The Ethics of Gratuitous Amputation

Suppose that a person wants one of his perfectly well-functioning limbs to be amputated, for no (other, instrumental) reason. He just has an intrinsic, inexplicable desire to be rid of it. Should surgeons accede to the request? That's the question raised in this fascinating article:

[Australian philosophers] Neil Levy and Tim Bayne argue that patients obsessed with having a limb amputated should be able to have it safely removed by a surgeon, as long as they are deemed sane.

"As long as no other effective treatment for their disorder is available, surgeons ought to be allowed to accede to their requests," the pair wrote in the Journal of Applied Philosophy.

Dr Levy, of the University of Melbourne's Centre for Applied Philosophy and Public Ethics, said some patients suffered so severely from the rare condition - known as Body Integrity Identity Disorder (BIID) - they tried to remove the limb themselves.

"There's cases of people using chainsaws or shotguns and there's been deaths, not surprisingly," Dr Levy said in an interview.
...
To reinforce their case, Dr Levy and Dr Bayne, of Macquarie University's philosophy department, relate the example of a Scottish surgeon's patient who said his life had been transformed for the better by his amputation.

Dr Levy said he believed such operations were less of a problem than cosmetic surgery like breast enlargement.

"Cosmetic surgery reinforces norms of appearance that are of themselves, undesirable - the idea that women have to be sexually attractive and if they're not, they're not valuable," he said. "Amputation surgery flies in the face of our norms of attractiveness. I think it's less problematic."

Well, it is less problematic in that sense, for sure. But it is more problematic in the sense that it involves deliberately disabling a person. It will make them less able to perform various actions. And that is, in general, exactly the opposite of what we ought to be aiming at. On the other hand, enabling people has predominantly instrumental value, in that it helps them achieve what they want out of life. So if what someone really, truly, wants is to lose their arm, then perhaps we ought to help them achieve that end. This conclusion is supported by the libertarian values of self-ownership and neutralism, but I wonder if the substantive autonomist might see it as self-undermining in the same way that selling oneself into slavery would be (though perhaps not quite so bad).

I think what it comes down to is how much they care about the amputation, as compared to how serious a (detrimental) impact it would have on their life. If the person does not have an accurate understanding of how severely the loss of their limb would impair them, then we have good paternalistic grounds to deny their request. But if they have made an informed decision, concluding that getting rid of the unwanted limb is more important to them, then I think we have to support that.

There are also good utilitarian reasons to allow the procedure to be done safely, as with abortion, if the alternative is that many would attempt it themselves in an unsafe environment (cf. Levy's mention of "chainsaws"). If this is reinforced with testimony from past amputees who are happy with their choice, then all the better, I suppose.

The requirement of "sanity" is a tricky one. One is tempted to think that anybody who wants to amputate a perfectly good limb is, ipso facto, irrational. "But the people I'm talking about are rational people, they're not insane in any way. They've just got this one, very strange, belief." (Quote from Dr. Levy.)

The article also quotes Dr Quinn, the Royal Australasian College of Surgeons' executive director of surgical affairs, as suggesting that "to remove a normal limb because somebody thinks it would be a good thing is unethical and we wouldn't do it." But he doesn't give any reason why it's unethical. Perhaps that was due to space constraints, I don't know. But one would hope that those who get to decide such matters have something more than blind prejudice to support their position.

Update: A better, more thorough, article on the issue is here. It offers a bit more by way of explaining the condition:

Past research has suggested this rare condition may be because they believe their body part is diseased or ugly, because the notion of becoming an amputee sexually excites them, or because of a mismatch between their body and their image of it... Levy says it's unclear exactly what causes BIID, although it may be the result of a cortical misalignment between how the brain "sees" the limb and what's really there. He says in the case of so-called "phantom limbs", people who lose a limb may experience the sensation that it's still there. This is because the way the limb is represented in the brain hasn't caught up with the physical change. But amputee wannabes may have the limb but not the cortical representation.