The subject raises issues as to the extent to which it is proper to treat adults with psychiatric or psychological disorders with radical surgery, particularly where the appropriate diagnosis and treatment of the underlying disorder is uncertain or disputed; the limitations which ought to be placed upon consent as a means of rendering surgery lawful and whether the criminal law ought to have a place in controlling operations provided by qualified surgeons upon competent adults with their consent.
Patients with the controversial diagnosis of body integrity identity disorder (BIID) report an emotional discomfort with having a body part (usually a limb) that they feel should not be there. This discomfort is so strong that it interferes with routine functioning and, in a majority of cases, BIID patients are motivated to seek amputation of the limb. Although patient requests to receive the best available treatment are generally respected, BIID demands for amputation, at present, are not. This paper criticises the appropriateness of the particular analogies that are thought to shed light on the allegedly unproblematical nature of BIID demands and argues that a proper understanding of the respect for autonomy in the medical decision-making context prohibits agreeing to BIID demands for amputation.
PSYCHOLOGY Cutting Desire A rare condition compels its sufferers to want to amputate, or paralyze, their own healthy limbs. Inside the strange world of what sufferers call Body Integrity Identity Disorder.
Body integrity identity disorder (BIID) is a very rare condition in which people experience long-standing anguish because there is a mismatch between their bodies and their internal image of how their bodies should be. Most typically, these people are deeply distressed by the presence of what they openly acknowledge as a perfectly normal leg. Some with the condition request that their limb be amputated.1 We and others have argued that such requests should be acceded to in carefully selected patients.1–4 Consistent with this view, a group at the University of Sydney is developing a programme to better understand and treat BIID and to offer amputation if appropriate.