An Ethical Dilemma: What to do with BIIDs

[Tellenbach]

There's a fascinating section in this book I'm currently reading about a mental illness called "body integrity identity disorder" or BIID. People with BIID seek elective amputations of their limbs because they feel it's a foreign object and they go to great lengths to remove the limb. Some have used guns to shoot off a hand; some stick a leg in a woodchipper; others use dry ice to destroy the limb, forcing surgeons to remove it.

"I feel that my legs don't belong to me and shouldn't be there." (from 'Falling into the Fire', Christine Montross)

There is currently no medical treatment for this disease. The only relief comes when the limb is amputated. Without the amputation, the sufferer feels extreme discomfort. What should the physician do?

I wouldn't want to pay for someone's elective surgery, especially something expensive like an amputation, but if the individual is aware of the consequences of such a request, then he should have the right to mutilate his body. What say you?

 

[Typh0n]

Well that must be pretty depressing to read about, lol.

The purpose of medicine is to treat the illness.

If you remove the limb at the person's request, you're not treating the illness. Im guessing there might be some way to treat this with cognitive therapy, though perhaps the illness is so rare that not much research yet been done into it.

Perosnally, if I were a doctor, I would refuse them the surgery. Of course, theyre just gonna go to the next doctor and ask for the same thing, so it might not be enough, I might also have to convince the entire medical body of following my decision.

 

[Tellenbach]

^ Right. Physicians are taught to do no harm so cutting off a healthy limb goes against their beliefs but there is no alternative, no solution to easing the suffering of these individuals. Once the limb is cut off, they are cured and no longer suffer from the discomfort.

Research shows that it's probably some damage or dysfunction in the parietal region of the brain. When the "foreign" limb is tapped, you get no signal in the parietal lobe but there is a signal from other limbs.

 

[á´…eparted]

This is a tough call. Honestly, if there is no other way for the individual to be releaved of psychological pain, then I think it should be permitted. Psychological pain is no joke (I've experience it many times), and can be just as bad as physical pain (and having experienced kidney stones, I know bad physical pain too). This clearly is a psychological disorder, and they need to be treated. So the whole "do no harm" thing is sort of moot. It's harmful either way to leave them or treat them.

I think that after all possible forms of therapy, medication, etc. have been exausted and proven to not work, then it could be permitted. They'd need to do a full psychological evaluation to see if there are any other underlying problems, but if that checks out then they can go forward. I'd also imagine a legal waiver would have to be signed so the individuals working for the hospital could not be sued or similar if they have a change of heat. The limbs could also be donated to individual needing a transplant so it wouldn't be completely for naught.

 

[Tellenbach]

The limbs could also be donated to individual needing a transplant so it wouldn't be completely for naught.

That's what I was thinking but I don't think limb transplants are done due to the compatibility (length of limb has to match the recipient) and the immune response.

 

[á´…eparted]

That's what I was thinking but I don't think limb transplants are done due to the compatibility (length of limb has to match the recipient) and the immune response.

They've been done, it's just very rare due to the genetic requirements, size requirements, timing requirements, etc. in order for it to work, as you stated.

 

[xisnotx]

as long as the expense falls onto them..

 

[Mole]

The problem is not the limb, it is the perception of the limb.

So it is not the limb that needs to be cut off, but the perception.

The limb is healthy but the perception is not.

 

[Such Irony]

The problem is not the limb, it is the perception of the limb.

So it is not the limb that needs to be cut off, but the perception.

The limb is healthy but the perception is not.

But what if the perception can't be cured by conventional means (psychotherapy, medications, etc.) What if the only means of providing comfort is to amputate the limb. Then by all means I say do it. The limb is not required to live.

Also, I wonder if an artificial limb is inserted in its place. Would the person with BIID also react to it in the same way?

 

[Mole]

But what if the perception can't be cured by conventional means (psychotherapy, medications, etc.) What if the only means of providing comfort is to amputate the limb. Then by all means I say do it. The limb is not required to live.

Also, I wonder if an artificial limb is inserted in its place. Would the person with BIID also react to it in the same way?

It's mutilation, not cure.

 

[ceecee]

I wouldn't want to pay for someone's elective surgery, especially something expensive like an amputation, but if the individual is aware of the consequences of such a request, then he should have the right to mutilate his body. What say you?

Sure. They could saw it off with a steak knife in the middle of the night when the issue got bad too. I just don't know that they're really aware of the consequences, regardless of how the limb comes off.

 

[Amargith]

Quality of life is the answer, i feel. If it causes chronic psychological damage and pain, who are we to condemn them to that?

Especially of we have no other satisfying way to treat them at present. To deny them this would be downright cruel.

 

[Tellenbach]

I just don't know that they're really aware of the consequences, regardless of how the limb comes off.

These people are fully aware of the consequences/implications of the act. Should they be allowed to get that procedure?

 

[ceecee]

These people are fully aware of the consequences/implications of the act. Should they be allowed to get that procedure?

Yes, it's their body.

 

[wildflower]

There's a fascinating section in this book I'm currently reading about a mental illness called "body integrity identity disorder" or BIID.

if it is a mental illness as you say then it needs to be treated that way. i can't imagine any physician doing elective amputations. that completely violates the hippocratic oath. just because a person is in psychological pain doesn't mean physicians should collude with their mental disorder. i don't really see an ethical dilemma in this at all. emotional pain is unfortunately a part of life, but it is there to tell us something is wrong that needs to be dealt with–not avoided through amputation.

 

[Cygnus]

We seem to be treating the limb as if it's its own sentient life form. It has no brain tissue. Nerve tissue, but no brain tissue.

 

[Tellenbach]

i can't imagine any physician doing elective amputations.

This is done all the time. Think breast reduction surgery and sex-change operations (with male patients, this means castration).

 

[iiiii]

Individual doctors should have the right to refuse to do the surgery, or any other surgery they personally feel is unethical.

However if a mentally healthy person wants to mutilate or amputate their own body part, and can find a doctor to do it for them, who am I to tell them that they cannot do so? My only concern would be weeding out the people who are mentally ill (in the sense that they might recover from their illness and really regret the decision later on).

 

[LadyRain]

What an interesting thread. Helping someone cut off a limb has become an ethical dilemma while suicide is literally illegal (punishable if the person fails). The only difference is in it's hated subject and the matter of extremes. Beyond this, I can certainly see the validity in these arguments:

This is a tough call. Honestly, if there is no other way for the individual to be releaved of psychological pain, then I think it should be permitted. Psychological pain is no joke (I've experience it many times), and can be just as bad as physical pain (and having experienced kidney stones, I know bad physical pain too). This clearly is a psychological disorder, and they need to be treated. So the whole "do no harm" thing is sort of moot. It's harmful either way to leave them or treat them.

I think that after all possible forms of therapy, medication, etc. have been exausted and proven to not work, then it could be permitted. They'd need to do a full psychological evaluation to see if there are any other underlying problems, but if that checks out then they can go forward. I'd also imagine a legal waiver would have to be signed so the individuals working for the hospital could not be sued or similar if they have a change of heat. The limbs could also be donated to individual needing a transplant so it wouldn't be completely for naught.

if it is a mental illness as you say then it needs to be treated that way. i can't imagine any physician doing elective amputations. that completely violates the hippocratic oath. just because a person is in psychological pain doesn't mean physicians should collude with their mental disorder. i don't really see an ethical dilemma in this at all. emotional pain is unfortunately a part of life, but it is there to tell us something is wrong that needs to be dealt with–not avoided through amputation.

 

[Magic Poriferan]

This is a neurological condition as far as I know, and until there is a way to alter that root of the problem, amputation appears to be the better outcome for the patient than deciding to keep the limb. So, amputate the limb.

As for it being elective, that's kind of debatable. Technically, there are a lot of surgeries that could be called elective that reduce physical suffering or increase life span that we wouldn't typically think of as elective for that reason. I think this condition can fall within that heading.

And I'm totally okay with paying for such a condition because I favor public health care.