The ethics of amputation by choice
Judy Skatssoon
ABC Science Online
Tuesday, 21 June 2005
Can society legitimse amputation by choice in a world where many have lost a limb through birth, war or natural disaster? (Image: Reuters/Faleh Kheiber)
People should be able to have healthy limbs removed by choice, say two Australian philosophers who are exploring the phenomenon of "amputee wannabes".
Amputee wannabes become obsessed with cutting off a particular part of their body, even though it may be healthy.
Past research has suggested this rare condition may be because they believe their body part is diseased or ugly, because the notion of becoming an amputee sexually excites them, or because of a mismatch between their body and their image of it.
Dr Tim Bayne of Macquarie University and Dr Neil Levy from the University of Melbourne argue that people who want a healthy body part amputated are suffering from a condition known as body integrity identity disorder (BIID), or amputee identity disorder.
Writing in the latest issue of the Journal of Applied Philosophy they say "such amputations should be morally permissible" on the grounds that people with BIID are not "globally irrational" and that they are experiencing suffering that can be alleviated through amputation.
The authors also say that people who don't have access to a surgeon may attempt to cut off a limb themselves or may damage it to the point that amputation is necessary.
"Surgery might be the least of all evils," they write. "Where a wannabe has a long standing and informed request for amputation, it therefore seems permissible for a surgeon to act on this request."
What is BIID?
The first person to use the term BIID was US psychiatrist Associate Professor Michael First from Columbia University, who interviewed 52 wannabes as part of a recent study which has been submitted for publication.
He found that 15% of wannabes identified sexual arousal as a reason for amputation, 63% wanted to be restored to their "true identity" and 37% said the limb "felt different".
Thirteen percent said the limb didn't feel like their own and six people had tried to perform their own amputation, including using a chainsaw.
Cortical misalignment
Levy says it's unclear exactly what causes BIID, although it may be the result of a cortical misalignment between how the brain "sees" the limb and what's really there.
He says in the case of so-called "phantom limbs", people who lose a limb may experience the sensation that it's still there. This is because the way the limb is represented in the brain hasn't caught up with the physical change.
But amputee wannabes may have the limb but not the cortical representation.
"[In the case of BIID] one possibility is that there's something wrong with the cortical representation of the limb in the brain of sufferers," he says.
Levy says BIID may also be a purely psychological condition, and often people who suffer from it have had an encounter with an amputee early in life.
Levy stresses that amputation should not be performed "on a whim" and people requesting an amputation should be thoroughly screened.
Normal limbs should be left alone
Dr John Quinn, the executive director of surgical affairs at the Royal Australasian College of Surgeons, says the college is aware of the issue.
Quinn says he has received one request to amputate a limb that a patient was deliberately harming, but he refused to proceed.
The college's position is that no surgeon may remove a normal organ without a medical reason, Quinn says.
"It's unethical to remove a normal limb just because somebody wants it removed," he says.
Professor Louise Newman of the Royal Australian and New Zealand College of Psychiatrists, says anyone who wants to amputate a limb, is considering harming themselves or performing surgery on themselves should contact their GP, local mental health service or call the College on (02) 9810 7963 and ask for a general psychiatrist.
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Hey guys! This was one of the topics on "Primetime" tonight. I found this interesting..I have never heard of this before in my life! have you?
