Amputees By Choice: Body Integrity Identity Disorder and the Ethics of Amputation

Flashcards covering key concepts, arguments, and objections related to Body Integrity Identity Disorder (BIID) and the ethics of healthy limb amputation, based on the provided lecture notes. Topics include definitions of BIID, BDD, and apotemnophilia, ethical arguments like harm minimization, autonomy, and therapy, and counterarguments regarding rationality, informed consent, and societal impact.

Who was Robert Smith and what controversial operations did he perform in 1997?

A Scottish surgeon who amputated a healthy lower left leg at a patient's request.

What was the patient's reported outcome two and a half years after the healthy limb amputation?

The patient reported that his life had been transformed for the better by the operation.

What was the public and hospital reaction when the story of healthy limb amputations broke in the media?

There was a public outcry, and Smith's hospital instructed him to cease performing such operations.

What term do would-be amputees use to refer to themselves?

"Wannabes."

What rare psychological disorder did Tim Bayne and Neil Levy argue might make healthy limb amputations permissible?

Body Integrity Identity Disorder (BIID).

What is Body Dysmorphic Disorder (BDD)?

A condition where an individual incorrectly believes a part of their body is diseased or exceedingly ugly, which causes intense concern and is resistant to evidence.

What is apotemnophilia?

A psychosexual disorder (paraphilia) in which individuals have a sexual attraction to amputees or to the idea of becoming an amputee themselves.

What is Body Integrity Identity Disorder (BIID)?

A condition where there is a mismatch between a person's actual body and their subjective or phenomenal body (their body as they experience it).

What is the "body schema" in relation to BIID?

A sub-personal and subconscious representation of one's body used for automatic regulation of posture and movement.

What is the "body image" in relation to BIID?

A consciously accessible representation of the general shape and structure of one's body, derived from various sensory experiences.

What is asomatognosia?

A condition characterized by discrepancies between a person's actual body and their body image, sometimes leading to denial of limb existence or ownership.

How does the BIID experience of disparity differ from that in anorexia or bulimia nervosa?

The wannabe with BIID is fully aware of the discrepancy between their body and body image, whereas those with anorexia or bulimia often fail to fully recognize it.

What is a key characteristic of the BIID model that aligns it with Gender Identity Disorder?

BIID might be importantly sexual without ceasing to be essentially concerned with identity.

What did Michael First's research suggest about the BDD hypothesis for wannabes?

His in-depth interviews with 52 wannabes found that only one person cited the ugliness of the limb as a reason for wanting amputation, suggesting BDD is not the best explanation for most.

According to Michael First's study, what percentage of wannabes cited feelings of sexual arousal as their primary reason for desiring amputation (supporting apotemnophilia)?

15% (n=8).

What was the leading primary reason given by subjects in Michael First's study for wanting an amputation, supporting the BIID model?

To restore them to their true identity (63%, n=33), with statements like "I feel like an amputee with natural prostheses."

What is one alternative interpretation of the "body image" discrepancy in BIID proposed by the authors, distinct from standard asomatognosia?

It might be closer to the self-image of a person desiring cosmetic surgery, where an idealized image of oneself differs from the actual body.

What is the first argument in favor of permitting healthy limb amputations?

Harm Minimization, which suggests that if surgeons refuse, many wannabes will resort to dangerous self-amputation methods, leading to greater harm.

What is the second argument in favor of permitting healthy limb amputations?

Autonomy, asserting that informed and autonomous desires should be given serious weight in medical decision-making contexts.

What analogy is used to support the autonomy argument for healthy limb amputations?

The refusal of life-saving treatment on religious grounds, such as a Jehovah's Witness refusing a blood transfusion, which is typically respected as an autonomous choice.

What is one objection raised against the autonomy argument for wannabes seeking amputation?

That wannabes might not be fully rational or competent to make such a decision.

How do the authors argue that BIID wannabes are not delusional, contrary to some objections?

They clearly recognize the limb is theirs and do not form the corresponding belief that it is alien, unlike patients with somatoparaphrenia.

What analogy is drawn to illustrate how declining to change a long-standing, non-standard sense of embodiment can be an exercise of rational agency?

The decision of an elderly person, blind from an early age, to decline the opportunity to regain her sight.

How do the authors compare the desire for amputation to the desire for cosmetic surgery or gender-reassignment surgery in terms of potential social criticism?

They suggest that the desire for cosmetic or gender-reassignment surgery might be more problematic due to reinforcing stereotypes or emphasizing appearance over substance, whereas amputation goes against culturally endorsed ideals.

What is the second objection to the autonomy argument regarding informed consent for amputation?

The argument that a wannabe cannot know what it is truly like to be an amputee without first becoming one, and therefore cannot give truly informed consent.

What is the third argument in favor of permitting healthy limb amputations?

Therapy, based on the idea that amputation can provide relief from significant suffering caused by the condition, especially if no other effective treatments are available.

What evidence supports the premise that wannabes endure serious suffering as a result of their condition?

The lengths to which they go for self-amputation, and Michael First's study showing 44% reported interference with social, occupational, or leisure functioning.

What do Bruno and Riddle suggest is the origin of the desire for amputation, and why do they believe amputation would not provide relief?

They suggest it originates from attention-seeking due to parental love deprivation, and believe amputation is unlikely to satisfy this need for attention or commitment.

According to the authors, what is the current understanding of psychotherapy's effectiveness for the desire for amputation?

Michael First's study suggests it is not particularly effective, as none of the 18 interviewed participants reported a reduction in desire after psychotherapy.

What reason do the authors give for why amputation might be the only treatment for some BIID patients?

Some wannabes might be resistant to available drugs or talking therapy, similar to how the phantom limb phenomenon is resistant to these treatments.

What is the "repugnance" objection to self-demand healthy limb amputations?

Many people find the idea intrinsically objectionable and disgusting, similar to reactions against practices like kidney sales or bestiality.

Why do the authors suggest caution when considering "repugnance" as a moral indicator?

Disgust responses can be elicited by many morally benign practices (e.g., masturbation, interracial marriage) and are not reliable indicators of moral transgression.

What is the "looping effect" concern regarding the legitimization of BIID as a disorder?

That giving official sanction to a psychiatric category can cause people to use it to construct their identities, reinforcing its reality and potentially leading to a proliferation of diagnoses, as seen with Dissociative Identity Disorder.

Why do the authors believe the "looping effect" for BIID is unlikely?

They argue the desire for amputation is at odds with current conceptions of the ideal body image and the deep-seated preference for bodily integrity in normal human beings, making widespread proliferation unlikely.

What is the author's final argument for considering healthy limb amputations permissible in some BIID cases?

They argue that a limb not experienced as one's own is not truly 'healthy' in an important sense, and the suffering from depersonalization disorders, though invisible, is real and may warrant amputation as a response.