Body Integrity Identity Disorder (BIID) - Is the amputation of healthy limbs ethically justified? [Body Integrity Identity Disorder (BIID) - Lassen sich amputationen gesunder gliedmaßen ethisch rechtfertigen?]

Definition of the problem: The term Body Integrity Identity Disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or the transection of the spinal cord. Arguments: Psychologists and psychiatrists offer quite different explanations for this phenomenon; but currently no successful psychotherapeutical or pharmaceutic therapy is available. Lobbies of persons with BIID explain the desire for amputation in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss controversly about elective amputations of healthy limbs: on the one hand, the principle of autonomy is used to deduce the right for body modification; on the other hand, the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body scheme, for which parallels in stroke patients are known. Conclusion: If BIID is a neuropsychological disturbance which includes missing insight into the illness and a specific lack of autonomy, then amputations would be counterindicated and would have to be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed in order to integrate the alien limb into the body scheme. © Springer Medizin Verlag GmbH 2008.