the head, the Bowner^ of
the body, or a qualitatively new person? Is the person
whose head is transplanted to another’s body the same
Bperson^ they were before the surgery? Following from
this are the challenges of the metaphysical and social
status of the resultant person. Namely, how should the
Bnew^ individual be treated - morally, legally and so-
cially - given that he or she incorporates the physical
characteristics of two distinct, previously unrelated in-
dividuals, and possess both old and new physical, psy-
chological, and social experiences that would not have
been available to the Brecipient^ without the transplant?
Thirdly, head-to-body transplantation raises questions
17
regarding the nature of the novel procedure and the
resultant donor-recipient relation: Is this a head trans-
plant, or a body transplant? Who is the donor and who
the recipient, and are such distinctions merely semantic?
Derivative questions include if, how, and what ought to
be done to prevent the misuse of the procedure for
frivolous reasons (e.g., cosmetic pursuit of an ideal body
image), and socio-cultural – if not political – agendas?
The precise nature of the relationship between the
brain, the cognitive and emotional functions known as
mind, and the concept of self remains a source of ongo-
ing philosophical debates, which, today, have been in-
formed by insights from the neurosciences. The possi-
bility of a human head transplant lends practical rele-
vance and urgency to the questions at the heart of such
debate and poses unprecedented challenges to notions of
personhood, self and identity. It is plausible to assume
that a successful head transplant would have profound
impact on the recipient’s life; but what would life in a
Bnew^ body mean for the recipient’s sense of self?
Would it change who he or she is and who would the
resulting individual become? As philosopher Bonnie
Steinbock pointedly asks, Bwould the patient’s life be
saved? This is not a medical or scientific question, but a
conceptual or metaphysical one^ [13]. Somewhat intu-
itively, one might assume that the individual who sur-
vives after the transplantation is the one whose head
Breceives^ a body; after all, the head is the repository of
the brain, which is essential to consciousness, thought
and the sense of self.2 Indeed, much of consciousness
entails embodiment of some sort. But, in a head-to-body
transplant, it is not necessarily obvious who Breceives^
and who Bgives^, and who Blives^ or Bdies^ considering
that the entire body of one individual (the Bdonor^)
survives its attachment to a part, albeit a central one, of
another (the Brecipient’s^ head).
Unlike other types of transplantation in which the
recipient’s body becomes the environment for a donor’s
body part, a head transplant involves a much greater
degree of inter-dependence between the donated Bpart^
and the receiving Bwhole^. We contend that this situa-
tion challenges both linguistic conventions and such
2
This view will not be shared by those cultures that believe that
the brain is not the locus of self and consciousness. Notably,
Buddhists deny the existence of the self [14, pp. 120–124] and
Taoists believe that the seat of consciousness is the body: BThe
ancient Taoist conceived the body as consisting of five orbs - liver,
heart, spleen, lungs and kidneys - which were associated with five
agents, five senses, five psychic centers...^ [15, p. 128]
18
conceptual binaries as Bpart-whole^. In essence, we are
now asking whether the body is part of the brain/mind,
or if the head (and brain) is a part to be fitted to the
Bwhole^ of the body. Is an entire body a Bpart^, and is
the head, given its importance as Bpart^ of the body and
its connection to thinking, self and memories, just an-
other Bpart^?
Rather, we opine that the result of a head transplant is
a new head-body unit (what we refer to as a Btrans-
somatic individual^). This contends against the initial
intuition that the surviving person is the individual,
whose head was transplanted. To understand properly
the characteristics of the resultant trans-somatic individ-
ual (or TSI), we must examine the fundamental ques-
tions of what makes us who we are, what constitutes
personhood and identity, and how they relate to one’s
mental and physical experience. These are philosophical
questions that have important ethical, legal and clinical
implications. How they are answered will depend on
one’s view of personal identity, i.e., what makes some-
one the same person over time, what makes someone
that person (e.g., memories, sensory experience, modes
of perceiving and responding), and how we know who
is who.
Biological vs. Psychological Continuity
Scholars have offered competing accounts of personal
identity. One proposal is that personal identity consists
of the continuity of one’s mental events and psycholog-
ical experiences over time. This psychological continu-
ity view has been favored by many Western philoso-
phers, including John Locke [16],3 Sydney Shoemaker
[17, 18], Derek Parfit [19] and Jeff McMahan [20].
Based upon this view, the person who will continue to
exist after head-transplant surgery is the one whose head
is transplanted onto another’s body, because the capacity
for mental life resides in the surviving brain. This view
is also known as mind essentialism, namely, Byou go
where your mind goes^ [21]. Such a position, however,
does not fully account for the relation between the
person qua psychological states and the biological or-
ganism. As Steinbock notes, on this view it is literally
impossible for a person who loses consciousness and
enters a persistent vegetative state (PVS) to continue to
exist as the same individual over time.
3
See particularly Chapter XXVII on BIdentity and Diversity^.
Pascalev A. et al.
In contrast, proponents of the biological continuity
view also called animalism (i.e., Eric Olson [22] and
David DeGrazia [23, 24]), maintain that psychological
continuity is not essential to the survival of the individ-
ual over time and that one’s identity will be preserved as
long as one’s body exists. This is possible because we
are organisms, and thus, what is essential to psycholog-
ical continuity and personal identity is physical continu-
ity [24]. Consciousness is just another property of the
organism. Consequently, DeGrazia speak of human in-
stead of personal identity and maintains that one would
remain the same individual even if he or she loses
consciousness permanently e.g., if he or she becomes
comatose, vegetative, or even brain-dead: B…if we are
essentially human animals, and not essentially beings
with psychological capacities, then… it is not clear—
indeed, it is false—that we go out of existence upon
irreversible loss of the capacity for consciousness; rath-
er, we die upon the collapse of organismic functioning^
[24].
We consider critically each of these views in turn.
Animalism and Head Transplants
Although animalists are able to explain the relation of
the person to his or her body, they also less than fully
account for the personal identity of the head transplant
because here, for the first time, the mental life of an
individual (i.e., the TSI) does not correlate with a single
organism. A head transplant preserves parts of two
distinct organisms, yet no single biological unit survives
the surgery.
One reply open to the animalist is to maintain that the
individual who survives the head transplant is the donor,
whose body is attached to the head despite the fact that
the donor would have completely new and unfamiliar
mental contents and history. Another reply is to claim
that the survival of the head/brain is sufficient for the
survival of the entire organism, and thus the resultant
person is identical to the one whose head survived the
surgery. However, such a response would imply that the
brain/head holds a privileged position in the organism,
which is hard to justify without also privileging the
functions of the human brain, which are primarily psy-
chological and include thinking, self-awareness and
memory.
Thus, if the animalist is to identify the organism with
the brain, the view would collapse into its opposite, the
Head Transplants, Personal Identity and Neuroethics
psychological identity approach. Alternatively, the
animalist could maintain two further, incompatible and
logically contradictory views: he or she can claim that,
in the case of a head transplant, both the donor and the
recipient die because their organisms no longer exist as
the units they were before the operation. Or, the
animalist could maintain that both the donor and recip-
ient survive the transplantation as two distinct organ-
isms, dismembered and stitched together. Neither of
these two options is particularly promising and neither
answers the question about the personal identity of the
post-transplant individual; rather, they explain it away at
the expense of the philosophical plausibility of the bio-
logical view.
Faced with the limitations of the psychological and
biological approaches, philosophers from both camps
have argued that we should separate the thorny question
of personal identity from the problem of what matters to
the self in survival, claiming that the latter issue (i.e.,
what matters to the individual) does not necessarily
require maintaining personal identity over time, regard-
less of whether the individual is understood as an or-
ganism or as psychological unity. For DeGrazia, what
matters to the person whose survival is in question is
narrative identity: B... a person’s self-conception, what
she considers most important to who she is, the way she
organizes the story she tells herself about herself^ [24, p.
8]. DeGrazia links this to concepts of autonomy, authen-
ticity and self-creation. It seems that one’s narrative
identity could be disrupted or even lost not only if one’s
memories are disrupted or lost (i.e., due to amnesia or
extended periods of unconsciousness) but also if one
experiences a profound loss, a catastrophic personal
event or loss of autonomy, which cannot be reconciled
with the meaningful story of one’s life.
All these conditions would lead to discontinuity in
one’s narrative identity, even if the individual con-
tinues to exist as a mental and/or biological unity.
When applied to the case of the head transplant, the
concept of narrative identity would require the pres-
ence of mental life and psychological continuity of
experiences. Since these are only possible if a func-
tioning brain is present, sophisticated animalists (like
DeGrazia) would have to concede that, at least as
relates to narrative identity, the post-transplant TSI is
that person who can tell a coherent story of survival,
i.e., the head. Thus, albeit for different reasons, the
conclusions of the narrative identity version of the
biological approach come very close to the
19
conclusions of the psychological conception of iden-
tity, particularly the views of Derek Parfit.
Psychological Continuity and Head Transplants
Parfit was the first to argue that personal identity (un-
derstood as numerical identity of a person over time) is
not what matters for the survival of the self. In his
seminal book Reasons and Persons [19], he explicitly
discusses brain transplants by way of thought experi-
ments intended to support his view on identity. Parfit
rejects animalism in all its forms and also denies that
personal identity is dependent on any form of substance,
be it a physical body or something immaterial.
Moreover, Parfit rejects the very notion of a person
and personal identity understood as Ba deep fact^, Ba
Cartesian Pure Ego^, something distinct, unifying, and
separate from the various states one is in. Parfit rejects
accounts of identity that presuppose the identity of the
person, or that the mental states are had by that person
[19, p. 212]. Instead, he starts from the connectedness of
memories, intentions, beliefs, desires and other mental
states. Connectedness for him is a matter of degree. BFor
X and Y to be the same person, there must be over every
day enough direct psychological connections,^ at least
the half that existed on the previous day. [19, p. 206]
Psychological continuity is Bthe holding of overlapping
chains of strong connectedness.^ A specific memory
can fade over the years, meaning my present memories
are no longer directly connected to it. (One may not
remember what he or she wore when attending a
Professor Rawl’s lecture in 1996.) Still, other overlap-
ping chains of memories, originating and fading over
the last twenty years help that person recall many im-
portant events (including attending the lecture in 1996).
Parfit Breduces^ the person to a series of psycholog-
ical experiences and relations between them and dubs
this view Breductionism^:
[W]e are not separately existing entities, apart
from our brains and bodies, and various interrelat-
ed physical and mental events. Our existence just
involves the existence of our brains and bodies,
and the doing of our deeds, and the thinking of our
thoughts, and the occurrence of certain other phys-
ical and mental events. Our identity over time just
involves (a) Relation R-psychological connected-
ness and/or psychological continuity-with the
20
right kind of cause, (b) that this relation does not
take a 'branching' form holding between one per-
son and two different future people [19, p. 217].
The ‘branching^ form to which Parfit refers is illus-
trated by fission – a process in which a single individual
divides into two or more other distinct individuals, thus
negating the numerical identity of the original individu-
al. Parfit claims that as long as the two individuals who
inherit the divided, original brain retain enough of its
memories and the organization of these memories, the
original person would have survived the fission as two
persons. Yet, the original person would no longer be
identical to the resulting persons. This leads Parfit to
conclude that it is not personal identity that matters to a
person’s survival, but rather the psychological continu-
ity of her mental life expressed as connections among
that person’s mental states, or BRelation R^. Parfit main-
tains that the only condition that is necessary for surviv-
al is Relation R, Bpsychological connectedness and or
psychological continuity, with the right kind of cause^
[19, p. 215]. He explains that the Bright kind of cause^
can be Bany kind of cause^ that evokes human psycho-
logical continuity through experiences, which bring
about mental events such as memories. Parfit’s expres-
sion Bany kind of cause^ allows for the possibility that
mental events can be the result of different causes and
need not be mediated by any particular physical body,
e.g., memories can be caused both by personal experi-
ences and via technological and medical means. Indeed,
today it is both conceivable and technologically possible
for mental events to be caused by brain manipulations
(e.g., deep brain stimulation, transcranial electrical or
magnetic stimulation), and/or simulated virtual realities.
According to Parfit’s view, the person who undergoes
a whole brain transplant will be identical to the one, who
maintains the necessary Relation R of psychological
continuity, i.e., the one whose functioning brain is pre-
served [25, pp. 9–12). If, however, the surgery causes
the loss of psychological continuity (i.e., due to severe
memory loss), Parfit would argue that neither of the
pre-transplant persons would survive, even if the trans-
plantation is successful and the resultant TSI recovers.
The TSI View and Head Transplants
Thus far, we have shown that the possibility of head/
whole body transplantation poses a number of
Pascalev A. et al.
philosophical and neuroethical paradoxes, which call
into question the plausibility of extant philosophical
approaches to personal identity, and their implications
for the identity of the post-transplant individual. Since
accounts of metaphysical and personal identity form the
basis of ethical analyses and judgments concerning
moral agency, responsibility and one’s place in society,
the philosophical difficulties we have identified also
hinder the analysis of the moral, legal, clinical and social
issues generated from Canavero’s proposed surgery.
Clearly, the transplant recipient would face a number
of challenges: from body image and a sense of self-
identity to social relations and legal status due to a
new (bodily) genetic identity. In the remainder of this
essay, we offer some preliminary reflections on these
issues as a first step toward a comprehensive philosoph-
ical and neuroethical evaluation of head transplantation.
The major challenge for existing philosophical views
is how to characterize the identity of the resultant indi-
vidual. As we have illustrated, the major psychological
and biological stances fail to fully account for, or define
the metaphysical status and personal identity of the
post-transplant TSI. The problem is rooted in a shared
aspect of both psychological and biological approaches:
an assumed opposition between the biological organism
qua body, and the person qua the head/brain/mind.
Consequently, the animalists see two bodies under the
same brain, and Parfit sees only the person (i.e., the
head/brain/mind) that received a new body.
We maintain that this presents a false dilemma, and
that both approaches are flawed. We claim that the self is
fundamentally embodied and the mental life of a person
is dependent upon (some form of) the physical body for
mental contents, orientation, and as a way of relating to
the world. Consequently, the continuity of the self (i.e.,
personal identity) is dependent on the body and on the
external environment. We need not disagree with Parfit
that Relationship R is what matters for identity. We
submit, however, that the Bright kind of cause^ is more
than just the immediate cause of brain processes, but
instead includes broader and more mediated causes that
involve the functional interactions (if not unity) of brain
and body.
The content of one’s experiences is not independent
of the biological Bmedium^; one’s embodiment struc-
tures the contents and form of one’s experience and
shapes one’s conceptual scheme. As Lakoff and
Johnson note, an individual with a very different bio-
logical structure (i.e. a spherical-shaped body) would
Head Transplants, Personal Identity and Neuroethics
experience the world differently and our special catego-
ries, e.g., up-down, might make little sense to such a
being [10, p. 57]. While the experiential differences
between individuals with species-identical human bod-
ies as in the head transplant case would be smaller in
comparison, the example of Lakoff and Johnson is
instructive. We could consider the impact of the bodily
experience on the self in a continuum of cases, from the
extreme to the more feasible: from transplanting a hu-
man brain to a whale’s body, to Pucetti’s famous sce-
nario of transplanting Churchill’s brain to a 6-year old
girl’s body [26, p. 60], to Parfit’s example of
transplanting an identical twin’s head to his sibling’s
body [19, p. 253]. At some point on this continuum,
the body would be too different to allow for continuity
between the memories and experiences of the old body
as retained in the mind of the brain and the experiences
and sensory impact of the new body. Perhaps a
head-to-body transplant between monozygotic twins is
the closest conceivable case of preserving the continuity
of the person whose head is transplanted to a new body
but even such a case will likely fall short of complete
continuity. Therefore, we conclude that a radical alter-
ation of the body will also radically alter the surviving
person, making him/her a different person. We argue for
a dialectical understanding of the resultant person. This
will be a new individual, who is partly continuous with
the head/brain (especially in terms of memories, psy-
chology, life content), and partly continuous with the
body donor, particularly in terms of the inputs and
regulatory patterns afforded by the structure and func-
tions of its nervous system, and the resulting self-image
of this (new) embodiment - all of which affect one’s
psychological states. The resultant person would need to
reconcile the two in the personal and social sense: he or
she must deal with questions of family and kinship,
history, narrative, and the way(s) that one is socially
regarded.4 We posit that this will make the resultant
person (viz. TSI) quite different from both the prior
individual whose head was transplanted (i.e., the
4
The questions of family, kinship, and the social and legal stand-
ing of the TSI merit their own in-depth exploration. For instance,
would the children of a post-transplant individual be considered
siblings of the pre-transplant body donor, based on their genetic
makeup? What would be the legal status of a TSI person, if she is
as we claim a new person? Would he or she be legally continuous
with the donor of the body, the donor of the head, neither, or both?
These important questions go beyond the scope of this paper and
need to be addressed separately.
21
previously embodied head/brain), and the former indi-
vidual to whose body the Bnew^ head would be attached
(but who previously sensed/perceived and was affected
by his prior brain).
Eric Steinhart also argues for the conclusion that the
survivor of a head transplant would be a new person. In
our opinion, however, Steinhart arrives at the right con-
clusion from erroneous premises. Steinhart views per-
sonal identity as Bthe functional persistence of cellular
and molecular systems^ (the central nervous system, the
enteric nervous system, the immune system and the
endocrine system) [27, pp. 1, 6]. Such strong biological
determinism entails that in the merging of two cellular
and molecular systems, as involved in the head-to-body
transplant, neither of the previous persons will survive.
In fact, Steinhart’s view entails that attaching the head
and one half of the body of one person to a half of the
body of another will result in a new person. It seems to
us that Steinhart proves too much leading to the conclu-
sion that not only a head-to-body transplant will also
result in a new person but so will a range of complex
thoracic multiple-organ transplants even though the re-
cipient’s head, brain and (most of the) body are retained.
The reality of a human head transplant, no matter
how remote, prompts further and deeper neuroethical
inquiry and guidance. Elsewhere, we have posited key
questions conceptual frameworks and responsibilities
that can, and arguably, should be required to assess
and direct the technical validity and ethical probity of
new neuroscientific and neurotechnological advance-
ments in medicine [28, 29]; we hold these to be wholly
applicable and necessary here. But the surgery proposed
by Canavero also incurs more deeply philosophical and
neuroethical questions and issues that must be ad-
dressed. The HEAVEN-GEMINI procedure evokes pos-
sibility for radical transformation of the body-brain re-
lationship and the relation of the self to his/her past, and
challenges the meaning (and perhaps values) of embodi-
ment and social relations, the outcomes of which remain
uncertain and unfixed. On the one hand, there are good
reasons to leave it to the individual undergoing the
transformation to negotiate the parameters of his or her
identity, on her own terms and at her own pace. To the
extent that we are social beings, however, the process of
transformation would also include a reciprocal transfor-
mation in the relations of others to the self, including
relations with the family and loved ones of the body
donor. Perhaps the novelty of this – and other avant garde
techniques and technologies on the proximate horizon of
22
possibility – call for new neuroethical principles that build
upon, and in some cases revise philosophical constructs
to adapt to changes in scientific knowledge, capability
and the social milieu of the twenty first century world
stage [30, 31]. It can be entertaining to speculate upon the
trajectories that brain science and its technologies will
assume, and instructional to engage ethical thought ex-
periments based upon fictional accounts. But we argue
that it is imprudent to be unprepared for those neurosci-
entific developments that can, and likely will occur in the
near future [32], and in this light, advance the discourse
that we have herein initiated. It is the task of neuroethical
analysis to illuminate and question these transformative
processes and to help to envision possibilities for mean-
ingful life within the expanding boundaries of science,
technology and the human condition.
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