American Journal of Bioethics.

Body Integrity Identity Disorder (BIID)?Is the Amputation of Healthy Limbs Ethically Justified?

The term body integrity identity disorder (BIID) describes the
extremely rare phenomenon of persons who desire the amputation of one
or more healthy limbs or who desire a paralysis. Some of these persons
mutilate themselves; others ask surgeons for an amputation or for the
transection of their spinal cord. Psychologists and physicians explain
this phenomenon in quite different ways; but a successful
psychotherapeutic or pharmaceutical therapy is not known. Lobbies of
persons suffering from BIID explain the desire for amputation in
analogy to the desire of transsexuals for surgical sex reassignment.
Medical ethicists discuss the controversy about elective amputations of
healthy limbs: on the one hand the principle of autonomy is used to
deduce the right for body modifications; on the other hand the autonomy
of BIID patients is doubted. Neurological results suggest that BIID is
a brain disorder producing a disruption of the body image, for which
parallels for stroke patients are known. If BIID were a
neuropsychological disturbance, which includes missing insight into the
illness and a specific lack of autonomy, then amputations would be
contraindicated and must be evaluated as bodily injuries of mentally
disordered patients. Instead of only curing the symptom, a causal
therapy should be developed to integrate the alien limb into the body

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Volume 9, Issue 1
January 2009