Abstract
Individuals with body integrity identity disorder (BIID) seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical model of health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be.
Highlights
Individuals with body integrity identity disorder (BIID) seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts
Can the harms commonly associated with amputation, those being the creation of a disability where none existed before, be disentangled from the physical act of removing a person’s limb? If this is the case, issues associated with nonmaleficence, as they relate to disability generation, can be evaded in the debate
To take a social model of disability (SMD) view of impairment and disability as a starting point for the ethical analysis of elective amputations in cases of BIID, we are faced with a different question from the one which opponents and proponents
Summary
One of the central tenets within medical and clinical practices is that of primum non nocere, or “first, do no harm.” This obligation sits at the centre of the principle of nonmaleficence as understood by Beauchamp and Childress’ mid-level principlist theory of ethics. This incision can, by most accounts, be considered harm, and, while the harm caused will be expected to heal, the principle of nonmaleficence is breached as healthy tissue is intentionally damaged This does not raise ethical issues because the benefits which such a surgery provides to that individual (no longer suffering from an appendicitis) are considered secondary to the practical necessities required in order to carry out such an operation. The reason to resist, according to Patrone, is that unlike cosmetic surgery, healthy-limb amputation deliberately results in a disability He writes: Even if we agree that the motives of both BIID patients and of some seeking cosmetic surgery are irrational, the analogy might be thought to break down, when we consider the fact that, at least ideally, no disability follows from the putatively non-problematical cases of cosmetic surgery. To demonstrate that healthy-limb amputation does not directly cause disability, this paper employs the SMD
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