Nov 6 2008
A Sydney University psychiatrist has argued that a surgeon should be allowed to amputate a patient's healthy leg if that is what the patient wants.
Body Integrity Identity Disorder (BIID) is a very rare condition where people feel that one of their limbs is not truly their own. Though able-bodied, sufferers believe that they should truly be an amputee. They are often deeply unhappy and may desperately seek removal of the unwanted limb.
BIID hit the headlines in 2000 when it was revealed that a surgeon in Scotland had amputated a healthy leg from two patients with the disorder. At the time, appalled Scottish politicians called the procedure "obscene" and clamoured for a law to ban these operations.
Now, Dr Christopher Ryan, an academic psychiatrist at the University of Sydney, has examined the ethics of the issue in a paper to be published in the international philosophy journal Neuroethics. He argues that, after careful assessment and after exhausting other treatment options, doctors have may have a duty to amputate a BIID sufferer's unwanted limb.
"I am not saying we should unthinkingly cut off people's legs", said Dr 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.
"We don't know why, but it is quite likely due to a brain abnormality they were born with. We do know, though, that they are often miserable their whole lives because of their 'extra limb', and we know that at least some of them feel much better if it is removed."
People with BIID are sometimes driven to desperate measures so that they can have their unwanted limbs removed, he said.
"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."
Drawing on the importance of patient choice and using analogies with plastic surgery, Dr Ryan urges the medical profession to be the open to the possibility of providing elective amputation to sufferers of BIID.
"Unless these patients know that doctors will take their concerns seriously, and at least consider their requests, more people will risk their lives trying to remove their own limbs."