Should Doctors Amputate Healthy Limbs for Patients Who Want to be Amputees?

There is nothing these days that can be safely considered permanently beyond the pale, unthinkable, flat-out undoable — and that apparently now includes cutting off healthy limbs of patients with a mental illness called body integrity identity disorder, or BIID.

BIID sufferers obsessively perceive their “true selves” as missing one or more arms and legs (hence the nickname for the term, “amputee wannabe”). It’s a difficult condition to treat and most patients have to learn to live with their desperate yearning to harm themselves. A few years ago, some fringe transhumanists and other assorted identity radicals began to argue that the principle of personal autonomy requires that BIID patients be aided in “safely” becoming the amputees they so desperately want to be. Now, this destructive notion has entered the mainstream, with an influential psychiatrist using the power of analogy to push us toward accepting amputation of healthy limbs as a legitimate treatment for this obsession. From the story :

“It actually sounds a lot like another condition which we already do recognize called gender identity disorderwhere, for example, people are born as a male, but feel they’re really a woman trapped in a man’s body,” said Dr. Michael First, a professor of clinical psychiatry at Columbia University in New York City, who has been studying this rare condition since 1999. “Typically it’s more common legs than arms, there are people who want bilateral amputations, and I actually know of someone who has achieved that,” he added.

First says in the story that he coined the term body integrity identity disorder with the explicit purpose of linking the condition to gender disorder—the treatment for which includes surgeries to amputate healthy breasts and genitalia during sex reassignment. Thus cutting off the limbs of BIID patients seems merely the next logical step. And who should be surprised? Once we accepted the principle that it is acceptable to surgically remove or profoundly alter healthy body parts based on the patient’s mental compulsions or desires, there was no reason to think that there would ever be a stopping point.

Back to the story:

BIID is not recognized in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV-TR), a book published by the American Psychiatric Association and regarded by most of the mental health community as the bible of identified mental illnesses. But First, as editor of the last two editions of the DSM, is working to change that, in an effort to create a reference for mental health professionals to use in identifying and treating the condition.
“Number one — for the people who have it — there’s a whole issue of labeling something as a disorder, and there are pros and cons labeling,” he said. “The disadvantage of labeling is stigma. We’re basically saying this is a mental illness — this is a sickness. But the advantage of having it in the book is twofold. It might encourage more work on treatment by getting it on the map and getting therapists and people aware of it.”

It is a sickness, clearly, but today virtually all of these unfortunate people get through life without chopping off their own limbs. But that may be about to change. We are clearly moving toward a time in which BIID sufferers will be able to receive amputations. Once that is deemed a legitimate treatment, it will be harder for sufferers to fight against their dark impulses. But here’s the thing: Once amputations become as unremarkable as surgical sex reassignments, we will, no doubt, “discover” another, even more extreme condition, that will also have to be accommodated. We live in a time in which feeding dysfunction has no limits.