Out on a limb: the ethical management of BIID - Intro (Ryan)

The idea of amputating a completely healthy limb, strikes just about everyone as lunatic when they first hear it. In the paper under discussion however, I argue that not only might it be a sensible treatment in certain (carefully assessed) individuals, but that the medical profession might have a duty to offer amputation to these people. I do this by first describing what we know of body identity identity disorder by a review of the medical literature, and then by a series of ethical arguments.

I am not the first person to have raised this sort of ethical argument. Another guest blogger - Neil Levy - argued similarly some years before. I have the advantage though of being a practising psychiatrist at the University of Sydney, meaning (hopefully) I can bring a clinical perspective to the debate.

At the time I published the paper earlier this year, I had only seen one patient with BIID, but now, as a result of the publicity the paper generated, I have seen five more, and had correspondence with another six or so.

I look forward to hearing your thoughts.

Chris

Comments

[Adam Kolber]

Here is a link to the original blog post:

http://kolber.typepad.com/ethics_law_blog/2009/05/out-on-a-limb-the-ethical-management-of-body-integrity-identity-disorder-.html

The blog post will take readers to the abstract and to a link to the full paper.

[Samanta Stillman]

In this discussion you are not authentic. Show to the public that you dis something for realization of BIID people and come down with your scepticism of people who will become paralyzed, blind or deaf. It´s a nice story writing if you and your colleges are searching for the illness behind BIID. You and your colleges will not find any evidence that BIID is any kind of illness. Try to understand human beeings and stop vilification against people wich your profession declaers for ill. BIID is nothing more then Homosexuality or Transsexuality and in this cases your profession has nothing to say today.

[Christopher Ryan]

Thanks Samantha -

You make two interesting points.

First, you are right (to an extent) about my treatment of people who desire (perhaps need is a better word) other losses of function - paraplegia, blindness, deafness etc. I did deliberately ignore these groups in my paper, but only because I was reluctant to comment on something I had little understanding of. Since the paper's publication, I have met with one person and had correspondence with several others, who "need" to be paraplegic and I find it hard to differentiate them from people who "need" to have an amputation. Whether this equates to the medical profession having a duty to provide elective spinal cord transsection is another issue, that readers may want to take up.

Second, though we can argue legitimately about what might or might not constitute an illness, there is preliminary evidence that people with BIID (amputation variety) may have brains that are wired differently from those of us that do not. Specifically, their superior parietal lobule does not light up when observed with functional neuroimaging. See http://precedings.nature.com/documents/2954/version/1 for these very interesting results from Paul McGeoch and his group.

[Samanta Stillman]

Ok, next year an other scientist write something else. This internal discussion is not in a public interest. Since 100 years your colleges are searching for the reason of GID and the highest European court said that the opinion of a doctor who is against sex surgery is no reason for deny surgery. That´s democracy. And I understand that many Europen doctors have problems with a demcratic thinking (i.e. in Germany, France, Spain). Never any reason for GID will be found from many reasons and with "BIID" we will get the same medical mystery. The good thing is that since 1000 years people solved their problems and they found help and got amputations, blindness and so on. The more your colleges in Europe and in the USA stigmatize people as ill people and the more media labels "BIID" people as ill people the more people fight for a solution in Asia or by a self injury. You and your collegs who belive in a different brain of "BIID" people (what I declare for stigmatization) need a partnership with real "BIID" people. Until now most of your colleges meet only people who need an amputation because of a sex dream. But the majority of real "BIID" people get what they want. Only if you show that you and your colleges are really interested in giving what people wish, you will get a partnership with real "BIID" suffers. So writing, doing research with a number of people who is not a valid number from the basis of statistically sciences give no input in to the discussion. That´s only a internal discussion in the Ethics, Brain sciences or for old fashioned friends of Sigmund Freud. Well, I wish you luck by the discussion of this illness, or a syndrome or a different brain. But you will never get a partnership with real "BIID" suffers. In so fare the doctor from India Ramachandran is right that you and your coleges discuss Apotemnophilie. True "BIID" people compare "BIID" with Homosexuality and Transsexuality and both is not a medical problem in a deep. So there is a high barriere between your thinking and the thinking of your colleges and us. You can jump but you need not to jump, because non of us is interested. We handl our problems like people did in the past. And Paul McGouch understand this because of the very low number of people who was interested in taking part in his studies. You also understand that if you are right with your thesis that "BIID" is a brain problem, it would cause much more people. Such illnesses are not rare. I am wondering of all this uncertainties of your profession (you wrote this too). But as I wrote above you must jump to the idea that you discuss nothing more than a thing like Homosexuality or Transsexuality.

[Simon]

Obviosly shrinks search for a new way earning money since Transsexuality is more a normal thing. Now they need an other way and other arguments to guid people. What a bad discussion and what a unserios argumentation that "BIID" is an illness. Stigmatization is a nice business for shrinks. Now they use a new play gound.

[Christopher Ryan]

I guess since I have now heard this "argument" several times, it is worth tackling head on. First, BIID is vanishingly rare, there is really no prospect of anyone making any money out it. Second, I and most psychiatrists like me, who would see people with BIID are paid as academics. I get paid the same amount no matter how many people I see. Third, even if I (and others) were to profit from BIID, that, in and of itself, hardly constitutes an ethical argument against the proper management of the condition. Appendicectomies generate income for surgeons, but no one thinks they are unethical.

I am not, by the way, particularly committed to classifying BIID as an illness. I think there are good arguments on both sides of this question. Speaking purely practically however, safe amputation requires a surgeon. Surgeons are much more comfortable helping people with illnesses. Also, there are a range of conditions, not usually disputed as illnesses, that mimic BIID. Psychiatrists have expertise in those other illnesses.

[Simon]

This could be an argumentation in your country. It´s not an argumentation in my country. If you or an other psycho will bring "BIID" to the DSM than this is form of stigmatization because this book is a book about psychiatric illnesses and not fictional literature (teh description of GID is today phantasy and fictional writing because only your profession think that Transsexuality is an illness. Also the highest European court that this is nonsens and most people in Europe agree). So and 500 years people got what they want if they fight for their goals. So what? Not all surgeons think that helping people out is unethical. Doctors who think this doesn´t belong to the group of good doctors because their old fashioned opinion. It might be in an interest of your profession in Australia, the USA, England and the Netherlands to solve the problem. For other regions your argumentaion and the public media interest brought much more problems. We here in Europe do not need much more publicity in this earea. And we need not German or Austrian females with a Sigmund Freud fetish discussing their problems with so called BIID people in our public media. Some years before scientists studied first and after that they brought their results to public. Today a so called study with 3 people done in the USA is a reason for a media contact. This is not a a valid thing.