The healthy who think they should lose limbs source

Original at: The Dominion Post

The healthy who think they should lose limbs Saturday, 08 November 2008

Ruth Hill - For The Dominion Post

Surgeons may have a duty to amputate healthy limbs if that is what patients want, an Australian psychiatrist says.

Christopher Ryan, a senior lecturer at Sydney University's School of Psychological Medicine, says people with the rare body integrity identity disorder (BIID) could be cured by getting rid of unwanted body parts. Though able-bodied, sufferers believe they should be amputees and often resort to maiming themselves.

"I am not saying we should unthinkingly cut off people's legs," Dr Ryan said.

"However, there are a small number of people who see themselves, and have always seen themselves, as amputees."

The origins of the condition were not known, he said, but it was probably due to a congenital brain abnormality. "We do know, though, that they are often miserable their whole lives because of their `extra' limb, and we know that at least some of them feel much better if it is removed."

His paper, published in the international philosophy journal Neuroethics, suggests that after exhausting all other treatment options (such as psychotherapy and anti-depressants), doctors could be duty-bound to offer "elective amputation" to stop patients taking matters into their own hands.

"A 30-year-old patient of mine ... eventually took the only step he thought he had open to him, and placed his leg in a bucket of dry ice until it died and had to be removed.

"Now, a year later, he is living happily as an amputee and getting on with his life."

Dr Ryan likened elective amputation to plastic surgery and cited the importance of patient choice. BIID sufferers could even be allowed to donate their unwanted limbs, he wrote.

In 2000 it was revealed that Scottish surgeon Robert Smith had amputated healthy legs from two patients with the disorder.

At the time, Dr Smith said he operated to end his patients' suffering.

"They may lie on a railroad line and get run over by a train. They use shotguns and shoot their limbs off. They really are a desperate bunch."

The head of orthopaedics at Otago University's Wellington School of Medicine, Geoffrey Horne, said he did not believe any New Zealand surgeons would consider elective amputations for a psychiatric problem.

"It would present serious ethical issues for a surgeon because you are destroying a healthy limb and wrecking the patient's life ... "And what happens when the patient attains a `normal' state of mind, whatever that is, and wants to know, `Why did you cut my leg off?"'

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