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.