In this paper, I will argue that amputation is an ethically appropriate medical intervention for patients with Body Integrity Identity Disorder (BIID) as long as certain criteria are followed. My argument for this is based on the fact that it is every medical professional’s ethical responsibility to relieve patients from their suffering and there is an inherent lack of alternative solutions to treating BIID. It might be objected to this that amputating a healthy limb inflicts unnecessary harm unto patients with BIID.
However, I will show that not allowing patients with BIID to obtain treatment in the form of amputation it only prolongs the patients’ psychological distress and physical discomfort. Patrone argues that it should be prohibited to amputate healthy limbs from patients with BIID. Patrone offers multiple reasons to forbid amputation for patients with BIID in his argument. First, he argues that amputation is not a proven cure for patients with BIID. There is not enough evidence that BIID patient who receive an amputation experience long-term satisfaction with their amputation.
Second, Patrone believes there have not been enough trials to test other possible cures that could offer better outcomes. Ideally, he would argue, patients would undergo therapy or another treatment options and gain a new perspective on their condition, come to terms with their bodies, and no longer feel a desire to become an amputee. Finally, and most importantly, Patrone believes that the amputation of a healthy limb leaves the patient with a physical disability that should not otherwise occur.
He states that it is unsure if the amputation will even cure the patient of their BIID condition, which is highly problematic because amputations are disabling and irreversible. Patrone argues that for these reasons, amputating a healthy limb from a patient with BIID is going against the medical standard of “do no harm”. While Patrone’s argument holds merit, I object to the idea that amputations are harming BIID patients. Patrone begins his argument against allowing the amputation of limbs from patients with BIID by stating the effects of the disorder.
He describes the experience of a patient with BIID as having “… discomfort so strong that it interferes with routine functioning and, in a majority of cases, BIID patients are motivated to seek amputation of the limb” (1). Even in Patrone’s own definition, the BIID condition is causing patients a significant amount of emotional distress and physical discomfort. Although BIID is not a life threatening condition, it does cause a significant amount of distress and discomfort to its victims both physically and mentally. Patients with BIID feel that an amputation would lessen their suffering.
Many patients with BIID understand that they will need to live with an amputation, which will make walking or other daily functions harder to complete. When considering the constant suffering and discomfort patients with BIID experience, is it really unethical to remove a healthy limb from the patient’s body if it is causing psychological problems for the patient? It seems just as possible that not allowing an amputation as a cute for patients with BIID is unethical because it is letting the patient continue to duffer when amputations have cured some people in the past.
Patrone makes valid arguments as to the ethical dilemmas involved in amputating the healthy limbs of patients with BIID. I believe his premises can be reevaluated and used productively to create criterion for allowing BIID patients a path to the amputation they desire. I believe these criteria should be as follows. First, patients with BIID must go through at least a year of rigorous therapy with the intent of delving into why the patient wants the amputation, how the patient will feel after, possible causes for the desire, and alternate solutions. Second, patients must try one alternate solution.
In this case therapy is not considered an alternate solution. However, the therapist working with patient may help the patient to design an alternate solution and carry out the process. Other possible alternative treatments include medicines that the therapist or physician working with the patient see fit. Finally, near the end of their year of therapy, patients would need to make a log with documentation proving that they have spent one consecutive month acting as an amputee would to ensure that they recognize the full weight of the decision they are making.
They should be required to discuss their experience with their therapist. After these criterion have been met, the therapist and the physician working with the patient would meet and discuss the best option for the patient. Requiring these criterions would discredit many of the arguments against allowing amputation for BIID patients. Many people think that patients who desire an amputation of a healthy limb must be mentally unable to make a sound decision.
However, by requiring therapy it ensures that a professional is confirming that the patient is capable of making a sound decision. Another argument is that patients requesting an amputation do not understand fully how difficult it is to live with an amputated limb or that they will be unnecessarily living with a disability that they should not have to live with. To solve this issue, the patient will have logged time spent living like an amputee would before the amputation to ensure that they understand every difficulty they will face as an amputee.
Through this, the patient would understand the challenges of being and amputee and be able to make the fully educated, sound decision whether or not their suffering outweighs the challenges of being an amputee. Finally, there is the argument that other treatments may help the BIID patient without requiring an amputation. This issue is solved by both requiring therapy and by requiring the patient to search and try other treatment options.
Ultimately this process would allow BIID patients a path to treatment, whether it is found before or after amputation, and would prove that amputation is the best treatment for every patient who did not find an alternative solution while completing the criterion. One possible objection to the criterion requires minimal time and effort on the part of the BIID patient. For example, the criterion require only a year of therapy, only one alternate treatment option in addition to the therapy, and only one month of living like an amputee to understand the challenges that come with living with an amputation.
Due to this, supporters of Patrone’s argument may think that amputation for patients with BIID may be too easy to acquire. Alternatively, some of Patrone’s supporters may feel there is no circumstance where removing a healthy limb from a patient is an acceptable action. These supporters may say that no criteria are appropriate for allowing an amputation. In response to this objection, I argue that it is a tricky ethical issue to decide where to draw the line on requiring patients to try other treatments through non-amputation means if they are not presenting a solution.
I argue that it becomes unethical to not allow patients with BIID to receive an amputation because it is prolonging the patients’ physical and psychological suffering when other BIID patients have reported that amputations have worked to lessen the effects the condition. In response to the first objection of needing to strength the criteria, I am reluctant to agree. Patients with BIID often desire an amputation so strongly that they attempt the procedure themselves or purposefully injury themselves in order to receive their amputation.
Requiring BIID patients to wait too long or inflicting too stringent criteria may encourage BIID patients to take matters into their own hands, rather than pursue the safer route of getting an amputation by a medical professional. Self-attempts to amputate endanger the life of patients with BIID, making this a pressing medical issue. For these reasons, I believe that the criteria laid out are appropriately designed to allow a reasonable path to amputation for BIID patients while recognizing and accommodating the issues of opponents to amputation by choice.