A question of identity

It is hard to nail down the fundamental markers of personal identity. Various definitions emphasise the biological, psychological or social aspect of a person that serve to mark him/her as a unique individual.

There are several techniques that can identify an individual from the biological point of view. The best of these involve DNA tests that have the capability of characterising a person as uniquely as a barcode at check-out counters. Other markers include the HLA system used primarily to identify recipients of organs for transplantation and can identify those who are most closely genetically related.

From the social point of view, identity issues specify who is an insider and who an outsider.

The recent uproar about boat people invading our living space has highlighted the importance of differentiating those who belong, as opposed to those who must be kept out. It is curious to note that social markers of difference have very little to do with biological make-up and a lot to do with geography, skin colour, or religion. Most of the ethnic wars that have plagued recent European and African history are based on one or other of these differentiating criteria.

At the psychological level, identity has to be seen as a measure of the self. We have a certain understanding of ourselves, who we are, what we stand for. Just as important is the significance that we place on others' opinion of ourselves; who they think we are, where we stand in the ladder of recognition by significant others.

In view of these issues, it is relevant to ask: How does a change of identity affect an individual? How does the interchange of biological tissues between individuals affect their concept of identity?

It is enough to bear in mind the objections that have been raised in the past to blood transfusions on the belief that somehow this might affect one's own character. Even now, some religions have strong objections to this life-saving practice. The heart, likewise, has been seen through the eyes of history as the centre of the soul, and thus heart transplants have been seen as possibly interfering with one's own identity. Most dramatic of all would be the possibility, at present non-existent, of transplantation of brain tissue from another person or even stem cells with a different genetic constitution that might imply a change of one's way of thinking and interacting.

Perhaps one of the most obvious challenges in this area is the introduction of total face transplant which has become a possibility in recent years. The face is without a doubt the most obvious target for recognition by others. It is hard to identify an individual without a clear mental image of the face.

It is through the face that most communication between one individual and another takes place. Recent discoveries on "mirror genes" indicate that our brain responds to and mimics what it sees in another person, thus forming the basis of the very concept of empathy. It could also perhaps explain the revulsion one unwittingly experiences on seeing deformities and trauma involving the face - we involuntarily step back when confronted with a visual image that conflicts with our concept of normality.

There is no question that facial plastic surgery might provide a boon for those affected by conditions like severe burns or other abnormalities to the face. There is also no question that changing the face of an individual must result in a considerable degree of insult to one's persona, which would require a long period of adjustment and psychological help to come to terms with.

These issues might raise ethical questions of various degrees of gravity. Currently, ethical issues relating to organ transplantations involve questions of ensuring equity, fairness in acquisition and distribution, informed consent and prohibition of commercialisation. Total facial transplantation moves one step further and challenges personal identity. Hence the need for more intensive preparation and counselling, to the patients as well as their families who will be facing what to all intents and purposes is a different external individual, albeit having the same intrinsic character.

mnc25@optusnet.com.au