Requests for Elective Amputation
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[edit] Original article
[edit] Author(s)
[edit] Source
Requests for Elective Amputations. Ethics & Medics. The National Catholic Bioethics Center. February 2011.
[edit] Abstract/Overview
The author argues that it is immoral to provide surgery for people who have BIID and attempts to refute several arguments made in favour of surgery in various journal articles.
[edit] Comments/Analysis
Individuals who lose their bodily integrity suffer an evil that deprives them of an authentic good that would have allowed them to engage in activities that can be perfective of the human being.
This ignores the effect that BIID has on individuals - it is a significant disability that stops people from participating fully.
Society is also diminished because one of its able-bodied members becomes handicapped.
The author's use of the word "handicapped" shows a lack of understanding and knowledge of the current thinking about disability and the self-perception of people with disabilities.
This explains why the act of intentionally blinding someone is evil. It deprives the victim of the good of sight, while simultaneously depriving his community of a seeing member who could have contributed to the common good in ways not possible to him now that he is blind.
So the author is saying that people who are blind can't contribute to society? The implication is of course that anyone with a disability can't contribute to society. I can think of any number of people with disabilities who could prove him wrong. Say.. Helen Keller, Franklin D. Roosevelt, and Stephen Hawking, to name just 3...
The basic moral argument - the good of society - is flawed. It assumes a premise where people with disabilities are helpless and unable to add "good" to society. It shies short of saying people with disabilities are evil, claiming that what happened to them is evil.
As the Catholic moral tradition and right reason acknowledge, however, there are times when a part of the body may be sacrificed precisely to preserve the greater good that is the totality of the whole person. Thus, a diseased eye riddled with tumor may be removed to prevent the cancer from metastasizing to the brain, and a gangrenous leg may be amputated to prevent the infection from spreading to the rest of the body. These acts that compromise the good of bodily integrity are morally justifiable only because they preserve the greater good of personal life. In sum—and this is the moral principle of totality—surgeons may remove a bodily part only if this preserves the greater good of the whole person.
This argument is not new, and continues to disregard mental well being as part of the greater good of the whole person. If we truly look at the person in a hollistic way, then we cannot look solely at the physical aspect.
Individuals with BIID appear to satisfy the DSM definition for patients suffering from a pathological delusion, in that they have beliefs that are firmly held despite what almost everyone else believes and despite incontrovertible and obvious proof or evidence to the contrary
The author ignores medical doctors and psychiatrists who have repeatedly stated that people who have BIID are not delusional. Individuals with BIID do not satisfy the DSM's definition of pathological delusions. The author should know this as he cites a study by Michael First, a psychiatrist and editor of the DSM, who specifically states in his paper that people with BIID aren't delusional.
Further, in the opening paragraph, the author states that "body integrity identity disorder (BIID), also known as apotemnophilia, a neurological disorder". So which is it? The author begins by stating it is neurological, then goes on to say it is psychological. For what it's worth, V.S. Ramachandran found evidence of neurological aspects of BIID.
As such, patients with BIID should receive psychiatric care to treat their psychological condition.
Yeah, psychiatric care would be nice, but IT DOESN'T WORK. Perhaps because of the neurological aspect of BIID...
How many times have we got to repeat that one? Show us a psychotherapy that works, and we'll go for it.
A surgical intervention would not cure BIID.
Anecdotal evidence shows just the opposite - over 2 dozen individuals who have had surgery report that it changed their lives for the best, that they are now functioning in their lives, that their relationship with their spouse has improved, are better parents, are back to regular work.
In fact, amputating the healthy limb of an apotemnophile would perpetuate the patient’s delusion that the limb is not really his.
Huh????? Of course the limb wouldn't be hers - she's be an amputee, the limb would be gone! Doh!
the elective amputation of the healthy limb compromises the bodily integrity of the apotemnophile without promoting his authentic good. As such, it is immoral.
But the author was talking about "the greater good of the whole person". I guess he really means "whole" in the sense of "entire physical body", rather than the sense of body & mind.
the harm minimization argument fails to address the morality of the act of elective amputation itself. If, as I argued above, such an act is immoral, then a surgeon should not engage in that act, even if the patient threatens to do it himself. Otherwise, one could justify the “lesser” evil committed by a surgeon who murders a woman, painlessly, today, because he knows that his patient—her husband who suffers from Capgras Syndrome (the delusion that a close relative has been replaced by an imposter)—intends to torture and to murder her, painfully, tomorrow. Is this not minimizing harm as well? And yet, this surgeon’s act could never be morally justifiable.
As I stated above myself, I can't come to the conclusion that such an act as surgery for BIID is immoral - the author's logic is based on flawed premises. Still, this analogy is laughable. He's comparing murder to the removal of a limb.
it is not clear if the psychological benefits of amputation described in the literature are significant—the sample size of patients is too small to be statistically powerful—and if these benefits outweigh the long-term physiological deficits brought about by the elective amputation.
It is true, the current evidence is only anecdotal, and the sample size is small.
We need two studies:
- Systematic interviews of people who have already had a limb removed because of BIID, taking into account time since it happened.
- Pilot study to provide surgery to some people and follow them along.
Of course, the second suggestion would never meet the ethics committee's approval, so we'll never know.
It seems disingenuous to say that the benefits of surgery aren't proven to be significant, and at the same time argue that surgery can't be provided on a moral ground because it hasn't been shown to have a significant benefit. If the level of benefit is going to be part of the equation, then full study of that level must be allowed - including providing surgery to enough people to gain a "statistically powerful" sample size.
To put this discussion in perspective, retrospective outcome studies of patients with body dysmorphic disorder, which is characterized by excessive concern with an imagined or minor defect in physical appearance, a disorder reminiscent of BIID, reveal that these patients do not benefit from surgical treatment.
The author is comparing BIID to Body Dysmorphic Disorder. There is no relationship between those two conditions. Phillips, Wilhelm, Koran, Didie, Fallon, Feusner and Stein make a point of stating the difference in Body dysmorphic disorder: some key issues for DSM-V (Anxiety and Depression, Volume 27, Issue 6, pages 573-591. June 2010).
Thus, as already mentioned above, it is reasonable to propose that, as we do with most other delusional disorders, we should first alleviate the suffering associated with a psychological disorder like BIID, not with surgical means but with psychiatric means.
And as I have already mentionned, people who have BIID are not delusional, and no psychiatric means have shown to make one bit of difference in terms of controling BIID, much less "curing" it.
Autonomy is deserving of respect precisely because it allows us to attain this great personal good. However, autonomy cannot morally justify human action. Autonomous murderers or adulterers or thieves who freely choose to kill or cheat or steal, by virtue of their free choices, are still not morally justified in their actions.
The author again compares surgery to murder. He also discusses automony in a broader sense than the medical concept of the word. Using analogies to explain one's argument is fine, but you have to compare apples with apples.
the moral prohibition against acts that mutilate the body exists because these actions attack the good that is the bodily integrity of the person. This good is worthwhile even if the patient does not affirm or appreciate it.
People who have BIID do appreciate the fact we have "whole" bodies.
But the good of the physical body is severely outweighted by the lack of mental and emotional well-being. Of course, from a Catholic's perspective, it doesn't matter much at all if you're miserable on earth, since what you should be striving for is to go to Heaven where all will be well. Never mind that BIID is a living hell.
Thus, acts of mutilation, regardless of personal choice, are immoral, in the same way that acts of murder, adultery, and lying—regardless of personal choice—are also morally reprehensible. By their very structure, these acts prevent the human person from attaining his authentic good and the perfection of his nature.
So from there, I assume that the author is also against any type of cosmetic surgery?
