Applied Ethics.
Background:
- Several thousand people worldwide suffer from an extremely rare psychiatric illness called body integrity identity disorder (BIID).
- The afflicted have an obsessive desire to be rid of a normal healthy limb, which they view as an alien appendage.
- BIID can be distressing and deadly, especially when patients decide to take matters into their own hands i.e. saw the offensive limb off, freeze it to death, or even conveniently place it in the way of an oncoming train.
Dilemma: Should surgeons grant BIID patients their wishes?
Yes
- To prevent BIID patients from injuring or killing themselves.
- Medical ethicists Tim Bayne of the University of Oxford
and Neil Levy of the University of Melbourne in Australia
No
- Amputation of healthy limbs violates the Hippocratic Oath (which instructs doctors to do no harm).
- BIID patients must be protected from their own desires for amputation, which are as delusional as the desires of anorexics for weight loss.
- Amputation is permanent while the desire for it may not be.
- Significant costs to society could be incurred if BIID amputees claim the right to medical rehabilitation and early retirement.
- Arthur Caplan, director of the Centre for Bioethics at the University of Pennsylvania
Thanks to: Mueller, S. (2007). “Amputee Envy”. Scientific American Mind 18:6. New York: Scientific American.
Finding the theory in reality: What metaethical theories do the respective stands represent?
Disclaimer: The above arguments are put forth solely by the respective persons to whom these arguments are attributed. By posting the above views, T-lymphocyte is by no means endorsing or criticising either stand. Please use at your own discretion.
One night I woke and found a leg
I thought it was a corpse
But when I threw it out of bed
I landed on the floor!
7 comments:
It should be mentionned that Body Integrity Identity Disorder is not only a desire/need to have an amputation, but a desire to have an impairment, including but not limited to amputations, or paralysis, or deafness, or blindness. Dr. Mueller was somewhat mistaken in her article in American Scientific Mind. Further comments on that particular article may be found at http://biid-info.org/Amputee_Envy
The arguments you list "against" surgery as a treatment option for BIID were made by Arthur Caplan, a bio-ethicist known for his position that "disability is a faith worse than death". As such, I don't believe we can attribute as much weight to his argument, as he is biased towards avoiding more people with disabilities.
Regarding the Hippocratic Oath, we would argue that to refuse surgery is in fact doing harm, or allowing constant and ongoing emotional suffering to happen. Does the surgeon not cut a cancerous leg? BIID is like a cancer eating people inside and the *only* known method to cure it at the moment is surgery. More on this at: http://biid-info.org/Hippocratic_Oath
Regarding the protection of BIID sufferers against their delusions, and the relationship to anorexia... Again, Dr. Caplan has it wrong. Numerous studies and renowned psychiatrists, including the principal editor of the DSM (Dr. Michael First) have repeatedly stated that people who have BIID are not psychotic, nor are we delusional. In fact, psychosis or delusion are factor specifically excluding from a diagnosis of BIID. Further, anorexia, which is in the family of "Body Dysmorphic Disorders" is quite different to BIID. People who have BDD have an erroneous perception of their body - for example, anorexics think they are extremely fat, when in fact they are unhealthy thin (generalisation). People with BIID know full well that their bodies are normal, we just wish for it to be different.
As for costs to society, most people who have BIID are self-sufficient, employed in good jobs, that they could continue doing post impairment. But even if all BIID sufferers were to avail themselves of rehab and wheelchairs or prosthesis, the "cost to the system" remains laughably low compared to the cost imposed to the system from people who have cigarette smoking related illnesses. If society is really concerned about these kind of costs, then perhaps it should consider making cigarettes illegal. But let's not forget that BIID is a significantly disabling condition and many BIID sufferers could legitimately be on public benefits due to it, but would be able to return to work were they symptom free, which would be achieved through surgery.
If you're going to discuss the ethics of our situation, you would do well to fully inform yourself of the issues, and not pass a snap judgement based on reading one article in a "pop psychology" magazine that is not fully accurate.
hi sean,
We don't take stands. The point of the blog is to provide examples for essays. We give whatever little information we have to the readers and it is up to them to find out more.
We are not discussing the ethics of the situation. We are informing the existence of such situations.
Anyway, thank you for providing counter arguments and external links. We welcome information.
To t-lymphoocyte:
darling, I think you better reply. Oh, perhaps you want to include some of the arguments Mr. Sean presented.
Regards,
DN
hey guys,
Thanks to Mr Sean for providing a different point of view, and as said by deathnote, we are merely acting as a central source for information that can be used in student's KI essays.
If Mr Sean does not mind, could we place your comments under one of our posts so that readers can take a look at other arguments? of course, you will be fully credited!
and lol t-lympho i would love to hear from you =P
thanks mr sean again!
You said "We are not discussing the ethics of the situation. We are informing the existence of such situations. "
But by the very way you present the information, you are stating a position. Never forget that.
As for putting my comment under one of your post, I have no real objection to that, except that I believe it's important to leave the comment under this post as well, because people reading about the arguments presented against BIID by Dr. Caplan need to get the full picture.
Chill yall, here I am.
Dear Mr. Sean,
Yes you are quite right about two things:
1. I am presenting information.
2. I am stating positionS (as opposed to A position).
However, I am not presenting these information and stating these positions as my own opinions, but rather as examples of what others have expressed to be their views. In posting these views, I am by no means endorsing or criticizing these views. Perhaps it was not clear enough in the post; I will add a disclaimer to clarify this. Let me reiterate once again: My point is not to “discuss the ethics” of surgery for BIID patients nor to “pass (snap) judgements” (in your own words), but merely to summarise what ethics others have discussed. Therefore, if you wish for Dr. Caplan’s arguments to be revised, then I’m afraid you have addressed your counterarguments to the wrong audience, for I do not happen to be Dr. Caplan. The only counterarguments applicable to my post would have to address some misquotation or misinterpretation on my part of a particular person’s view.
On the other hand, if you are merely seeking to inform us, then thank you for sharing your views and further developing this case study of an ethical dilemma. You evidently know a lot about the subject. Without passing any judgement on the ethics of the situation at hand, I would just like to make some comments on the logic of your arguments:
First, I disagree with your view with respect to the validity of Dr. Caplan’s arguments: “As such, I don't believe we can attribute as much weight to his argument, as he is biased towards avoiding more people with disabilities.” For one, you did not provide sufficient justification to substantiate your claim about his being biased towards the disabled. For another, even if he was indeed biased in some manner, that cannot be used as a counterargument to his arguments. His personal inclinations must be evaluated separately from the validity of his arguments.
Similarly, your last paragraph seems to be discrediting my reference simply on the basis of its being “pop psychology”. If by “pop psychology” you mean that Scientific American Mind is a publication for the popular masses, why yes, I do agree with you. But so what? Popular science is hardly a synonym for pseudo science. It merely refers to science that is accessible to the lay person. And we are no professional scientists. Popular science is good enough for a school essay for English, thank you. Is the reference you quoted - http://biid-info.org/Main_Page - not a popular site too? I regret that I do not have a comprehensive enough understanding of BIID, as you have so kindly pointed out in your opening paragraph, but then I am not seeking to write a thesis on BIID or to educate the public about BIID per se. Rather, I am using the controversy over granting BIID patients surgery as a case study - an example of an ethical dilemma. Thus, it is natural that I focus only on the relevant aspects of BIID - namely, the desire for amputation.
Next, you argued that “to refuse surgery is in fact doing harm, or allowing constant and ongoing emotional suffering to happen”. But I feel that the first clause cannot be equated with the second. By refusing surgery, a physician does not actively cause harm whereas by granting surgery, he does - at least, with respect to the physical body. This calls to mind the difference between passive and aggressive euthanasia. While the former involves the withholding of common treatments, the latter involves the use of lethal substances to actually kill. Unsurprisingly, the latter is much more controversial. While I’m saying here is not that I endorse denying a BIID patient surgery, or that a physical disability necessarily outweighs emotional suffering; but rather, that the difference between passively and actively causing harm - even if both result in the same outcome - does exist and often comes into play in ethics.
In the same paragraph, you mentioned “Does the surgeon not cut a cancerous leg?” But cancer arises from uncontrollable cell proliferation in the body and is very much a physical diagnosis, as opposed to the psychiatric condition BIID. What makes the analogy between cancer and BIID any more appropriate than that between anorexia and BIID (which you convincingly argued to be false in the next paragraph)? As you yourself mentioned, the offending leg of a BIID patient is perfectly normal. The same cannot be said of a cancerous leg.
Further, you wrote that “the *only* known method to cure it at the moment is surgery”. I don’t wish to debate the truth of this statement, but merely to point out the distinction between a palliative “cure” and a true cure. Perhaps surgery is not so much a cure as a last resort. This can explain the reservations of physicians about granting surgery. Once again, this is not to endorse the view that BIID patients should be denied surgery and made to endure the symptoms of their condition while awaiting the development of an elusive cure that may never see the light.
Finally, I personally would have no complaints about the banning of cigarettes, but in this case your reference to “the cost imposed to the system from people who have cigarette smoking related illnesses” is a red herring that has no relevance to your argument. Nevertheless, I feel that you have provided a convincing counter to Dr. Caplan’s argument about significant costs to society as a consequence of granting surgery to BIID patients. Further, that BIID is itself a debilitating condition is a valid point of consideration.
Last but not least, on a personal note, thank you once again for your feedback, which motivated us to find out more. Conversely, I hope you have a better understanding of where we’re coming from and not fault us for arguments that are not our own.
I didn't know we do critical thinking as well.
Not bad, I only took 30 minutes reading that.
Now you do (:
Well honey, you and banana were the ones who asked me to reply ...!
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