November 26, 2022

Amputate healthy legs if patients don’t want them, says psychiatrist

Inspired by analysis of Julian Savulescu

A Sydney University psychiatrist has argued that surgeons should be allowed to amputate healthy legs if a patient is suffering from Body Integrity Identity Disorder (BIID).

“I am not saying we should unthinkingly cut off people’s legs”, said Dr Christopher Ryan. “I realise that the idea strikes almost everyone as lunatic when they first hear it. However, there are a small number of people who see themselves, and have always seen themselves, as amputees.”

Since BIID, which is sometimes confused with a similar condition called apotemnophilia, is very rare -– there are only four reported cases -– the main interest of Dr Ryan’s article in the new journal Neuroethics is his reasoning. He attempts to show that BIID (if it exists) is not a psychosis and that people suffering from it are capable of making rational decisions about their welfare.

He then shows that mutilating operations which radically alter bodies are already accepted by doctors, such as kidney donations, preventative mastectomies or gender reassignment surgery. A policy of erring on the side of caution would entail suffering for people with BIID, if all other reasonable options have been exhausted.

Dr Ryan says that his argument is supported by Oxford bioethicist Julian Savulescu, who contends that “we must be open to such radical possibilities” if a patient is capable of making a rational, autonomous decision. In fact, Dr Ryan contends that doctors actually would have a duty to amputate a leg at a patient’s request, or at least to refer to a more willing doctor.

This, he believes, is a principle which has already been established for abortions. “As is the case in termination of pregnancy, dissenting doctors should be under no obligation to proceed with an amputation in these circumstances, but [they are] are under an obligation to refer the patient to another doctor whom they believe might proceed with the amputation”.

Although American bioethicist Arthur Caplan says that “It’s absolute, utter lunacy to go along with a request to maim somebody”, Dr Ryan believes that BIID patients would be, on the whole, better off without a leg.

“A 30-year-old patient of mine lived his whole life feeling he was truly an amputee. He was ashamed of the way he felt and did not tell a soul about it. Eventually he took the only step he thought he had open to him, and placed his leg in a bucket of dry ice until it died and had to be removed. Now, a year later, he is living happily as an amputee and getting on with his life.” ~ Neuroethics, Nov 4; Uni of Sydney, Nov 6

 

Julian Savulescu

One thought on “Amputate healthy legs if patients don’t want them, says psychiatrist

  1. One should not break what one can not mend, these psychiatric patients should be treated effectively rather than made permanently disabled. I respect the freedom of choice, however, these are psychiatric patients and in such conditions the freedom of choice should be replaced by incapacity to make rational decision.

    What would the surgeon do if the mental condition of amputee gets better and he/she wants the limb back?

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