Ethics in Medicine continues to be a controversial topic today. Divided views, contrasting opinions and different religious backgrounds are all factors that have influenced the progression and limitations in the practice of Medicine. Sex-change surgeries, cosmetic procedures and other unnecessary measures have opened the door to arguments of how ethical “patient elected” procedures are. Though patient autonomy is important, there is cases where harmful or unnecessary procedures with many complications and or effects are performed to achieve a patients’ desired results. In my opinion, I believe that there must be restrictions and limitations on what a person can do with their life and body, especially when there is more harm than good, results are permanent or influenced by a disorder like BIID.
Body Integrity Identity Disorder is a psychological disorder where a person’s mental body image completely differs from their actual composition. Individuals with BIID have a strong desire of becoming disabled, paralyzed or amputating a limb that they feel does not belong to them. (Nursing times, 2018) People who suffer from BID pursue body modification with or without medical assistance. It is believed that BIID is an identity disorder where the brain does not map out the body correctly to the actual body schema creating a mismatched image. The cause of Body Integrity Identity Disorder is not yet known, however psychologists believe that this disorder could be caused by a traumatic childhood, Obsessive tendencies and a strong connection and exposure to amputees.
Though BIID could include some sexual fascinations, BIID is not considered, but closely related to Apotemnophillia or “amputee love” where people are sexually aroused by the idea of being amputee or the attraction to amputees. In a medical journal published by French anatomist and surgeon Jean-Joseph Sue, The first BIID case was explained in a account of an Englishman who sought amputation of his own limb after falling in love with an amputee woman. This account clearly separates the motives of BIID and Apotemnophillia. In a survey, Evidence shows the motivation of patients who suffer from BIID to remove these body parts is in search of ” feeling complete” instead of sexually aroused. BIID patients describe feeling a limb superfluous and unnecessary feeling incomplete as if the limb were not a part of their body and it did not belong to them.
From studies, successful psychotherapeutic and pharmaceutical therapy is not yet known. (Henig, 2018) Because of lack of body identity and control, patients with BIID often display symptoms of frustration and depression because of their body dysmorphia. This disorder can be so severe that patients’ urge of amputation, disability, blindness or deafness leads to self-mutilation of their body parts. Patients diagnosed with BIID who result in self- mutilation practices cause even more harm if not death by infection, the use of crazy tools and dangerous procedures. Because of the negative psychological and physiological effects on a person with BIID, some psychologists argue that elective amputations should be performed. Elective amputations would reduce this self-surgical procedures and allow patients to safely remove the unwanted body parts and provide satisfaction to patients. However, Surgeons argue that it would be unethical and medically unnecessary to remove a healthy limb from a person. The result would be a physical defect that would only affect the quality of life.
The mutilation and removal of healthy body tissue is a major ethical battle in healthcare. Acceptance of sex reassignment and or cosmetic surgeries to enhance or modify healthy body areas encourage the argument of Autonomy, the ability to “self-govern”. (BIID.org, 2018) Body Integrity Identity disorder causes similar stress and confusion as in individuals who suffer from gender identity or body dysmorphic disorder. Sex change surgeries allow patients who suffer from identity/ gender dysmorphic issues to undergo surgery where the accepted and identified sex is surgically assigned. While sex change surgery is successful and allows autonomy in many cases, the surgical modification or cosmetic enhancement of healthy, working body parts into non-working (ability to reproduce), is often argued as unethical because of its negative results. Dr. First a Psychiatry professor at Columbia University stated “When the first sex reassignment was done in the 1950’s, it generated the same kind of horror” that voluntary amputation does now,”…. “Surgeons asked themselves, ‘How can I do this thing to someone that’s normal?’ The dilemma of the surgeon being asked to amputate a healthy limb is similar.” (First, 2012) However, practices like such encourage the acceptance of autonomous surgical procedures to aid psychological deficits and encourage the acceptance of self-image.
Because of this psychological disorder, the ability to make proper rational decisions is questioned. Per the Mental Capacity Act of 2005, it is stated that people are unable to make a decision because of an “impairment of, or disturbance in the functioning of, the mind or brain.” Though medical professionals respect patient autonomy, it is argued that obligations in ethics such as beneficence and non- maleficence overrules autonomy. When considered, Doctors should act in the best interest of the patient and factors of how much good or harm is being done. It is argued that offering these amputations for specifically BIID patients can have some negative results. Because of the psychological effect BIID takes on a person, doctors argue that removing a limb will cause the patient to focus on a different body part and want it later amputated as well. These compulsive tendencies frighten healthcare professionals because of the disability caused by amputation of a healthy limb. The Equality Act of 2010, disability is displayed as a person who has a mental or physical impairment that has a long-term negative effect on the quality of life. BIID can cause a different body part focus on a patient after an amputation possibly leading to more amputation wishes. It is also argued that because amputation can provide a therapeutic effect, it could also result in regret of amputation with no reversible actions. (Karnath..Baier, 2010) In a counterargument presented by psychologists lack of medical attention and help of amputation, patients are resulting in dangerous self-mutilation procedures that could increase the risks in patients and overall danger. This claim suggests the best interest for overall health of the patient is to allow medical led procedures to promote a safe and less dangerous surgical procedure for BIID patients.
Doctor-Patient relationships have greatly evolved within the last decade. Patient autonomy has become more popular and widely practiced today. The ability to self-govern and the ability to make decisions concerning their own life has been accepted in many forms of medical treatment. Cosmetic procedures and sex-change surgeries are examples of allowing patients to make long-term and even permanent changes affecting one’s body. Though autonomy should be respected, I believe that limitations and restrictions should be enacted when deciding to perform a permanent, irreversible life change. Like in sex-reassignment surgeries, psychological evaluations and medical evaluations study the patient’s ability to make a rational and concise decision. Because outcomes vary person to person, patients who undergo such procedures and later are dissatisfied or remorseful serve as prime examples of regret and irreversible mistakes. Because mental illnesses and psychological disorders like BIID exist, it is crucial that patients undergo psychological evaluation before acting upon one’s wishes. Restrictions and limitations should be placed on people who are not able to make rational decisions. Because BIID is so rare, researchers have not yet established possible causes, successful treatments, and prognosis of those affected. In cases like such where one’s self-perception is affected, moving forward to amputate can lead to regret of an irreversible action. Medical professionals should always act upon the best interest, well- being and overall functioning. The distinction of what a patient wants and what is best for the patient are two very different theories and Medical professionals should act upon what will benefit the patient most and what will cause the less harm overall. Psychologic disorders like BIID should be carefully diagnosed and studied to develop better, less invasive treatment. It is tragic to allow patients result to amputation to satisfy one’s personal image desire. In many cases like these, disorders like such can over take and change one’s life forever.
Nursing Times. (2018). Is it ever acceptable to amputate a healthy limb?. online Available at: https://www.nursingtimes.net/roles/nurse-educators/is-it-ever-acceptable-to-amputate-a-healthy-limb/5074324.article Accessed 20 Nov. 2018.
Karnath HO, Baier B. Right insula for our sense of limb ownership and self-awareness of actions. Brain Struct Funct. 2010;214:411–417
First MB, Fisher CE: Body Integrity Identity Disorder: the persistent desire to acquire a disability. Psychopathology 2012;45: 3-14
Biid.org.(2018). Treatment Of Biid – Biid.org. online Available at: http://www.biid.org/treatment-biid.html Accessed 20 Nov. 2018.