Body integrity dysphoria and moral responsibility: an interpretation of the scepticism regarding on-demand amputations.

Abstract

A patient who requests an amputation deemed medically unnecessary by professionals is disqualified per se from being regarded as having medical decision-making capacity. This decision is based on the assumption that there is an option to pursue something other than amputation; such an assumption in many cases overflows into therapeutic obstinacy. This is the case for individuals who have ill or damaged body parts and who wish to avoid recurrent and painful medical treatment designed to save the limb, as well as for individuals affected by body integrity dysphoria (BID). BID is a condition that is recognised by the WHO and is included in the International Classification of Diseases, 11th edition. Individuals who are affected develop an intense feeling of overcompleteness of their body configuration, which leads to the development of a strong sense of dysphoria and consequently the desire to amputate in order to remove the source of such discomfort. In the few cases in which amputation has been carried out, the results have proved successful; the individual's quality of life has improved and they have had no new amputation desires. No medical therapy, including medical amputation, is available currently for individuals affected by the condition. This situation leads many with BID to mutilate themselves. Such events create a challenging ethical dilemma for the medical world.The present paper is focused on the capacity of the individual with BID to do other than request amputation and the implications that this carries regarding moral responsibility. It is proposed that the autonomy of the patient cannot be disqualified by default based on the amputation request, despite its oddity, and that any scepticism demonstrated by the physicians is based on a false preconception of ill will or ignorance, which results in a blaming attitude towards the requesting person.