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.