I am going to assume that no one has an intrinsic ethical or moral
objection to the idea of removing body parts. That is, if a woman has
breast cancer, no one objects to her having a mastectomy. Or, if a
child is suffering renal failure, no one objects that a parent or relative
has their kidney removed and transplanted to the child. Or, if a
person has any of a variety of blood disorders and has their healthy,
but blood-eating spleen removed in order to minimize self-harm to
the body.
Assuming that everybody is on board here -- that there is nothing
intrinsically wrong with '-ectomies,' but that medical context makes
such removals ethical or unethical -- I'd ask you all to consider the
following websites:
www.biid.org
en.wikipedia.org/wiki/Apotemnophilia
BIID, or Body Integrity Identity Disorder, is a mental condition in
which the sufferer feels incomplete with all four limbs. That is,
they desire to have an amputation of a physically healthy limb because
of the degree of mental agony they suffer.
Quoting from the first website's FAQ:
There have been no reported "cures" for this condition as a result of therapy. No one has reported any substantial relief of symptoms throughout any significant course of therapy. Anecdotally, patients undergoing surgery for this condition have had their symptoms resolved and no longer suffer with the desire, function better on a daily basis and have had an overall improvement in their lives. Their need of psychotherapeutic services usually ceases.
That is, those individuals who suffer from the condition who have
undergone intensive psychological and psychopharmeceutical treatment
have not resulted in any relief from the condition, which tends to
worsen as the individual ages.
The condition does not arise because of abuse or association with
excessive numbers of amputees. People who suffer from this condition
generally are otherwise very normal and successful individual, although
as they age, they tend to suffer from severe depression as a result of
the disorder.
And, while the Western World does not permit the amputation of an
otherwise healthy arm or leg, those who have sought (and survived)
non-Western amputations or have done harm to themselves such that
an amputation became medically necessary (sitting on train tracks,
for example) seem to have found complete relief from the condition.
So, I propose the following question: If it is okay to remove breasts,
kidneys, speens and anything else because of medical necessity or
to ease future suffering, why does it remain impermissible to amputate
a 'healthy' limb? Assuming that the BIID sufferer signs all sorts of
release-from-liability forms, has undergone psychotherapy and drug
regimines over an extended period of time, and is a fully willing
participant in the operation, why does it remain 'unethical' in the
medical profession? If the limb causes severe mental and emotional
anguish, to the point of being willing to sit on train tracks or suicide
and the amputation seems to result in complete relief from the
condition, why is it impermissible?
Nemesio
Originally posted by zintierivStarving to death isn't in the best interest of the individual. However,
anorexia nervosa is a mental disorder too ... then, should we allow them to starve until they die ???
as I observed, losing the limb has resulted in the cessation of all
the mental agony and the beginning of a mentally healthy life.
Starvation doesn't do that.
I am sure that, if a person with BIID could take a pill to relieve the
agony, they would do so rather than lose a good arm or leg. But no
such thing exists or even has the remotest prospect of existing.
Indeed, many of the people who have self-amputated or self-mutilated
in the hopes of getting an amputation have undergone decades of
therapy, both counseling and through medication.
Nemesio
Originally posted by AThousandYoungI'm not disputing this, but that's not the issue for debate here. The
People have the right to do with their bodies as they will. No one has the right to force them not to have limbs removed or starve themselves to death.
issue is that the AMA recognizes the permissibility of mastectomies,
or kidney transplants, or the removal of a healthy spleen for those with
certain blood disorders.
They do not recognize the amputation of a limb for those with BIID
even though there is some evidence to suggest that this will solve the
agony for sufferers of this condition and no evidence to suggest that
intensive therapy of varying types does any good.
My question is why should or shouldn't this be the case?
Nemesio
If it is okay to remove breasts,
kidneys, speens and anything else because of medical necessity or
to ease future suffering, why does it remain impermissible to amputate a 'healthy' limb?
Because people like to control each other. Everyone thinks they know what's good for you better than you do.
I can only speak from the british medical standpoint, but the central ethical guides are:
1) to allow the patient to themselves make an informed choice about their treatment
2) to act in the best interest of the patient.
This includes accepting a patients wishes even if you don't think that it's wise, such as a patient refusing a blood transfusion or an operation to save their life.
I'd therefore see the issues around BIID to be:
1) is cutting the limb off really in the best interests of the patient. From what you've said, amputation is a very effective treatment and nothing else works, so this would have to be taken into account when deciding precident for 'best interest'.
2) as BIID is a mental issue, is the patient mentally compitent to make the decision? This is one of the few times you caxn override a patients wish not to be treated, and even then it's tricky (in the UK, in the US I believe it's much easier, although I'm not convinced that's a good thing).
3) doctors are only obliged to follow a patients wishes not to perform an action; they aren't obliged to perform any action the patient selects - otherwise it'd be free nose jobs for everyone. Cutting off a perfectly health limb does go against the grain, especially when it's irreversible, the gain is uncertain, and any gain is mostly invisible from the outside.
I think the above is why complaints like BIID are not straightforward to treat. However, I don't think it's impossible that amputation for such cases could become the norm. For example, sex change operations are carried out because the patient feels like they are the wrong sex. They have to go through many psych checks to make sure that changing sex is reeally what they need (because it's a late to change your mind afterwards), including living as the other sex (ie. in drag) for a whole year before any operation is carried out, but there is a clear procedure on how to go about getting a sex change. If this is possible I think that similar steps could be laid out for BIID to make this surgery possible in the very rare occasions it is desired.
Originally posted by AThousandYoungwhich is precisely why the British medical community is changing (or at least trying to change) from a paternalistic "I'm doctor, and this is what's best for you" to a doctor/patient partnership where the doctor helps give the patient the information they need, in a way they can understand, so that the patient can chose for themselves what their treatment will (or won't) be.
Because people like to control each other. Everyone thinks they know what's good for you better than you do.
I'm not saying it'll take effect all through the NHS quickly - with some doctors we'll have to wait for them to retire because they ain't going to change - but I think it's broadly a step in the right direction.
Originally posted by belgianfreakI agree with your post, BelgianFreak. And, unsurprisingly, medical
...If this is possible I think that similar steps could be laid out for BIID to make this surgery possible in the very rare occasions it is desired.
professionals see BIID and Gender Identity Disorder. Once upon a
time (not too long ago!), gender reassignment was seen insane;
people sought to 'treat' the disorder by compelling people who had a
penis to believe that it was the right thing.
Those who support amputations for BIID sufferers point to GID as a
model, and, after all, how different is it? Not much. BIID sufferers are
fully willing to go through the analogous steps of psychological tests
and many of them often live lives as if the limb in question didn't
exist (tying up their leg or keeping their arm in their shirt) as a way
to get relief.
And, so we come to the same conclusion: assuming that the person
with BIID does go through all of these exams and tests and
verifications, why does it remain impermissible to perform these
surgeries? That is, no one is forcing doctors to perform these
surgeries, but those who are willing are prevented from doing so by
threat of losing their license.
Does anyone have an argument for this or is it just small- and closed-
mindedness which drives this?
Nemesio
Yet, it remains
Originally posted by NemesioMy mommy came in the dark and told me i was sick.
I am going to assume that no one has an intrinsic ethical or moral
objection to the idea of removing body parts. That is, if a woman has
breast cancer, no one objects to her having a mastectomy. Or, if a
child is suffering renal failure, no one objects that a parent or relative
has their kidney removed and transplanted to the child. Or, if a
perso ...[text shortened]... ult in complete relief from the
condition, why is it impermissible?
Nemesio
I lay awake, her hand to my head, feeling only...
tiredness.
warmth.
love.
want.
need.
We went to the doctor and he confirmed,
her alarm to me that I was sick.
away from alarm.
i was warm.
alone, but my mum.
need.
He told of my illness, he said i was ill.
He said he could cure me. he said...
alone i wondered.
alone i thought.
alone.
need.
So they came and i went to the gas.
and they cut and they cured.
alone.
I awakened.
Cured. I awakened.
Cured. I awakened. But what did i have?
Originally posted by Nemesiothinking about it I can only offer 2 suggestions:
why does it remain impermissible to perform these
surgeries?
Does anyone have an argument for this or is it just small- and closed-
mindedness which drives this?
Nemesio
Yet, it remains
1) all new things take time to be thought out and procedures put in place
2) because BIID is such a rare condition there isn't a drive to commit resources into doing this, extending the length of time it'll take
Because gender reassignment is already accepted it shoul dbe easier for BIID to follow it's model & get accepted, but there probably isn't the driving forces to make this happen any time soon.