Under What Conditions, if any, Should it be Permissible for Doctors to Amputate Healthy Limbs?
Our values and priorities as individuals differ. As a result, when someone makes a controversial choice in life, it could be viewed by others as being either irrational, or going against their interests. When such choices involve the medical profession, the individual in question feels challenged with respect to the fundamental medical principle that he/she ascribes to (First 4). On many occasions, doctors decline to honor controversial choices made by patients on paternalistic grounds. While we ought to facilitate and respect the controversial choices made by competent individuals, our own autonomy and well-being, and that of others is subject to the public interest. At times, such choices could be indicators of unusual values to which certain individuals ascribe to. However, on certain occasions, controversial choices could be deemed as being irrational and not in the least an expression of our individual autonomy (Beckford-Ball 188). Such is the case with a patient’s request to a doctor to amputate healthy limbs. In this case, the essay seeks to answer the question: Under what conditions, if any, should it be permissible for doctors to amputate healthy limbs? The essay will argue that it may be permissible for doctors to amputate healthy limbs in case the patient is discovered to be the subject of profound distress due to BIID (Body Integrity Identity Disorder).
While it is highly unusual for a patient to request his/her surgeon to perform an amputation on a healthy limb, such requests are not unusual with patients diagnosed with BIID. BIID is a highly rare psychological condition where the patient harbors a profound desire to have a healthy limb amputated on account of distress linked with its presence. While some of the BID patients master the courage to ask their surgeons to perform the amputations, others are not so courageous, and instead opt to self-mutilate their healthy limbs, often with disastrous outcomes (Bayne and Levy 75). Physicians and psychologists alike are at pains to give a valid explanation as to why BIID patients specifically, are more likely to request that part of their healthy limbs be amputated, more than any other individuals. However, their desire has been likened to that harboured by transsexuals seeking sex change (Muller 39). Accordingly, neurologists, psychologists, and psychiatrists have all come up with different theories to explain this desire by wannabes to amputate healthy limbs. While some of the medical professionals term it as a form of obsessive-compulsion disorder, others cite a possible neurological conflict and identity disorders. One plausible explanation is that wannabes have an incorrect belief that a part of their body is either exceedingly ugly, or diseased. This is a key symptom of the Body Dysmorphic Disorder (BDD) (Ryan 25). As a matter of fact, such a belief could be the source of intense concern to an individual who might even resist evidence on the contrary (Bayne and Levy 75).
The strong desire by wannabes for an amputation has also been linked with their sexual attraction to amputees (Ryan 26), as well as a mismatch between the actual structure of the wannabe’s actual body structure, and their experience with their body. This view has been linked to wannabes suffering from BIID (Ryan 27).
For a long time, medical ethicists have been embroiled in debates on the controversy surrounding the elective amputation of healthy limbs. While such debates have relied on the principle of autonomy to argue in favor of patients who have a right to undergo body modifications, other medical ethicists have also doubted the autonomy of BIID patients. Research findings of neurological studies indicate that BIID causes disruptions of body image in a similar way to what is experienced by stroke patients (Muller 38). If we were to argue in favor of the statement that as a neuropsychological disturbance, BIID also includes a certain lack of autonomy and missing insight into illness, we are likely to witness a reduction in the number of amputations. It would also result in an evaluation of amputations not as an individual desire to rid of psychological distress affiliated with the disorder, but bodily injuries borne of a mental disorder. Accordingly, medical practitioners would be forced to seek causal therapy that integrates the patient’s perceived alien limb into their desired body image, as opposed to just finding a cure for the symptom.
Ethical Considerations for Elective Amputations
Ethicists appear to differ on whether there are any conditions under which surgeons may grant the wishes of a patient to have their healthy limbs amputated. Bayne and Levy, two of the leading medical ethicists at the University of Oxford and University of Melbourne (Australia) respectively, infer that in the event that a patient is proven not to be psychotic, has a long-standing desire for amputation and is fully aware of the consequences and risks of an amputation, performing surgery is ethically permissible as it would prevent majority of the BIID patients from either killing or injuring themselves (Bayne and Levy 79). As a matter of fact, amputation of an otherwise healthy limb has since emerged as an ethically invulnerable treatment alternative among patients with BIID and on this ground, should be provided under certain circumstances. However, it should not be offered before a clarification of the diagnosis has been made and other treatment options considered (Tomasini 25). While BIID has over the years elicited a huge amount of moral concern among medical ethicists, it is interesting to note that thus far, available literature on the subject only mentions three past attempts to formally assess the ethical considerations in its management.
Johnston and Elliot (43) contend that amputation of a healthy limb ought not to be regarded as a treatment plan. On the other hand, Bayne and Levy (81) disagree with this statement, arguing that under certain conditions, amputation of a healthy limb should be permitted. Elsewhere, Savulescu (103) proposed that certain situations might actually permit amputations, and that it could in fact be desirable as well. This is a clear indication of just how divided medical ethicists are as regards the amputation of healthy limbs. However, the premise of this essay is to examine the conditions under which a surgeon might be permitted to carry out an amputation on a healthy limb.
Patient’s Autonomy and Respect for it
As human beings, we act independently with the benefit of insight into the situation at hand and with intention. More importantly, our actions are devoid of any coercive influences or external controlling factors. These are the defining elements of the principle of autonomy. It is indicative of the sense of independence that individuals enjoy against authorities, including medical practitioners. Accordingly, physicians are required to not only respect their patients’ autonomy, but to also speed it up. On this, majority of the BIID sufferers and medical ethicists (for example, Bayne and Levy 2005) contend that elective amputations should be permissible in case the patient is well informed and not psychotic. Accordingly, various scholars (Bridy 153; and Tomasini 26) have argued on the need to respect a patient’s autonomous decisions as regards undergoing body modifications. However, obligations for patient autonomy excludes delusional, drug-dependent and mentally sick patients as they lack the capacity to act in an adequately independent manner (Beuachamp and Childress 181).
While surgeons are obligated to patient autonomy, the issue of amputation of healthy limbs should be handled with caution so that it does not become common in society. Patients who wish to have one or more of their healthy limbs amputated are more likely to visit private hospitals in the hope of swaying surgeons in such facilities into agreeing to perform the amputations. However, we must remember that all doctors are bound by the Hypocratic Oath, regardless of whether they are in private or public hospitals. As a matter of fact, there are instances where surgeons in private hospitals have consented to amputating the healthy limbs of patients, only for the hospital managers to refuse such requests. The patients have then gone ahead to have amputations performed in public hospitals (Bedford and Jones 18). Therefore, the most important thing therefore is to closely monitor and regulate amputations of healthy limbs.
In line with the principle of nonmaleficience, physicians are not meant to undertake amputations in the absence of a medical indication as amputations carry a lot of risks and usually bear severe consequences, over and above the actual disability (Beckford-Ball 188; Doting n.p.; Johnston and Elliot 44). While a number of physicians conduct such harmful surgeries as breast enlargement surgeries, this is not enough justification to conduct even more harmful surgeries. Even if doctors may be inclined to perform amputations for the sake of making profits, this would no doubt renegade the principle of nonmaleficience and if found guilty, such doctors risk losing their license to practice, imprisonment, or both. Even in the case of a BIID patient, performing such amputations is both risky and non-reversible.
The only time when it would be justifiable to perform amputations on healthy limbs is if the patient stands to gain more benefits than harm. In other words, such a procedure should be able to sustain the effect, is effective, and should carry less harm than any other form of therapy.
While many medical ethicists argue that the above three conditions are fulfilled by amputations (for example Byane and Levy 80, and First 6), there has been no scientific evidence thus far to ascertain the effectiveness of amputations in regards to BIID therapy. However, if the choice is between the amputation of a healthy limb by a surgeon and worse consequences, such as self-amputation by the patient, then the former is preferred (Beauchamp and Childress 115).
In conclusion, the main question is if the desire to amputate a healthy limb is an obsessive one or an autonomous decision by the BIID patient. Indeed, there are many explanations by psychologists, neurologists, and psychologists regarding the causes of the desire to amputate healthy limbs. While neurological studies point towards brain disorders as the cause for a desire for elective amputations, psychiatrists argue that the desire of an individual to have an amputation desire hinges on a monothematic delusion or is an obsession. BIID has also been touted as an identify disorder. Medical ethicists are also divided on the conditions under which it would be permissible for a doctor to perform an amputation of a healthy limb. Although medical practitioners are supposed to respect the autonomy of a patient, such autonomy ceases to exist in case the patient is diagnosed as being neurotic or ill informed. The principles of non-maleficence and beneficence forbid surgeons from performing amputations on incapacitated patients. However, for a patient who is not psychotic and is well informed about amputations, the procedure can be performed if it proves to be a remedy for worse consequences, and when other alternatives have been exhausted.
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