Should We Amputate Someone’s Healthy Limb If They So Desire?

How far should we go in enabling people to shape their own physical identities? The Guardian on the ethical quandary posed by Body Integrity Identity Disorder:

In January 2000, the mass media ran several stories about Robert Smith, a surgeon at the Falkirk and District Royal Infirmary who had amputated the legs of two patients at their own request and was planning a third amputation. The director of NHS trust running the hospital at which Smith works described the amputation of healthy limbs as “inappropriate”; since then, no British hospital has performed a voluntary amputation.

The first documented case of BIID dates back to a medical textbook published in 1785, by the French surgeon and anatomist Jean-Joseph Sue, who described the case of an Englishman who fell in love with a one-legged woman, and wanted to become an amputee himself so that he could win her heart. He offered a surgeon 100 guineas to amputate his leg and, when the surgeon refused, forced him to perform the operation at gunpoint.

Most BIID sufferers describe their feelings in terms in terms of identity. “My left foot is not a part of me,” said one of Smith’s patients. “It feels right,” says another sufferer, “the way I should always have been and for some reason in line with what I think my body ought to have been like.” “I didn’t understand why,” says yet another, “but I knew I didn’t want my leg.”

To date, there have been approximately 300 documented cases of BIID. Most of these are male, almost all of whom desire amputation of a limb on the left side of the body. More often, it is the arm that is affected rather than the leg.

Most wannabes also pretend to be an amputee prior to having the limb removed, by tying the limb back, or using a wheelchair or crutches to move around the house. This behaviour could be analogous to cross-dressing in transgender individuals before they undergo sex reassignment surgery.

The idea of amputating healthy limbs is anathema to most surgeons, but I would argue that in some cases it might be the best possible treatment option. My rationale is simple. Psychotherapy and drugs are completely ineffective in alleviating the condition, and BIID sufferers will go to any length to be rid of the unwanted limb. Some build home-made guillotines, blast their unwanted limbs off with a shotgun, or try lie under a jacked-up car and try to crush it.

One particularly popular method is to submerge the limb in dry ice for several hours, in order to damage the limb irreparably and thus force doctors to amputate. In May 1998, a 79-year-old man from New York travelled to Mexico for a black-market leg amputation, and then died of gangrene in a motel about a week later. Offering a clean surgical amputation to those BIID sufferers who really want it would therefore minimize the harm that they might cause to themselves by taking matters into their own hands.

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  • Freak

    Why is this question even being asked? Of course we should. My body is my temple, not yours and if i chose to cut parts of it off, tattoo it, pierce it, fill it full of drugs then that is my choice and no one elses. Obviously like drugs/tattooing etc it should not be done for free but people should not be stopped from pursuing whatever body/mind modifications they want. And at the end of it if they have made a bad decision then that is theirs to live with as well, just like the junkie who once thought heroin was a good idea. Freedom means freedom.

    • Jin The Ninja

      i think the question, though asked improperly, has to do with the medical ethics of such a procedure.

  • JohnFrancisBittrich

    Yes, but only as long as they can not only afford not only the procedure but also any upkeep or physical therapy that will be required after the fact. You can intentionally impair your own health all you want as long as you don’t ask other people to do more for you as a result of your impaired health.

    • JohnFrancisBittrich

      Which incidentally is why I have a problem with certain people who try to promote body-image positivity by telling obese people that they don’t owe it to anyone to stay healthy. Truth is a lot of obese people are not very well-to-do financially, and if your health care is paid for by the state you absolutely DO owe it to everybody else to try and stay as healthy as possible!

  • Jin The Ninja

    ‘This behaviour could be analogous to cross-dressing in transgender individuals before they undergo sex reassignment surgery ‘

    wrong. wrong. wrong.

    does the author a) not know any trans-persons he could speak with? b) even a passing knowledge of trans issue and identity? c) access to the internet where he could easily find blogs dealing with such issues, or medical journals detailing the very complex psychology of being transgender?

    to liken it, to a rare (300 people in a world of billions is rare), psychological condition that needs further study, and serious examination, ethically and medically, is very transphobic. i also want to know why he used the term, ‘cross dressing,’ when clearly that refers to transvestism, an unrelated fetish practice?

    the guardian should know better.

    • Russ_R

      The parallels are not only immediately obvious, but have been the subject of clinical research. For example: Lawrence, A. A. (2006). Clinical and theoretical parallels between desire for limb amputation and gender identity disorder. Archives of Sexual Behavior, 35, 263-278.

      • Jin The Ninja

        but the catagorisation of trans-identity as ‘gender identity disorder’ is very contentious and controversial. most trans people reject the medicalised labeling of what could be interpreted as physiological, psychological and sociological reaction to victorian gender binaries.

  • tooCents

    There isn’t a “right” answer to the question the article is titled with.

  • Guest

    It’s fine with me as long as I don’t have to pay for it in any way, whether its by some form of universal healthcare or through my tax dollars paying their disability coverage.

  • neurolux

    Maybe keep the limb cryogenically stored in case they change their mind. They would have to pay for the procedure themselves, like cosmetic plastic surgery.

  • http://www.facebook.com/rthoneunomia.celine Threedinium

    Is it not possible to find a cosmetic surgeon who would do the proceedure for you rather than having to use the time of surgeons who are employed to prevent disease and cure injury in emergency situations? I don’t really know any surgeons to ask. I don’t see how wanting to remove your own limb is so different from say, a breast reduction or liposuction. It would be total bullshit if you got refused for any of them.

  • BrendanBabbage

    Nucking Futz…

    I don’t think that perhaps if I am “liberal” enough to believe that people of different races shouldn’t be killed on sight or enslaved, or that most sickening perversions be tolerated (keep yer pooch and kid away from ‘em!) that I have to accept or condone everything and anything under the sun.

    “Voluntary Amputees” are … in plain English “Nucking Futz”…
    No one daring to call themselves a doctor, under the Hippocratic oath, save for disease/injury should ever consent to such a thing.

    There’s a cool article from years back (1) on a wanna-be surgeon who dropped out just before completing med school but then went “underground”…  Since Abortion was still legal, and most gangsters either had high paid private doctors or were in and out of jail vermin with no money, he had to do things that most hospitals rejected.  The first was providing low rent gender change operations to street hustler boys.  This crowd was cheap, he rarely got $600 for what a real hospital would charge $60K for.

    The Cash Cow, so to speak, but the hardest to work for were “Voluntary Amputees” that were mostly suburban prosperous people who’d nursed their Nucking Futz delusions for years.  And they’d pay $20,000, $40,000 etc. though plenty of doctors in Mexico would do it for 1/10th that price…

    But while they’d be tearfully begging him to chop off their arm to be “Complete” as they handed him money they’d stolen from their wive’s account to fund their kid’s college…  Well, after the operation he’d have to RUN for they’d in minutes get remorseful, tearful, even murderous enraged, ready to beat him to death with the bloody limb he’d cut off!

    He was finally caught in the early 00s when he cut off the leg of a guy, again paid a ton, but the guy freaked out and thrashed around, ripping open the wound and squirting blood all over the cheap motel room. (2) He realized this one would bleed to death before 911 service would be there, so he took him to the hospital and got arrested.  He had some ethics at least, if he’d run he’d never have been caught.

    Sure he’s out by now.  He’s one person who doubtless hopes Romney will win, banning Abortion is probably the ONLY thing that man will do for a non-billionaire donor…

    Now, MMMAybe in the future we’ll have high-functioning bionic limbs, enhanced tissue replicas, etc.  It might not be a violation to “upgrade” and a few doctors pushing the edge, hopefully for accident/disease victims so if it doesn’t work, little harm done.  But for right now, a person wishing to cut off their own healthy limb is DERANGED, literally a danger to themselves.

    1- “America’s worst surgeon; he’ll leave you in stitches”  Think published in a Maxim.  Google it if you care.
    2 – I bet he got nicknamed “Shaytan” by all the cheap motel owners along the strips.  All the half done so the hospital has to finish gender reassignments, the voluntary amputees running tearfully to try to have re-attached…  The piles of blood all over the hotel rooms the butcheries were performed in…