A Szaszian Rorschach Test

Presented for amusement, possible enlightenment, and for no direct polemical purpose, the first-person tale of Susan Smith, as told to the British Guardian, who wants to be legless, and has gone through a fair amount of personal difficulty to get halfway there. Is she:

a) a screwed-up nut who ought to be locked up to prevent her from hurting herself;

b) suffering from the identifiable medical disorder "body identity integrity disorder," probably because of the chemical make-up of her brain, who doctors have an obligation to help achieve her stated "need" to lose her limbs;

c) a woman with an unusual preference who should be permitted to contract with a willing professional to achieve her desires about her body;

d) who cares what she is or how she gets her jollies as long as I don't have to pay for her fun and games?

An exercise for the reader. I'm aware that your answer could be a combination of some of the above, or parts of some of the above not linked with the other parts, or something completely different.

Jacob Sullum's July 2000 interview with Thomas Szasz, whose writings give many interesting perspectives on these questions. 

Comments

Duckman | February 5, 2007, 10:48pm | #

Any answer but (a).

thoreau | February 5, 2007, 10:59pm | #

You know, philosophically I know I'm supposed to answer (c) and (d). But somehow, I just can't bring myself to endorse the right of an able-bodied person to get her legs cut off.

My answer is "Tough shit. Learn to live with your legs. Don't like using them? Buy a wheelchair and shut the fuck up. But hang on to them, cuz you might change your mind later."

Yeah, I'm a bad libertarian. I mean, we're not talking about a piercing, we're talking about losing her freaking legs.

I don't know where to draw the line between "pierced nipple" and "leg removal", but I'm pretty comfortable saying that leg removal is on the wrong side of the line. The fact that a line is hard (impossible?) to draw doesn't mean that some shit isn't beyond the pale.

Jesse Walker | February 5, 2007, 11:05pm | #

How do you feel about transsexuals, Thoreau?

brian423 (not Brian24) | February 5, 2007, 11:06pm | #

What Duckman said.

I'll accept (c) and (d) without hesitation and (b) somewhat grudgingly. I appreciate the orthodox Szaszian's problems with the "diagnosis" of moods, attitudes, desires, and behavior patterns. But the failure of Szaszian orthodoxy to support medical marijuana, for example, tells me that it suffers from the foolish consistency of small minds.

thoreau | February 5, 2007, 11:09pm | #

Good question, Jesse. A transsexual can still get around and do their thing and take care of themselves, so I figure "Eh, if they'll have more fun with different genitals, have fun."

I know that people in wheelchairs can still get by pretty well, but they're stacking the decks against themselves pretty heavily. And they're doing it in an extreme manner. It would be irresponsible for an ethical professional to help them.

Plus, I can't get past the "For God's sake, we're talking about freaking legs!" aspect. Maybe that's my weakness.

Eric | February 5, 2007, 11:09pm | #

I don't see this as being any different from transsexuality. The person feels they're not in the proper body and they want to change it. I say go for it. I don't understand it, I'll admit that, and of course it makes people uncomfortable. But hey - it's her body.

Thoreau - I doubt she'll change her mind. She said in the article she's felt this way since she was basically a kid. If her eldest child is 15 and she was 23 when she met her "future husband," we can deduce that she's felt this way for at least two, maybe three, decades. It seems to me like that's a belief so firmly ingrained in her that it'll never change.

thoreau | February 5, 2007, 11:10pm | #

I didn't mean to dismiss transsexuals as just being in it for fun. I know it goes deeper than that. I should have said "If they'll be happier with different genitals, well, whatever. Go for it."

Grotius | February 5, 2007, 11:13pm | #

The point is of course not to assume that your personal preferences are the appropriate answer for anyone else.

tarran | February 5, 2007, 11:15pm | #

What Duckman said too.

Although, if I was a doctor, and she came to me asking to amputate her leg, I would refuse.

This business of her having to kill her legs via frost-bite to "force" surgeons to remove them if they wish to save her life is degrading, sick, and needlessly painful.

It's also shame that other people are being forced to pick up the tab for her expensive surgeries (I belive emergency amputations are expensive in that the cost of having the equipment and trained doctors on standby for emergencies is pretty high. Planned amputations are probably less expensive.)

I pity her.

Aresen | February 5, 2007, 11:16pm | #

Just because I go along with c) or d), doesn't mean I disagree with the first four words of a).

FinFangFoom | February 5, 2007, 11:17pm | #

I'm not sure where the bias against answer (a) comes from. Nuts, you'll forgive me if I use the clinical term, may be akin to children, in that they don't have the ability to act freely.

Warren | February 5, 2007, 11:24pm | #

thoreau,
I find your analysis disturbing and disgusting. I don't know what phobia has raised itself to make you suddenly want to tell other people how to live their life, but I hope you at least recognize it as such.

Grotius | February 5, 2007, 11:25pm | #

thoreau,

Check out some of the work of Judith Halberstam sometime.

brian423 (not Brian24) | February 5, 2007, 11:26pm | #

thoreau,
I believe in an adult's right to commit suicide, so I don't see a problem with allowing unnecessary amputation.

FinFangFoom:
Nuts, you'll forgive me if I use the clinical term, may be akin to children, in that they don't have the ability to act freely.

That's dangerous. In recent history, political dissidents and homosexuals have been infantilized with a label of that mysterious quality called mental illness.

FinFangFoom | February 5, 2007, 11:32pm | #

I fail to see how disagreeing with someone politically or desiring to have sex with someone of your own gender equals having one's legs cut off.

Besides the question of whether or not someone will injure themselves due to mental illness, they may also, like children, be incapable of understanding the duties that they might freely take up with regards to others, i.e. they are incapable of entering a contract.

RDNZL | February 5, 2007, 11:36pm | #

Whatever you have to do to have a good time, let's get on with it, so long as it doesn't cause a murder.
~Frank Zappa

thoreau | February 5, 2007, 11:37pm | #

Warren-

I don't have a desire to tell others how to live their lives in general. But every now and then something comes along that crosses my threshold. I know, I know, I shouldn't have a threshold, it should all just be anything goes. Well, FWIW, I probably set my threshold higher than 95% of the population.


Brian423-

Suicide is complicated. If somebody wants out, well, fine, check out then. But if somebody wants to do it in front of me, or try to involve somebody else (except in the case of the terminally ill, who may not be able to do it to themselves without great pain), well, I think just about anybody would try to intervene and stop them. It's not fair to put somebody else in the position of witnessing it (except for the disabled, of course).

Of course, leg removal is the sort of thing that can't be done without an outsider's involvement, so I guess that they have no choice but to involve somebody else.

Like I said, maybe I'm the one who's defective here.

Sudha | February 5, 2007, 11:40pm | #

This is similar to an episode of "Nip/Tuck" where a man wanted his leg cut-off as he didn't feel right with it on. I assumed they were jumping the shark on that one but perhaps there have been a number of cases of this kind of thing?

As to the reasoning "It's just a personal preference": what about the Hippocratic Oath? Wouldn't a doctor at least naturally feel some conflict between honoring a patients wishes and not wanting to violate the oath?

Or how about this: someone with their legs cut off might need more services. I suppose if the amputee wanabee is prepared to pay for it all that takes care of that question. This should include pension and perhaps a signed agreement not to sue under any existing rights for the handicapped legislation if the prospective amputee feels a violation has occurred. Does the legislation currently handle such contingencies? This could get messy.

Grotius | February 5, 2007, 11:42pm | #

...well, I think just about anybody would try to intervene and stop them.

Why?

dead_elvis | February 5, 2007, 11:43pm | #

I would normally be willing to give her the benefit of the doubt that she really feels the way she says. But what's up with the freezing and coaxing the doctors into doing what she wants? If she *really* wants it as badly as she says, what's stopping her from taking a power saw to herself? Or blowing it off with a homemade bomb? While one could say that it would be very difficult to make yourself do something that causes that much pain, she seems perfectly capable of sitting in dry ice with incredible pain.

The fact that she hasn't attempted to do it herself but rather is trying to corner someone else into doing it makes me question her claim as to her motivation.

thoreau | February 5, 2007, 11:46pm | #

Maybe I should pose it this way:

Would it be responsible for a professional to agree to help them? (Assume a consenting adult paying with his own money, all on private property, whatever other details you like.) I'm not asking whether the law should get involved (let's stipulate that there shouldn't be a law here, at least for the sake of argument). We'd all agree that the professional should have the right to turn down the job.

But would anybody here actually be willing to do it? Would anybody here have a high opinion of a surgeon who agreed to do it? If you were responsible for training surgeons (assume it's in a private school, private funds, all that good stuff) what advice would you give to surgeons on whether it would be a good idea to take such a case?

I'm not asking whether these opinions should be translated into law. I'm not even convinced that my own disgust should be translated into law. I'm asking whether anybody can actually justify the action (which is different from discussing a law concerning the action).

brian423 (not Brian24) | February 5, 2007, 11:48pm | #

I fail to see how disagreeing with someone politically or desiring to have sex with someone of your own gender equals having one's legs cut off.

They have in common harmlessness and the tendency to shock and offend many people. The latter tendency has made them crimes in many times and places; the former tendency means that we libertarians know better than to criminalize them.

Besides the question of whether or not someone will injure themselves due to mental illness, they may also, like children, be incapable of understanding the duties that they might freely take up with regards to others, i.e. they are incapable of entering a contract.

You're reasoning backwards. You're assuming that Susan Smith has only a child's intellect, then rationalizing restrictions on her liberty from that dubious assumption.

thoreau | February 5, 2007, 11:48pm | #

Grotius-

So, you could live with yourself if you watched somebody (other than a terminally ill patient) commit suicide?

Or are you just asking "why?" to be a contrarian?

Grotius | February 5, 2007, 11:49pm | #

Would it be responsible for a professional to agree to help them?


That depends on the situation and how those interact with the ideas of the "professional."

Duckman | February 5, 2007, 11:52pm | #

thoreau, I find I usually agree with you but apparently not this time. Unfortunately I think that there is no reasonable way for anyone to draw an arbitrary boundary around what kinds of actions are or are not acceptable if those actions can in no way harm you. Being "repulsed" at the thought of what they are trying to do is not a valid harm. Neither is feeling that the action is "wrong" or "crazy." Many other actions which we would both agree should be acceptable could be condemned by others on these sorts of grounds. The best way to define what behaviors are or are not acceptable is to ask the question, "can this behavior harm me or anyone else?" And if the answer is no, it must be permitted in a truly free society.

Grotius | February 5, 2007, 11:54pm | #

thoreau,

So, you could live with yourself if you watched somebody (other than a terminally ill patient) commit suicide?

Yes, I could. If it is the free and conscious choice of the individual that is. I don't assume that staying alive is necessarily the best option for everyone.

brian423 (not Brian24) | February 5, 2007, 11:56pm | #

thoreau,
Hypothetically, if I trained surgeons, I would urge them to make sure that the patient was firmly persuaded on the course of action over a long period of time--both for ethical reasons and because of legal liability. Beyond that, I don't see a conflict in professional standards here.

Eric | February 6, 2007, 12:00am | #

As to the Hippocratic Oath, I assume the debated section is something along the lines of "Do no harm." I don't think amputating this patient's leg is against that tenet, if the patient desires the amputation. I don't think it's harm against someone if that person wants it.

thoreau | February 6, 2007, 12:00am | #

Duckman-

Yeah, I'm not convinced that I'm right on this. But, well, call me a crazy statist, but I'm just not ready to jump on the pro-right-to-amputate bandwagon without going around the block with the arguments a few times.

There's the issue of consent here, and whether it's meaningful. I'm prepared to contemplate the possibility that the desire to harm one's self (except to bring about the imminent end in the least painful way possible) is a sign that you aren't in your right mind.

Maybe I'm wrong, but this seems extreme enough that I'm not prepared to just apply principle in the usual manner and say "Eh, whatever."

One could say that this is a sign that I'm not really committed to principles. Yeah, maybe. Then again, I don't see that as necessarily a bad thing. Absolute adherence to a set of principles requires absolute certainty, and I'm not prepared to go down the road of absolute certainty. I need to think this one through before I conclude that nobody should try to stop another person from cutting off her legs.

Ken Shultz | February 6, 2007, 12:02am | #

Has anyone else out there read "Geek Love"?

http://www.amazon.com/Geek-Love-Katherine-Dunn/dp/0446391301

...it's about a freak show and a particular freak. He starts a cult in which people do exactly this sort of thing. ...Have major surgery to make themselves...er...unique.

Well it's about that among other things.

Madpad | February 6, 2007, 12:06am | #

I don't see this as being any different from transsexuality. The person feels they're not in the proper body and they want to change it. I say go for it.

Using transexualism as an example of why someone should be allowed to harm themselves is
a pretty odd reach.

This "it's not up to me to tell anyone how to live their life" is a pathetic cop-out.

To quote Ms. Smith, "I have something called body identity integrity disorder (BIID), where sufferers want to remove one or more healthy limbs.

She has a disorder. Get it? She even says she has it. It's a malfunction in her noggin. This isn't a lifestyle choice. It's a mental illness.

There's no excuse for letting people harm themselves no matter how rational she comes off.

Aresen | February 6, 2007, 12:06am | #

thoreau has an excellent point.

While we may agree that all people have a right to control their own destiny, that in no way obligates us to collaborate with them in fulfilling their desires.

If you want to kill yourself, take certain drugs, or mutilate yourself, you are free to do so, but I refuse to help you.

And I won't think very well of anyone who does.

Skip | February 6, 2007, 12:07am | #

There's a good short documentary called "Whole" which is about several people with this condition. It does seem to be a real disorder, and some people will attempt to perform these amputations themselves if no one will do it for them.

It's not about "jollies," either. That's a different disorder. Sexual feelings are not associated with this one.

Grotius | February 6, 2007, 12:08am | #

Aresen,

thoreau's point seems rather obvious.

thoreau | February 6, 2007, 12:12am | #

Ah, getting testy again, Gunnels?

Grotius | February 6, 2007, 12:13am | #

Madpad,

No, relying only on the qoute (I haven't read the article) she appears to only merely relate what others describe it as.

thoreau | February 6, 2007, 12:14am | #

Madpad-

Good point. If she's calling it a disorder, if she's saying that there's something wrong with her, she's basically calling into question her own capacity for rational thought (on this matter), and hence her ability to consent.

Grotius | February 6, 2007, 12:14am | #

thoreau,

No, are you?

BTW, the only reason that I get testy with you is because of your self-described efforts to troll me. If your blog Inactivist were up I'd link to one such confession.

Grotius | February 6, 2007, 12:19am | #

Here is the statement which the quote in question is nested in:

To the general public, people like me are sick and strange, and that's where it ends. I think it is a question of fearing the unknown. I have something called body identity integrity disorder (BIID), where sufferers want to remove one or more healthy limbs. Few people who haven't experienced it themselves can understand what I am going through. It is not a sexual thing, it is certainly not a fetish, and it is nothing to do with appearances. I simply cannot relate to myself with two legs: it isn't the "me" I want to be. I have long known that if I want to get on with my life I need to remove both legs. I have been trapped in the wrong body all this time and over the years I came to hate my physical self.

FinFangFoom | February 6, 2007, 12:19am | #

brian423, I am simply making the point that if she is nuts, she is incapable of making decisions (such as enter into a contract), she is like a child and as such is incapable of making decisions about her ownself. In regards to some issues, she may be like a child. The other responses to the original question, in Doherty's post, seem to indicate that her mental state is irrelevant, as she is an adult, and can make whatever decision she chooses.

Eric | February 6, 2007, 12:20am | #

MadPad - Is it harm if the person desires it? I don't think so. And I think you're missing the point of that quote. The important part, in my eyes, is the second sentence: "The person feels they're not in the proper body and they want to change that." I used transsexualism as an example because it's appropriate in this case, I think. It's a person who desires a major physical change requiring major surgery, the end result being that the person is different, and (presumably) happy. Transsexualism is currently classified as a disorder, as I understand it (one of my close friends is beginning her->his transition), and requires a lengthy psychological evaluation and the shrink's signature on various forms in order to begin the necessary treatments. BIID should be (and assuming it ever becomes better-known and more accepted) the same, minus the classification as a disorder.

Grotius | February 6, 2007, 12:25am | #

I thought the most telling portion of that quote was this one:

I simply cannot relate to myself with two legs: it isn't the "me" I want to be.

Again | February 6, 2007, 12:28am | #

I'm with Thoreau. People who wish to permanently disfigure themselves for no reason except for personal preference, I think pretty much fail the "of sound mind" basis for these sorts of decisions.

Anyone know what the numbers are on this, and if there's been people who have amputated healthy limbs and subsequently regretted it and added a prosthetic limb?

Grotius | February 6, 2007, 12:41am | #

People who wish to permanently disfigure themselves for no reason except for personal preference, I think pretty much fail the "of sound mind" basis for these sorts of decisions.

I suppose from her perspective she isn't disfiguring her self.

dead_elvis | February 6, 2007, 12:41am | #

ut would anybody here actually be willing to do it? Would anybody here have a high opinion of a surgeon who agreed to do it? If you were responsible for training surgeons (assume it's in a private school, private funds, all that good stuff) what advice would you give to surgeons on whether it would be a good idea to take such a case?

I'm going to say that no, I wouldn't take that case, and I wouldn't recommend it to anyone outside of Dr. Nick (Hello everybody!). I would recommend leaving it off the resume when applying for jobs. If you feel compelled because you really think you're helping her, go for it, but only after having her evaluated several times by a mental health professional. But do it at her house and don't go around bragging. Strictly being practical here.

I'm not asking whether these opinions should be translated into law. I'm not even convinced that my own disgust should be translated into law.

Once again, we demonstrate why we on H&R are a totally different species from the average voter ;)

And again, I would question why she's willing to corner others into doing it for her in a way that risks her life and is painful yet not it any way that's potentially messy.

Sorry | February 6, 2007, 12:45am | #

Anyone know what the numbers are on this

Binary.

Grotius | February 6, 2007, 12:45am | #

dead elvis,

The article deals (in a way) with some of what you are saying:

I think BIID will stay taboo until people get together and bring it out. A hundred years ago, it was taboo to be gay in many societies, and 50 years ago the idea of transsexuals was abhorrent to most. I have tried to make the condition more understood but it is difficult to get a case out in the open by yourself. My psychiatrist went to a meeting last year in Paris, and many doctors there told her that they had operated on people who needed an amputation under mysterious circumstances, and how happy the person was when they woke up. It led them to believe that perhaps BIID is more prevalent than people think.

rm2muv | February 6, 2007, 12:48am | #

Perhaps one could suggest that she read up on Pegleg Smith, a mountain man who had to amputate his own leg after a severe injury.

I find it hard to accept that anyone who would willing cut off healthy legs is acting with 'free will'. I guess I'd be unwilling to become a participant in any way, regardless.

I was considering a response that included 'not having a leg to stand on' but thought it might be inappropriate.

Sorry again | February 6, 2007, 12:54am | #

What if, technology making it feasible in a few years, she wanted instead to add a leg (or a finger, or a wing, or horns)?

You guys figure it out; I'll just watch.

Speaking of which, why has no one lowered the stakes to other irreversibles: taking out an eye (or two), cosmetic breast reduction, vasectomies, circumcisions, electrolysis?

Grotius | February 6, 2007, 12:57am | #

Sorry Again,

Very good point. If you don't mind I'd like to expand on it a bit.

In the future we might be adding all manner of devices to our bodies and removing our "natural" appendages. What do folks think of that?

Ken Shultz | February 6, 2007, 1:00am | #

So if I'm reading the consensus correctly, the question isn't really about whether she should be allowed to have the surgery, but whether whomever performs such a surgery should be criminally liable for performing it.

...and yeah, if I'm sittin' on the jury, I'm lookin' at that doctor like he raped a retard.

Still sorry | February 6, 2007, 1:01am | #

expand on it

...making use of whatever the future inverse of gastric bypass surgery will be...

Aresen | February 6, 2007, 1:06am | #

It occurs to me that any physician who did assist this person would be violating the first rule of medicine:

"Do no harm."

Of course, cosmetic surgery does come very close to the line, but it is cosmetic and, theoretically, reversible to some degree. We may reach the point someday where a limb or organ can be replaced at will, but for now we cannot replace a leg.

TCR | February 6, 2007, 1:08am | #

I just read a fascinating article in an old book (The Man Who Mistook His Wife for a Hat by Dr. Oliver Sacks) that is weirdly similar. The patient in question had suffered some kind of stroke and ended up "rejecting" his left leg - it got to the point where he woke up one day thinking his own left leg was someone else's dead , amputated leg placed in his bed as a joke. Horrified, he tried to push the leg out of his bed and ended up falling out with it. A fascinating book if you were looking for a little light reading.

Has anybody considered that this woman has had some kind of brain damage? If she does have some kind of real damage to her brain, does it help to make up trendy names for her "disorder" and talk about raising awareness?

TCR | February 6, 2007, 1:14am | #

Or to talk about her freedom of choice for that matter?

TCR | February 6, 2007, 1:15am | #

In the future we might be adding all manner of devices to our bodies and removing our "natural" appendages. What do folks think of that?

I've always thought a prehensile tail would be nice.

Duckman | February 6, 2007, 1:18am | #

I'm with Thoreau. People who wish to permanently disfigure themselves for no reason except for personal preference, I think pretty much fail the "of sound mind" basis for these sorts of decisions.

People who choose to smoke cigarettes are also making a choice that they do not mind disfiguring their health and perhaps even ending their lives prematurely. Are they not in their right mind?

Also, to Aresen's earlier point... to not forbid something is far from "helping" someone to do something. It merely shows that your own opinion may be wrong, and you are willing to give someone the benefit of the doubt. It does not mean you condone of their actions.
Or, think of it this way...just because I've not forbidden you from mowing my lawn doesn't mean that I am going to help you get the job done.

This reminds me of the old adage that everyone loves the concept of a free person until they actually meet one...

Grotius | February 6, 2007, 1:19am | #

TCR,

Most bloggers would surely want some sort of device implanted in their brain which gives them web access, wi-fi, etc. so that one can simply "think" comments into existance.

Laudanum Milkshake | February 6, 2007, 1:34am | #

The only thing that truly sickens me is what seems be her inability to accept responsiblity for her actions. She shrugs off responsibilty by saying "it's a disorder" and then attempts to damage herself (in a rather inefficient way I might add) in order to force a surgeon to remove her legs. Also I must wonder if amputation is what she truly wants, or if (like many suicide attempts) she is merely trying to draw attention to the fact that she has psycholoogical issues. I notice that many people on this blog assume that we must make the distinction of whether or not she is "sane". To me the only question is whether or not she is a self-aware sentient. If so, then we have no right or obligation to hinder her actions regardless of how bizarre we judge them to be.

mrbill | February 6, 2007, 2:08am | #

Can we use her for 2nd base after shes done....

ChicagoTom | February 6, 2007, 2:51am | #

My opinion is to let her do what she wants to do.

It's a "disorder" because some doctors say it is. Since the average or typical person finds it repulsive or disgusting, all of a sudden people want to say "well obviously there is something not right with her". I dunno if I buy that. Maybe the only thing "not right" about is her is that she was born with two legs.

It does seem like an arbitrary line some people are drawing. The sex change example does seem rather apt. To most people, it's considered a form of self-mutilation. Someone is literally mutilating their genitals and their body in order to have the body parts they believe they should have been born with. What makes this different than BIID? In both cases someone feels that have been born physically incompatible with their mental state.

What makes the mental state of someone labeled as having BIID sick or psychologically screwed up? (esp when compared to someone who wants to have a sex change)

I just don't how so many people can accept that there must be something wrong with her or that she can't be trusted to make this decision for herself and that someone doctor should be able to trump her decision. Obviously, any doctor should be able to refuse to perform the procedure, but I don't think that any doctor who performs this operation should be stigmatized or treated with contempt.

As for the "do no harm" argument. If, by all accounts this person is functional in their life and society except for a persistent feeling that they shouldn't have their legs, I believe refusing to give the patient what they want is doing more harm. Forcing someone to live in a state that is causing mental anguish(and might even compel them to take drastic measures to force an amputation) is more harmful than performing this as a voluntary procedure in a safe setting.

To me this is no different than when plastic surgeons who keep performing face lifts and tummy tucks and botox and countless other procedures things on women who desire to be thinner/younger looking/prettier etc. What makes the women and men who do these procedures trying to stay beautiful/young "normal" or at least not mentally incapacitated??

genie arnold | February 6, 2007, 3:16am | #

See novel called "Limbo" by Bernard Wolf

Syd | February 6, 2007, 3:34am | #

Anybody considered
(e) This is a hoax?

biologist | February 6, 2007, 4:26am | #

FinFangFoom | February 5, 2007, 11:32pm | #

I fail to see how disagreeing with someone politically or desiring to have sex with someone of your own gender equals having one's legs cut off.

you appear to be confusing transsexuals with homosexuals.

transsexuals are usually expected to live as a member of the sex they want to become for a period of time (months to a year) before doctors will perform the surgery. there's no reason this woman couldn't be asked to live as though she has no legs: give her a wheelchair and, I don't know, tie her legs together.

alternately, give her medication and see if she still feels the same way.

I take it most here disagree with the Baker Act provision that individuals can be prevented from harming themselves, and would limit the Baker Act to preventing individuals from harming others?

former libertarian | February 6, 2007, 8:10am | #

How could any or you side with this weirdo? This is just more proof to me that libertarianism is a cooky cult with no sence of decency. Congradulations. I am now no longer a libertarian.
No-one in their right mind should deny the existance of mental illnesses. This just confirms my suspicions thatlibertarians are just a bunch of PoMo creeps. This person should be cured, not allowed to hurt herself.

AM | February 6, 2007, 8:17am | #

It was Szaszianism that got all the mental hospitals closed and set the crazies out onto the streets in the 80's.

FinFangFoom | February 6, 2007, 9:06am | #

biologist, No, I was responding to brian423's comment that it is dangerous to say that some like this woman is nuts and shouldn't be allowed to do this because people have said the same thing to gays and political dissidents.

Rhywun | February 6, 2007, 9:12am | #

What makes this different than BIID?

It's different because the ultimate goal of a transsexual is to become as fully-functional in the opposite sex as possible. The goal of this woman is to become a helpless cripple.

Warren | February 6, 2007, 9:31am | #

How could any or you side with this weirdo?


Good point. Anyone who is different is a weirdo and doesn't deserve the protection of law. We should never recognize the rights of people that frighten us because they think/look/pray differently than we do.

former libertarian,
Your comment just confirms that only libertarians have any decency. And that other social doctrines are just a pretext for indulging prejudice and oppressing others.

David | February 6, 2007, 9:35am | #

I was going to say that she can't do it herself without dying, and no doctor is going to do it for her, so it doesn't matter. But I wonder if she could damage her legs enough to make amputation necessary without killing herself? I think that puts her in category a).

Grotius | February 6, 2007, 10:01am | #

David,

According to the piece one of her legs has already been amputated.

jtuf | February 6, 2007, 10:06am | #

Breaking up the ethics and law is the best way to handle this. It's immoral for a doctor to remove legs from a person unless there is something physically wrong with them. Since we shouldn't legislate ethics, it should still be legal. I would try to stop it by exercising my 1st ammendment rights, but I would oppose any law against it.

Madpad | February 6, 2007, 10:11am | #

If I'm reading this right, the libertarian view is that anyone making a decision that causes them harm - no matter how insane, irrational, disordered or diseased they are - should be viewed as simply making a lifestyle choice as long as they aren't harming anyone else.

I'm going to take the view that that's stupid as hell. That essentially renders all advances in psychology and neurology moot and pointless and asserts a warped view of personal choice.

There is a gray area and a shifting line where mental disorder and choice overlap. It's individual and involves a growing understanding of the brain by the medical and psychological communities.

Lumping all serious medical and psychological problems into "choice issues" is an oversimplication. It only helps libertarian absolutist rationalize their philosophical determination to remain uninvolved.

Grotius | February 6, 2007, 10:18am | #

That essentially renders all advances in psychology and neurology moot and pointless and asserts a warped view of personal choice.

Not really. I assume that most folks will avail themselves of such advances, just as I assume that most folks will avail themselves of new cancer treatments.

Not That David | February 6, 2007, 10:39am | #

Breaking up the ethics and law is the best way to handle this. It's immoral for a doctor to remove legs from a person unless there is something physically wrong with them. Since we shouldn't legislate ethics, it should still be legal. I would try to stop it by exercising my 1st amendment rights, but I would oppose any law against it.

Works for me.

pinko | February 6, 2007, 10:56am | #

"Has anyone else out there read "Geek Love"?

Yup, that was the first thing I thought of. I'm waiting for club feet, hairlips, and hunchbacks to be added to the list of disfigurements that bored middle class kids (especially) will undergo in order to gain some kind of circus cred. The legless thing certainly goes beyond this trend toward disfigurement, but I think it's related.

Some quick questions: How many of these urges to elaborately disfigure oneself (beyond genital mutilation and neckrings) and/or starve oneself are really just the product of well-to-do societies? Is there anorexia in, say, Ethiopia? Do semi-nomadic women get their legs chopped off? Any anthropologists out there who have any thoughts about this? Just curious.

de stijl | February 6, 2007, 10:59am | #

After reading about this a little, I have to admit it's quite disturbing but fascinating. Apparently the incidence of BIID is not tiny. It's not as prevalent as the "my friend ana" crap, but there are websites and codewords like "pretenders." Wannabes post crowing messages when they've got the surgery.

There is even a disorder where some folks have a sexual desire for people who have had amputations by choice. Stump chasers or something.

How did people with rare and well out of the mainstream compulsions like this cope with life before the internet?

Warren | February 6, 2007, 11:03am | #

If I'm reading this right, the libertarian view is that anyone making a decision that causes them harm - no matter how insane, irrational, disordered or diseased they are - should be viewed as simply making a lifestyle choice as long as they aren't harming anyone else.

No, if we are indeed talking about an "insane" person, then they can be deprived of their rights by a due process of law. However, you can't just label someone "insane" and deprive them of their rights because you find their actions personally repugnant.

Your comment implies Ms Smith is grossly insane, irrational, disordered or diseased. But there is scant evidence of this. You seem to think that anyone who would cut off a limb must be crazy. That sort of narrow minded hubris is dangerous.

Marc Nelson Jr. | February 6, 2007, 11:03am | #

"parts of some of the above not linked with the other parts"

An interesting choice of words, given the subject matter! I pick C and D.

JasonL | February 6, 2007, 11:08am | #

People should be able to contract for this sort of thing, in theory. If this woman has sufficient funds to handle her life with a decreased capacity to produce, it is an odd request with no implications to anyone but her and the doctor - i.e. the parties contracting here. There are other moral considerations if this woman's choice eliminates her ability to support herself, unpleasant though it may be to contemplate.

I recognize that this is a mental disorder of some sort, but it isn't like there is an alternative you can throw at her. Taking this whole thing as a non-hoax because it is interesting to do so, we have a person saying she is propelled into depression because she has a leg. I'm not ready to say that we can legislate perpetual misery for this person.

Robert | February 6, 2007, 11:26am | #

I go for "c" for that word "permitted", but I'd hope no doctor would ever take her up on it. She's never going to be happy no matter what.

Grotius | February 6, 2007, 11:29am | #

Let's try to analogize to a common enough religious activity - self-flagellation. Are self-flagellants "nuts?"

Madpad | February 6, 2007, 11:29am | #

Your comment implies Ms Smith is grossly insane, irrational, disordered or diseased.

Bingo

But there is scant evidence of this.

In your opinion. Talking in a calm voice with rational speech patterns is not, by itself, evidence that she does not have some sort of disease or severe mental problem compelling her decision. Lots of very troubled and/or disturbed people can appear rational.

You seem to think that anyone who would cut off a limb must be crazy.

No. There is certainly occassions that may warrant it. But in Ms. Smiths words, "I have long known that if I want to get on with my life I need to remove both legs. I have been trapped in the wrong body all this time and over the years I came to hate my physical self.

These are not the musings of a rational mind. I suggest that the wish to remove her legs is likely the outlet of some other issue.

Applauding her for making an individual life choice by cutting off her legs while not exploring the actual issues that may be driving her decision is typical of some of the more cloddish attempts to shoehorn the great notions of libertarian thought into areas where it is if limited practical use.

That sort of narrow minded hubris is dangerous.

Jesus. Whose being more close minded here? The libertarian absolutist who can't admit the lady may have mental problems or the guy who says it's more complicated than that? From my view, the hardcore libertarians are among the most close-minded and inflexible on virtually every issue.

Grotius | February 6, 2007, 11:33am | #

From my view...


Bingo!

whoever | February 6, 2007, 11:37am | #

Who am I, the government, or her husband?

Her husband should lock her up for her own safety.

thoreau | February 6, 2007, 11:40am | #

Jason, I think your point is very reasonable. But I wonder if this is really the only way to alleviate her misery. Again, I'm not sure that some law should be used to try other ways of alleviating her misery. But I also wonder if any professional could in good conscience go down that road without considering the possibility that there may be a psychiatric remedy.

If some guy begged a doctor to cut off his hand because the voices in his head told him to, I think we'd all agree that the doctor would do better by giving him a prescription for antipsychotics. (No, I didn't say anything about coercing the use of antipsychotics, just a simple "Look, I'm not going to voluntarily contract to use my private property yadda yadda for this, but I will voluntarily offer the service of yadda yadda recommending some [insert drug here]."

I'm not willing to say that honoring any and all crazy requests (assuming private funds, yadda yadda) is the way it should be in a free society. It may be that nobody should be forced to deny certain requests, so maybe as far as the issue of coercion all we need to do is apply principles and say "Eh, whatever." But I still think there's more to this, and I'm not willing to just say "Hey, whatever floats her boat, who am I to say that this is messed up?"

Madpad | February 6, 2007, 11:50am | #

Jason, I agree that you make a fairly good point but as for this statement:

I recognize that this is a mental disorder of some sort, but it isn't like there is an alternative you can throw at her.

The prospects of alternatives is left unaddressed in the article and may be unexplored in her real life. If you recognize that she she has a mental disorder, then the question of whether she has received any treatment for it is unknown.

As a result, letting her cut off her legs without at least attempting to treat the mental problem is pretty irresponsible.

Grotius | February 6, 2007, 11:52am | #

Which of these activities should be proscribed?

Mountain Climbing
Cocaine Use
Single-Person Ocean Sailing
Voluntarily Cutting Off A Limb
Eating Pufferfish
Reading Marx
Gambling
Barnstorming
S&M

xon | February 6, 2007, 12:01pm | #

I think the comments asking about her future intentions bear some looking at. The blanket waiver of all ADA/handicapped/publicly funded medical/lifestyle benefits seems to be a likely useful filter here. And anybody contemplating this should be required to demonstrate a willingness and ability to do so BEFORE we go chopping things off.

As to the legal/moral, jtuf got it right, but also needs to add the future implementation of it. Is she prepared to drag herself up steps with no assistance whatsoever? Am I right in being offended to the point of refusing my services/business/association to her in all cases?

Another angle, the is perhaps more relevant: Is she calculating that MY regard for HER will be altered (likely in a way that could be rationally assessed as 'in her favor') by becoming a 'cripple'? When I see her dragging herself up 2 flights of steps, how am I as a decent, western man supposed to feel? What about wheeling herself the 4 blocks from the peasant's parking spaces in many office complexes/public venues? Is she subconsciously calculating that I'll feel compassionate toward her? That people will let her cut to the front of a long line? Could that be what is motivating her: escapism? Bottom line, this seems like she is seeking the status of victim to alleviate the un-articulated trials of living her life.

As ever, 'cui bono' strikes again. . .

Grotius | February 6, 2007, 12:05pm | #

Bottom line, this seems like she is seeking the status of victim to alleviate the un-articulated trials of living her life.

Based on what exactly?

anon | February 6, 2007, 12:05pm | #

I would like to see some followup data from people who have a voluntary amputation - are they satisfied with their choice, 1/5/10/30 years down the line, or do they wish someone had intervened to stop them? I have the impression that most transsexuals are very happy with their choice, whereas suicidally depressed people are sometimes grateful that they were stopped and are happy and relieved to be on antidepressants, so I am very opposed to interfering with transsexuals, but somewhat in favor of forcibly preventing suicides or at least requiring that suiciders try antidepressants first. If amputees don't generally regret their amputations then I think they should be free to do them, but if they usually later "come to their senses" about it, I think as a society we have some obligation to those future "saner" people to protect them from themselves, the way you would not let a drunk friend get a tattoo.

Son of a! | February 6, 2007, 12:08pm | #

I hate being late to the party.

The libertarian in me says, "Choose (d), even if it makes you feel all weird and stuff."

The part of me that lives in the real world says, "(d) is not a valid option, thanks to the Americans with Disabilities Act."

xon | February 6, 2007, 12:08pm | #

Grotius,

Address my questions/assertions.

Grotius | February 6, 2007, 12:10pm | #

anon,

...but somewhat in favor of forcibly preventing suicides or at least requiring that suiciders try antidepressants first.

Require how? Someone committed to killing themselves will do it, whether they are on antidepressants or not. Antidepressants aren't some "magic happy pill" after all.

Grotius | February 6, 2007, 12:14pm | #

xon,

I did. You made a claim. I'd like to know what evidence you have for said claim.

Neu Mejican | February 6, 2007, 12:16pm | #

It seems to me that those arguing that this woman's choice is a free choice have a very unsophisticated understanding of how the mind works.

Check out
http://www.amazon.com/User-Illusion-Consciousness-Penguin-Science/dp/0140230122

The deeper question for libertarians is not about the ethics of harm, but the biology of free will.

Which part of the mind gets status here?

For doctors this is a clear ethical choice.

Treat the mental illness, leave the legs intact. The legs are not the cause of the problem, so they should not be part of the treatment plan. A doctor who cut off the legs should loose licensure because they don't seem to understand the basics of diagnosis and treatment.

Grotius | February 6, 2007, 12:18pm | #

"Grotius | February 6, 2007, 12:14pm | #

xon,

I did."

Based on what exactly?

. . .

BladeDoc | February 6, 2007, 12:21pm | #

As a practicing surgeon I can just about guarantee that she would not find a facility to get herself an elective amputation. There is no contract or consent form strong enough to prevent her from calling a lawyer the day after the surgery and suing the doctor for removing a healthy leg.

The other objection I have has been touched on briefly by others but I'd like to restate it strongly. In a country with the ADA that makes demands on other people as well as medicaid that pays for the disabled's medical bills you should not be allowed to cause yourself to become eligible for public assistance or put yourself in a position to force other people to make job concessions on your behalf. Get rid of those laws or make those who voluntarily make themselves eligible and more power to her. As long as I'm (the taxpayer) is paying, no.

Neu Mejican | February 6, 2007, 12:21pm | #

And to pre-empt the analogy between cosmetic surgery and this... cosmetic surgery should cause no functional deficits... this would and is, thereby, a very different animal.

Grotius | February 6, 2007, 12:23pm | #

Neu Mejican,

Alright, maybe I do have an unsophisticated notion of how the mind works. But let me ask you a query in relation to the following statement of yours.

The legs are not the cause of the problem, so they should not be part of the treatment plan.

So, what happens if, after ten years of "treatment," an individual still wants to be rid of his or her legs?

Neu Mejican | February 6, 2007, 12:29pm | #

Grotius

"So, what happens if, after ten years of "treatment," an individual still wants to be rid of his or her legs?"

So continue to treat the underlying cause. Some illnesses, mental or not, are chronic. This disorder does not manifest in the legs, it manifests in the mind.

Imagine, for instance, that she gets her amputation, and this results in the (very common) phantom limb syndrome.

pigwiggle | February 6, 2007, 12:30pm | #

Clearly she is insane. She isn't competent to make this kind of decision. Having said that, if the only way to offer the poor woman relief from her disorder is to treat the symptom, that is, by removing her leg(s), then I suppose that's fine. I don't know that there is any point in waiting for a cure; it isn't uncommon to have a suboptimal procedure or surgery when no clear alternative is available. For example, some folks have such severe seizures that they have portions of their brains removed, which can result in profound brain damage. Now, most seizures aren't directly life threatening, although very infrequently they result in heart attack. Would you have the person afflicted with an extreme seizure disorder wait for a non-distructive cure? Of course not. Off with her legs.

Grotius | February 6, 2007, 12:30pm | #

Neu Mejican,

What happens if the "treatment" leads to a simple desire for suicide?

Neu Mejican | February 6, 2007, 12:31pm | #

BladeDoc,

So nice to know that your only consideration is your own legal liability.

Fucking scary that you don't even consider the ethics of an inappropriate treatment.

Neu Mejican | February 6, 2007, 12:35pm | #

Grotius,

You are still off target.
Whatever the success or failure of the treatment of the disorder... cutting off her legs is not addressing the cause of the disorder... treatments must be aimed at the underlying cause.

Trade-offs like those Pigwiggle refers to are different since they are actually addressing the cause of the disorder (even if they are sub-optimal).

Leg amputation does not cure mental illness.

thoreau | February 6, 2007, 12:36pm | #

Neu Mejican-

In defense of BladeDoc, I think his concern is that there's no way to know that the patient will indeed be made happy by this (i.e. that it will really help the patient). If he does the surgery and the patient isn't any happier then he's screwed in court, and the patient is still unhappy AND disabled. So nobody wins.

Warren | February 6, 2007, 12:39pm | #

Jesus. Whose being more close minded here? The libertarian absolutist who can't admit the lady may have mental problems or the guy who says it's more complicated than that?

Not so. I can admit that the lady may have mental problems. I'm just not going to take your word for it. If you want to take away her rights as a citizen I'm going to require some due process of law.

Neither are you claiming this is "complicated". You are claiming that you possesses an infallible ability to spot the musings of a rational mind. At least you claim Ms. Jones are not such. Based on what? Nothing more than you're ignorance.

I agree that amputation may not be the preferred method of treatment in this case. But that is a matter for her and her doctor.

Grotius @ 11:52am hits the nail on the head. When you start saying we can deprive people of their liberty based on self evident wackaloonyness and not lose any sleep over it, that is the proscription for a totalitarian regime where only blond-haired blue-eyed purebred Aryans are allowed to roam the streets.

Grotius | February 6, 2007, 12:39pm | #

Neu Mejican,

Actually, I think I am completely on target. If your "treatment" is worse than the "disease" then maybe the "treatment" ought to be reconsidered.

pigwiggle | February 6, 2007, 1:07pm | #

treatments must be aimed at the underlying cause. Trade-offs like those Pigwiggle refers to are different since they are actually addressing the cause of the disorder (even if they are sub-optimal).

There are lots of disorders or 'problems' where medicine is only capable of treating the symptoms, often with unpleasant or harmful side effects. A trivial example would be sinus congestion. Many congestion treatment cannot correct the underlying cause and simply treat the symptom. Most will cause congestion if used for more than a few days; not a particularly terrible side effect. The cause of Chron's is unknown (perhaps autoimmune), and the treatments only target the unpleasant symptom. Some with adverse effect; liver damage, osteoporosis, etc. It is a similar trade off. There is a litany of others.

A great deal of medicine only makes a sick person more comfortable, sometimes at the expense of other aspects of their health.

Grotius | February 6, 2007, 1:27pm | #

Warren,

I don't know if I hit the nail on the head or not. However, I would say that my default position is one where I try not to impose my own moral vision on others. So in the case of voluntary leg amputation I'm going to argue for the freedom to do so until I can be convinced otherwise.

I'd say that the best argument so far is the ADA argument. Still, some people (no one here I assume) make similar arguments about aliens (illegal or not) using government resources and I don't find those arguments compelling enough to support restrictions on immigration (indeed, I want it to be liberalized).

Jennifer | February 6, 2007, 1:29pm | #

This thread reminds me of a colleague I once had, an immensely annoying fellow who would argue anything solely for the sake of arguing. I remember once he said that sunrise is a matter of faith--we don't know that the sun will rise tomorrow, since of course the sun might explode or a rogue asteroid knock earth out of its orbit tonight. . . he's right in an overly semantic way, but he insisted that there is no qualitative difference between my "faith" that day will follow night tomorrow, and a fundamentalist's "faith" that she will never die because Jesus will rapture all the Christians to heaven tomorrow.

If he knows about Hit and Run, he's one of the guys arguing that really, there's no qualitative difference between a woman who wants to remove a healthy leg and a woman who wants breast-reduction surgery.

Neu Mejican | February 6, 2007, 1:31pm | #

Pigwiggle,

Treatments can target the symptom, true.

Again, her symptoms are not in her legs. Her symptoms are in her mind.

Treatments that are used to make patients more comfortable typically have a demonstrated ability to provide the intended relief.

Neu Mejican | February 6, 2007, 1:35pm | #

Grotius,

You haven't convinced me of your aim yet.

While this "If your "treatment" is worse than the "disease" then maybe the "treatment" ought to be reconsidered" is true.

You are fogetting to apply it to the treatment under discussion... leg amputation.

If it applies it applies to all treatments and it is the very principle that would exclude treatment by amputation.

Grotius | February 6, 2007, 1:36pm | #

Neu Mejican,

Treatments that are used to make patients more comfortable typically have a demonstrated ability to provide the intended relief.

So, presumably if we establish (you pick the criteria) that removing the legs of the individual does provide relief, then the treatment is appropriate, right?

Grotius | February 6, 2007, 1:38pm | #

Neu Mejican,

You are fogetting to apply it to the treatment under discussion... leg amputation.

So, are you basically arguing that there are no circumstances where leg amptutation is perferred option for someone with this issue?

Neu Mejican | February 6, 2007, 1:40pm | #

Grotius

"So, presumably if we establish (you pick the criteria) that removing the legs of the individual does provide relief, then the treatment is appropriate, right?"

How would you gather the evidence base to establish your proof?

Neu Mejican | February 6, 2007, 1:43pm | #

"So, are you basically arguing that there are no circumstances where leg amptutation is perferred option for someone with this issue?"

Yep.

And you are confusing medical justification with political rhetoric.

thoreau | February 6, 2007, 1:45pm | #

To put a different spin on this:

Suppose that, in the future, electronic implants become available that can control (and reversibly turn off or on) nerves. Such implants could simulate paralysis. Assuming they were safe, easy to implant, reversible, all that good stuff, such a device could be used to simulate the loss of a limb in a reversible manner. This would provide at least partial relief for people who insist that amputation is the only way to relieve their suffering, without involving any significant disfigurement (beyond a small surgical scar where the implant is put in).

Now, I can think of plenty of more urgent applications for such a technology (e.g. helping the paralyzed), I doubt anybody will be rushing out to develop it for the sole purpose of aiding would-be amputees, but if it became available as a byproduct of some other endeavor, it could provide a fascinating means for studying this condition without actually cutting off any limbs.

I don't see any ethical concerns (assuming it's safe and all that) in such a reversible treatment.

Grotius | February 6, 2007, 1:48pm | #

Neu Mejican,

Well, there may be people injuring themselves in order to get a limb removed. So one way to do so is to investigate perhaps some case histories on them can be gathered.

_______________

A lot of the concerns expressed here seem to deal with issues of "future consequences." However, if an individual is taking a legal, institutional route for this sort of procedure there is clearly going to be a fairly long wait (probably years) between expressing the desire and having the procedure done.

Grotius | February 6, 2007, 1:51pm | #

Neu Mejican,

And you are confusing medical justification with political rhetoric.

As it is the case that most of the objections here are based on subjective moral viewpoints I don't see how "rhetoric" of a political nature or otherwise can possibly be divorced from this issue.

Neu Mejican | February 6, 2007, 2:09pm | #

Grotius,

Since we will fail to agree on the issue of whether the amputation is the right medical decision... think again about the issue of free will in these cases.

Why does a compulsion that, most likely, results from a impairment of some cognitive system (the body identify system, let's call it), get raised to the status of a free choice?

If you know people with OCD, you know that they don't have a choice in their compulsions. Treating the compulsion as a free choice leads to many problems.

I am not, by this, trying to reduce the complexity involved in determining the difference between a compulsion and a free choice... but BIID doesn't seem to be a marginal case.

Stormy Dragon | February 6, 2007, 2:09pm | #

A lot of the commenters are commiting a semantic slippery slope falacy. The fact that the boundary between two cases can not be satisfactorily determined does not mean that the two cases are in fact the same.

Typical example: people have varying numbers of hairs on their head. People with few or no hairs are bald, people with many hairs are not. However, it is impossible to denote a number of hairs (X) such that people with X or fewer hairs are bald but people with more than X hairs are not. Therefore there is no difference between being bald and not being bald.

The commenters are making the same mistake when they argue that because a particular person (e.g. thoreau) can't explictly state the boundary between morally allowable body modifications and morally unallowable body modifications that there is no disction between the two.

Memnon | February 6, 2007, 2:21pm | #

You didnt have any legs just a smile and some stumps
No smelly feet a torso to hump
No baby love yeah thats what wed be making
Ride you like a sit and spin until your stumps started aching
Spin you around yeah roll you near yeah
Turn you upside down to hold my beer

Grotius | February 6, 2007, 2:29pm | #

Neu Mejican,

Since we will fail to agree on the issue of whether the amputation is the right medical decision...

I respect your opinion even if I disagree with it.

...think again about the issue of free will in these cases.

Well, I ain't really convinced that such a thing as "free will" exists to begin with, especially outside of a few areas of our lives.

Stormy Dragon,

The commenters are making the same mistake when they argue that because a particular person (e.g. thoreau) can't explictly state the boundary between morally allowable body modifications and morally unallowable body modifications that there is no disction between the two.

Sure. But it also isn't unreasonable for to ask where that boundary lies.

pigwiggle | February 6, 2007, 2:42pm | #

How would you gather the evidence base to establish your proof?

We should look at the number of folks with the disorder who are now living comfortably post-amputation. It is my understanding a substantial number of people with this problem have gone to Mexico for otherwise illicit amputations. And we should look at the number of folks who die or are injured in other ways trying to force the amputation, and those that are successful. And finally, we should look at the number of folks who's symptoms were relieved in other ways, or just went away, and the prospect of relief in the future by other means.

In short, balance the putative comfort against the potential harm and prospective cures.

Oh, and it doesn't matter the location of the symptoms. If a patient with a phantom limb perceives the problem to exist in thin air, but the problem resides in the mind, and the symptoms can be relieved with acupuncture of the neck ... what's the problem?

Grotius | February 6, 2007, 2:48pm | #

pigwiggle,

You of course point out something important: it is unlikely that we can stop someone from undergoing this sort of surgery if they a