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]

Any answer but (a).

[thoreau]

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]

How do you feel about transsexuals, Thoreau?

[brian423 (not Brian24)]

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]

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]

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]

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]

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

[tarran]

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]

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

[FinFangFoom]

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]

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]

thoreau,

Check out some of the work of Judith Halberstam sometime.

[brian423 (not Brian24)]

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]

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]

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]

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]

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]

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

Why?

[dead_elvis]

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]

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)]

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]

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]

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]

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]

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)]

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]

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]

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]

Has anyone else out there read "Geek Love"?

http://www.amazon.com/exec/obidos/ASIN/0446391301/reasonmagazinea-20/

...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]

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]

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]

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]

Aresen,

thoreau's point seems rather obvious.

[thoreau]

Ah, getting testy again, Gunnels?

[Grotius]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

Anyone know what the numbers are on this

Binary.

[Grotius]

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]

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]

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]

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]

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]

expand on it

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

[Aresen]

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]

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]

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

[TCR]

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]

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]

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]

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]

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

[ChicagoTom]

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]

See novel called "Limbo" by Bernard Wolf

[Syd]

Anybody considered
(e) This is a hoax?

[biologist]

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]

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]

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

[tad2]

I think its unfair that you're all grilling thoreau as if he's some kind of heretic. Jeeze. Sometime you "libertarains" can be just as doctrinaire as all the other political types.

[FinFangFoom]

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]

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]

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]

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]

David,

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

[jtuf]

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]

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]

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]

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]

"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]

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]

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.]

"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]

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]

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]

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

[Madpad]

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]

From my view...

Bingo!

[whoever]

Who am I, the government, or her husband?

Her husband should lock her up for her own safety.

[thoreau]

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]

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]

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]

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]

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]

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!]

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]

Grotius,

Address my questions/assertions.

[Grotius]

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]

xon,

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

[Neu Mejican]

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/exec/obidos/ASIN/0140230122/reasonmagazinea-20/

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]

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

xon,

I did."

Based on what exactly?

. . .

[BladeDoc]

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]

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]

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]

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]

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]

Neu Mejican,

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

[Neu Mejican]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

"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]

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]

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]

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]

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]

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]

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]

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]

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]

pigwiggle,

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

[Jennifer]

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?

In this case I'd say none, because acupuncture won't leave the patient with irreversible damage. Leg amputation will.

[Neu Mejican]

Pigwiggle..

"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?"

The treatment is of the nerves that are supplying the sensation (potentially accessed through the neck) ... how is this related to limb amputation or my point?

[Madpad]

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.

Oh please...save the hyperbole for the mouth breathers. We already deprive people of their liberties on occassion for crazy behavior and we're not exactly sliding toward the 4th reich.

At least you claim Ms. Jones are not such. Based on what? Nothing more than you're ignorance.

Incorrect...it's based on her actively orchestrating having her own legs cut off because of a self-proclaimed identity issue. Most rational people would call that "crazy." I merely assert that there's no evidence in the article that she has been evaluated for her mental state.

You, on the other hand, have attacked thoreau for merely being honest, questioning and open-minded about the issue and you blanket attacked anyone who would dare treat this as anything other than a simple lifestyle choice.

If there's anyone here dealing from a position of total ignorance, it's you.

[Grotius]

Madpad,

Yes, whether we agree or disagree the language does seem to be somewhat hyperbolic.

I merely assert that there's no evidence in the article that she has been evaluated for her mental state.

She does have a psychiatrist.

[Neu Mejican]

Grotius,

"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.

Doesn't a libertarian philosophy require free will axiomatically.

If there isn't free will, then who cares if we curtail freedom?

Look back at your arguments. You are positing that there is no justification for curtailing this woman's free choice based on a subjective judgement of the value of that choice. This assumes that she is making a free choice. If she is not making a free choice, then we are talking about something much different.

My position is based on the underlying assumption that her compulsion does not fit the category of free choice, so restricting access to amputation is not limiting her free choice. The compulsion is not her will, it is her symptom.

If that is not at the heart of the issue, then what are you concerned about?

[Madpad]

Go Neu Mejican,

Good point. And essentially goes to the point I made previously.

The ultimate question, of course, is where is the line that splits choice and mental illness? As I said before, it is highly individualistic and shifts depending on a variety of factors.

As far as that goes, the only ground I'll give the libertarian stalwarts on the pro-amputation side is, "yes, it's pretty much betwen her and her doctor."

As for : She does have a psychiatrist.

The article makes no mention about how involved the phychiatrist was or what the diagnosis is beyond BIID.

From the article, the shrink appears to have had no involvement in the activities she orchestrated to get her leg infected so someone would cut it off.

The fact that she has a psychiatrist would suggest that she has a mental/emotional condition that even she ackowledges requires her being under psychiatric treatment.

So I rest my case. She's crackers.

[Warren]

Incorrect...it's based on her actively orchestrating(sic) having her own legs cut off because of a self-proclaimed identity issue.

And therefore we can rest assured she must be crazy. Exactly the elitist thinking I'm against.

...you blanket attacked anyone who would dare treat this as anything other than a simple lifestyle choice.

That is not what I'm saying. I have acknowledged that this woman may be suffering from an illness for which amputation may not be an appropriate treatment. What I'm attacking is anyone who thinks they can sit in their underwear and make that call.

BTW, would you feel any better if it was a lifestyle choice? What if she said "I identify with the legless community. I don't want to be part of the 'walkers' and their world". (I've heard more than a few people express such attitudes about deafness.) I don't think it would affect thoreau's discomfort if that were the case.

[Warren]

The fact that she has a psychiatrist would suggest that she has a mental/emotional condition that even she ackowledges requires her being under psychiatric treatment.

So I rest my case. She's crackers.

Exactly what people use to say about homosexuals.

I rest my case. You're tyrannical.

[Jennifer]

Exactly what people use to say about homosexuals. I rest my case. You're tyrannical.

False analogy, Warren: "It was wrong to say that homosexuals are crazy; therefore it must be wrong to say that ANYBODY is crazy."

What if she said "I identify with the legless community. I don't want to be part of the 'walkers' and their world". (I've heard more than a few people express such attitudes about deafness.)

I'm not comfortable with the whole "deaf culture" thing, but even then it's a different case: people who are already deaf and making the most of it by developing a "culture," not people whose hearing is perfectly fine but want to have their eardrums removed so that they, too, can be deaf.

[Grotius]

Neu Mejican,

Doesn't a libertarian philosophy require free will axiomatically.

Require that it actually exist, nope?

If there isn't free will, then who cares if we curtail freedom?

Well, to borrow a bit from Julian Sanchez, it seems that we assume free will exists even if it doesn't. I'm not quite sure if that assumption is correct. To me it is very thorny philosophical issue that is likely not answerable.

This assumes that she is making a free choice.

Nope. It does assume that my value choices might not be appropriate for her. That is seperate (in my mind) from the free will issue.

If she is not making a free choice, then we are talking about something much different.

Well, we are coming at this from different assumptions.

If that is not at the heart of the issue, then what are you concerned about?

Largely issues of societal control and deviance.

Madpad,

In my own general experience psychiatrists do evaluations throughout the process of treatment. Whether what happens in the UK is different I can't say.

[thoreau]

Warren, would you agree that skepticism on a rather rare and extreme case like this is not equivalent to an overall desire to regulate how people live?

Yeah, yeah, I am contemplating the possibility that it might be OK to regulate leg removal. And, everybody just happens to have two legs. So you could argue that I do want to regulate everybody's bodies. But that would miss the point. This is a rather rare and extreme case, where somebody who is not self-evidently rational (i.e. capable of free and informed consent) wants to do something that, at least on the surface, would appear to be harmful to herself.

Wanting to explore the issue rather than immediately sticking to principle and saying "Eh, whatever, hack 'em off!" is hardly equivalent to a general desire to regulate everybody's lives.

[Warren]

Jennifer,

I never said that nobody is crazy, or even that this Susan isn't. My analogy was to point out that just because someone is under psychiatric care does not mean they are mentally deficient.

As for the deaf culture thing. I don't know of any hearing person destroying their own ears, but I've heard of deaf parents wanting to make their hearing children deaf.

[Chris Peterson]

Anyone know what the numbers are on this?

-2?

[pigwiggle]

The treatment is of the nerves that are supplying the sensation (potentially accessed through the neck) ... how is this related to limb amputation or my point?

Look, the point you are (perhaps purposefully) missing is that the logistics don't matter. Is there a treatment and what are the ramifications, period.

For the sake of argument lets assume that by cutting her legs off she would be magically cured of the disorder. Maybe the most regrettable outcome. So she's cured, but now wishes she had legs. Was the torment of the disorder worse than the imposition of the disability? If it wasn't then we made a poor decision to allow the amputation. She's justifiably angry that we let her mutilate herself while she was ill. Now, what if she is more at peace crippled than tormented by the disorder; isn't she better off? You know she is, and that's all there is to it.

[Madpad]

What I'm attacking is anyone who thinks they can sit in their underwear and make that call.

Come on Warren, give me some credit. I'm not armchair quarterbacking with no life experience declairing rules I expect the world to follow.

I'm an educated man who spent time working in my mother's psychology practice and I nursemaided a bipolar first wife. My boorsish statements about Ms. Smiths sanity (said mostly for effect) notwithstanding, I'm not insensitive to either her suffering or her right to aspire to and attain the happiness she seeks.

Experience tells me there's more going on here psychologically. Just because there's a whole community of folks out their able to articulate their desire to lose limbs doesn't impart sanity or mental health.

For most libertarians, choice is an absolute fought for with a religious zeal. Bravo. But sometimes freedom of choice is not and should not be the overriding ideal. Other issues come into play. The "freedoms" involved in choices made by someone who has compulsive desires is very murky territory.

But we could split that hair all day.

[Chris Peterson]

As for the deaf culture thing. I don't know of any hearing person destroying their own ears, but I've heard of deaf parents wanting to make their hearing children deaf.

There is an interesting documentary called "Sound and Fury" about deaf culture:

http://www.netflix.com/MovieDisplay?movieid=60003753

[Grotius]

Neu Mejican,

On free will you might want to check out the book reviewed here: http://web.mit.edu/holton/www/pubs/Wegner.pdf

[Lincoln]

Here's another one for you guys: What if we had the ability to create cybernetic limbs? What if she could get the leg back? I suspect that most of the problems Madpad and Thoreau have with her choice would suddenly not be problems at all. I'm not accusing, I'm just interested - it seems as though the objections to her limb lopping come mostly from an economical basis (she'll never be able to get back what she lost and therefore never be able to reach her full potential) rather than any preconcieved notions of what the body should be.

If I'm right then I would caution both of you on this line of reasoning. Cause lets say you have two 16 yr old girls. One gets her legs chopped off and the other gets pregnant and delivers triplets. I'd say the young mother of triplets is far more likely to have her options limited in life then the amputee. If, as libertarians, we're going to get into cost benefit analysis for individual decisions then we're not really liberarians at all but utilitarians.

Another point this debate strikes home for me is how important education is to Libertopia ever existing. How can we ever get a movement going for freedom when poor Latin Americans will vote for the absolute worst in government and individuals will choose to harm themselves and their children willingly? Where is the line? I'm becoming more and more convinced that Libertopia is actually forcing a standard level of education until 16 and then allowing a live and let live philosophy for the rest of one's life. And it saddens me to be honest. Sorry for the rambling.

[thoreau]

it seems as though the objections to her limb lopping come mostly from an economical basis (she'll never be able to get back what she lost and therefore never be able to reach her full potential) rather than any preconcieved notions of what the body should be.

Pretty much. I'm fine with letting individuals assume risks and make cosmetic adjustments. But when somebody expresses a strong desire for an irreversible modification that will do guaranteed harm (the magnitude of which will, admittedly, depend on how many skills the person has that can lead to a satisfying career, as well as how helpful friends, family, neighbors, co-workers, etc. will be), I'm not prepared to just say "Eh, whatever. Your choice." I'm willing to contemplate that maybe, just maybe, this person is not sane and hence capable of meaningful consent.

I could be wrong about this. I'm willing to consider that. But I'm not just going to say "Eh, whatever" on something this extreme. A quick application of principles without considering the consequences only works if you have absolute certainty about principles. I don't have absolute certainty about anything.

If some day medical advances make it possible to reverse the damage, hey, chop off anything that you want to chop off. In that case the harms involved will be mitigated.

[Warren]

Yeah, yeah, I am contemplating the possibility that it might be OK to regulate leg removal. And, everybody just happens to have two legs. So you could argue that I do want to regulate everybody's bodies.

I wouldn't be any happier if you only oppressing a few people.

But that would miss the point. This is a rather rare and extreme case, where somebody who is not self-evidently rational (i.e. capable of free and informed consent)

Again, rarity doesn't seem relevant to me. I oppose your requirement that she be "self-evidently rational". Indeed I'm arguing against the whole notion of 'self-evidently' in this case. She is not self-evidently rational, but neither is she self-evidently crazy. If you want to deprive her of making her own medical decisions because she is incapable of giving 'free and informed consent', you need to have a finding in a court of law. And you need make a better case than "she should not be allowed to make her own decisions because we don't approve of the decision she made".

..wants to do something that, at least on the surface, would appear to be harmful to herself.

Here we have some common ground. If she is a danger to herself, I can live with allowing the state to restrict her liberties. BUT, only as a last resort AND, the fact that she wants to be legless does not in and of itself demonstrate that.

[Madpad]

Wow, lincoln...I was just thinking something very similar...that at least part of the problem was the irreversability of what Ms. Smith desires.

I've heard of transexuals going through surgery and then wanting to change back. Don't know how often that happens but it might be worth exploring for the purposes of this thread.

[thoreau]

Warren, like I said, if I won't even reconsider a simple application of principles in rare and extreme cases that means I have complete confidence in principles, even in cases that I haven't really considered before. I don't have complete confidence in anything. Do you?

[Grotius]

If you are like Elmer J. Fudd and own a mansion and a yacht, chop away. 😉

A quick application of principles without considering the consequences only works if you have absolute certainty about principles.

I think most folks - who are alright with this - assume that any process which leads to amputation will not be "quick."

[00===D]

00==

I feel much better now.

[Choice]

Limb abortion on demand! It's a woman's right.

[Warren]

Madpad,

Well your 4:01pm comment puts a different light on your position. I find it hard to reconcile with your previous ones. How much anguish should we have to go through before we deny her the power to make her own medical decisions?

For most libertarians, choice is an absolute fought for with a religious zeal.

I vehemently object to this sweeping characterization. I see no evidence of this at all.

[mediageek]

She's a crazy bint.

If she is indeed suffering from a mental condition that would make her behave in an utterly irrational manner, then the answer is that her family and friends need to watch out for her, get her to seek treatment, and deal with it.

If, in the meantime she hacks her own goddamned leg off with a meat cleaver, I don't care what happens, so long as I don't have to foot her medical bill.

[David]

Here we have some common ground. If she is a danger to herself, I can live with allowing the state to restrict her liberties. BUT, only as a last resort AND, the fact that she wants to be legless does not in and of itself demonstrate that.

What would constitute being a danger to oneself if freezing one's own leg with dry ice so it will require amputation doesn't?

If a person who needs to cut off her own legs to satisfy a self image issue isn't "insane", then the term has no meaning.

[Grotius]

mediageek,

Do you live in the UK?

[mediageek]

Thankfully, no.

The denizens of Airstrip One seem to be getting a tiny bit loco.

[Grotius]

Anyway, at this time I'm going with (C). That would be my provisional answer.

[thoreau]

David and mediageek pretty much sum it up for me.

[Warren]

I don't have complete confidence in anything. Do you?

No I don't. But my principal is that guaranteeing individual autonomy should be our highest priority.

I don't hold that there are no circumstances where it is proper to violate individual autonomy. But doing so is extreme, and should be very rare indeed. It must be made deliberately difficult, and done only with great hesitation.

[Neu Mejican]

"Doesn't a libertarian philosophy require free will axiomatically.

Require that it actually exist, nope? "

An axiomatic system can be based on incorrect assumptions, but the assumption is nonetheless still there. Without the leg of free will, libertarianism falls on its face, it seems to me.

"his assumes that she is making a free choice.

Nope. It does assume that my value choices might not be appropriate for her. That is seperate (in my mind) from the free will issue."

The appropriateness of your values to her situation might not be the same issue as free will, but the decision to call the "choice" a "choice" is essential for determining what you are placing a value judgment upon. Again, if you feel like you do not have the right to make decisions for someone else, it seem inherent in that position that you feel they are making decisions. If both you and the other are not making decisions, then there is no conflict with you interferring as neither you nor her have made a decision. The action is the result of the outside force that controls both of you. No conflict of rights exists without the concept of free choice.

"If that is not at the heart of the issue, then what are you concerned about?

Largely issues of societal control and deviance."

Again, you're just ignoring the reason why societal control and deviance are an issue... if it is not for free will, then who cares.

The book review is interesting.
You should read the book I linked to up thread.

[Madpad]

How much anguish should we have to go through before we deny her the power to make her own medical decisions?

Curious statement...but we have a lot of competing ideals here. Some of those in competition hold sway over what's seen as ethical by the medical community.

Others, like Ms. Smith, come up with inventive ways to circumvent that and get what they want. As it is, it appears that things are working out for Ms. Smith largely as she desires and the medical community is spared having to face aguish of its own.

Your admirable libertarian ideals do not change that large parts of finding happiness in any life involve a struggle. In this case, at least part of Ms. Smith's struggle is convincing gatekeepers that she is making a sane and rational choice and is aware of the consequences and is prepared for them.

So ultimately, it matters not what you and I think. It matters what people do.

I vehemently object to this sweeping characterization. I see no evidence of this at all.

You're kidding, right?

Nonetheless, delightful sparring...very thought-provoking. One of the best threads in a few days.

[Warren]

David and mediageek pretty much sum it up for me.

I see. So because we find her desires strange and frightening, we don't need to respect her rights.

for shame

[highnumber]

"d," but if this woman were a close friend or loved one, I suspect I would change my answer to "a."

[Grotius]

...it seem[s] inherent in that position that you feel they are making decisions.

I'm not quite sure why this inherent.

...then there is no conflict with you interferring as neither you nor her have made a decision.

Well, whether I am interfering or not isn't a matter of my own will, correct? So I don't have a choice in that.

No conflict of rights exists without the concept of free choice.

Some philosophers claim that is the case, some claim the exact opposite.

Again, you're just ignoring the reason why societal control and deviance are an issue... if it is not for free will, then who cares.

Well, presumably I care because my destiny leads me that way, correct? I am the object of determinism as much as the other person is.

You don't want to confuse the objective situation with the way that I perceive it.

The book review is interesting.

Glad you liked it.

[Neu Mejican]

Warren,

You assume that her desires correspond coherently with her condition. I'll be there is a part of her that wishes the compulsion to be legless were not part of her mental make-up. That desire will not make the compulsion for amputation go away, but I bet it is part of the struggle she deals with.

[Warren]

In this case, at least part of Ms. Smith's struggle is convincing gatekeepers that she is making a sane and rational choice and is aware of the consequences and is prepared for them.

But that is exactly backwards. The gatekeepers should need to be convinced that she is insane before they take the power of choice from her.

[Grotius]

Neu Mejican,

Anyway, I fear that we are getting far afield. Maybe I'll do a "Is there a free will" write up on my blog some time and invite folks over.

[Lamar]

My two cents: chop away.

[Warren]

You assume that her desires correspond coherently with her condition.

I make no such assumption

I'll be there is a part of her that wishes the compulsion to be legless were not part of her mental make-up. That desire will not make the compulsion for amputation go away, but I bet it is part of the struggle she deals with.

You may very well be right. But it's not good enough that you would bet on it. There needs to be due process before we strip people of their rights.

[creech]

So will the right to self amputate find itself into the next LP platform? And where do the announced LP candidates stand on this issue?
The voters can't wait to hear.

[thoreau]

Warren-

This is a rather small deviation from principle, in the grand scheme of things.

Anyway, this is probably the best thread we've had in a while that went over 100 posts. Usually at the 100+ stage it just gets dumb, but this one has stayed interesting. Thanks, everyone!

[Neu Mejican]

"...it seem[s] inherent in that position that you feel they are making decisions.

I'm not quite sure why this inherent."

It seems that the right to make her own decision is part of the right you are asserting she has. If she is not making a decision, then there is no violation of the right.

I don't want to confuse the objective situation with your subjective experience of it, but analyzing the inherent logic underlying your position doesn't seem to involve the objective reality, but rather the consistency of your position under the axiomatic assumptions framing the issue. As soon as you posit that the woman has a right to make a "free and conscious choice" then the ethical framing of the issue involves whether or not she is freely and consciously choosing. If she is not, then there is no conflict of rights based on the way you have framed your position. The review you link provides some examples of how there are grounds to question whether this woman's choice is free and conscious.

Like I said, if this isn't at the heart of libertarianism, then I don't know what is.

[Grotius]

Neu Mejican,

Well, I ain't a libertarian. I lost my decoder ring some time ago.

It seems that the right to make her own decision is part of the right you are asserting she has.

Actually, I've deliberately (and thus consciously) eschewed "rights" talk in this discussion because I'd wager that "rights" don't exist, at least not (generally) "natural rights."

As soon as you posit that the woman has a right to make a "free and conscious choice" then the ethical framing of the issue involves whether or not she is freely and consciously choosing.

Well, I only used that language with regard to suicide. Suicide may be a "natural right."

...but analyzing the inherent logic underlying your position doesn't seem to involve the objective reality...

What set of value choices does?

Isn't it more honest to state that one's value choices aren't based on objective reality, but instead are based on contingent influences which bring about various preferences?

[Neu Mejican]

Warren,

"You may very well be right. But it's not good enough that you would bet on it. There needs to be due process before we strip people of their rights."

Of course due process, due process. But due process is framed by a default position. Your assumption is that an stated desire is by default sane and rational and due process would need to show that it is not. This is unrealistic. The very concept of sanity is gradient and determined by normative criterion. The default position in determination of sanity includes the normative position that, unless shown otherwise, the desire to do grave harm to yourself, is insane.

It is one of the ways we recognize the category. It is not a matter of "her desires strange and frightening" but her desires indicating that she is outside the normative category described typically as "of sound mind."

[Neu Mejican]

Grotius,

"Isn't it more honest to state that one's value choices aren't based on objective reality, but instead are based on contingent influences which bring about various preferences?"

How do these contingent influences bring about various preferences if they are not objectively real? How does the unreal influence anything? I, of course, assume that mental states have objective reality.

[Warren]

This is a rather small deviation from principle, in the grand scheme of things.

In the grand scheme of things? Well, maybe. But here's the thing; To Susan Smith, this is the most important issue there is. From her point of view, getting that amputation matters more than all the wars (Iraq/Drugs/Terror) and the Capital Gains Rate, put together.

As a libertarian I respect Susan's right to set her own priorities. More than that, I expect everyone else to too.

[JasonL]

Hmm. What if wanting not to have a leg is the result of a similar mental process to, say, homosexuality?

Now, before anyone gets bent over this suggestion, I'm just saying. There are biologically originated preferences that make your life a lot harder. Some of them might have treatment options. Some might not. My experiences with a relative who suffers bi polar disorder do not lead me to believe there is a clean treatment here.

If you have the choice between losing a leg (assuming that actually helped your state of happiness) or living with two legs but in a drugged stupor - I'm telling you I've seen it, and it isn't clear that anyone else should be making that call. I agree with madpad that if there were a magic button, we should make that the treatment. As it is? I dunno.

[VM]

"Well, I only used that language with regard to suicide. Suicide may be a 'natural right.'"

In other words, "savoir mourir" instead of "savoir vivre"? Our actions can be fatal? (not "fatalistic" in the lay person playing philosopher way, but that we know that we can ultimately control our own termination?)

This is getting a bit afield in metaphysics.

Is this recap accurate:

Madpad (who had a very eloquent post at 4:01 or so) thinks there's something else going on that should be investigated first, and until said investigation is complete, we should belay the hacking. (although I'm not sure about the "religious zeal" apart from a few posters)

Warren (not yet drinking) says "go for it. Chop away, pal. Saw her blue".

Mediageek, not in the UK, apparently fortunately for him, says "whatevs. Don't bone me with the bill"

Neu and Hak are in some sort of philosophical argument that has a friendly tone. I see this as a good time for some of you haters to re-evaluate your opinions of Hak.

And JasonL really nails a consistent libertarian position with this: "I'm not ready to say that we can legislate perpetual misery for this person."

And thank you for an interesting read. My answer is the usual choice R: "hey! I ordered a cheeseburger!"

respectfully,
VM

[thoreau]

VM-

You forgot to mention that I want to think this through before I endorse the ideologically consistent stance, and because I'm willing to consider a deviation from purity on this issue, Warren thinks I'm awful.

Sorry to bum you out, Warren. You must need a drink right now! 🙂

[Grotius]

How do these contingent influences bring about various preferences if they are not objectively real?

Well, there is climate, topography, etc.

[Grotius]

VM,

Well, I can few think of few things that one can do more "individually" than suicide (I guess some folks would argue with that). Certainly if one can make decisions, if one has "free will," I can think of no more clear exercise of such (as to whether one should or should not commit suicide).

[Neu Mejican]

"How do these contingent influences bring about various preferences if they are not objectively real?

Well, there is climate, topography, etc."

I am afraid you lost me with that response. Are you saying topography and climate are not objectively real?

[lincoln]

I'm not prepared to just say "Eh, whatever. Your choice." I'm willing to contemplate that maybe, just maybe, this person is not sane and hence capable of meaningful consent.

Sure, but I don't see where anyone is saying "whatever". The issue, as in almost every thread, is "should the government stop her from doing this" or at least "when should the government stop her from doing this". And I'm saying that in a free society everyone has the right to make informed choices to their own body. Even if those choices lead to negative consequences. So the key to me is informed. If she does not have the requisite mental ability to make an informed decision or adequate knowledge on negative side effects than by all means stop and educate her. Now we will never agree on what the word "requisite" means but let's say she has:

1) Passed an IQ test. And yes I am all about Daniel Goleman's notion of emotional intelligence. So I agree a standard IQ test is not sufficient. But we're never going to agree on the IQ test either. So let's say the test is able to determine emotional and mental decison making with an error rate of 10% or so.
2) Signed a non-liablity waiver.
3) Been formally evaluated by a psychatrist and deemed to be able to make her own decisions rationally and is free of any siginificant negative external influences (no family member has died recently, no one is blackmailing her, etc.)

...and after all this she still wants to go through with it. What do you do? In my mind it is clear that once "informed consent" is met then she gets to do whatever she wants as long as it does not violate other's rights. She does not have to meet Thoreau or Madpad's definition of the good life in order to modify her body.

I want you all to think of the absolute worse thing that can possibly happen. No, worse than that. Beacuse in a free society it will happen. Someone will bathe in feces. There are 300 million people in America and 3 billion in the world. No matter what the odds are they will be met. Some 20 yr old goth girl will decide to die her skin albino white and her eyelids purple. She'll pass all the tests and swear on a Cure CD that she understands the ramifications of her actions. You will say to her "do you understand that you'll be mocked everywhere you go?" "Do you understand what your child will go through?" And she'll say "of course I do" and sign on the dotted line even though she's really only doing it to impress some faggy goth boy who will dump her in ten years. In twenty she'll show up on Sally Jessy Rapheal 2026 and sob her eyes out. As a moral person you can make sure she understands the ramification of her actions, set up a home for the purple eye-lidded, try to change bigoted responses and even telathon your heart out. But you cannot use the force of the government except when it is absoultely, positively necessary.

[VM]

d'oh!

Sorry Dr. T.

That's right. Dr. T said that and bummed Warren out. Warren couldn't be reached for comment. His press secretary Cutty Sark gave out a blended response.

Thanks Gro! Savoir mourir it is!

[Warren]

Warren (not yet drinking) says "go for it. Chop away, pal. Saw her blue".

WHAT? That is not what... Look, what I said... What I mean...

Oh screw it. Go ahead and fire up Poulan.

That's it for me. Bar's open.

[Grotius]

Neu Mejican,

Oh, I'd say the liklihood of that is very, very small. 😉 I mean, it is sometimes useful philosophically to ponder Descartes' demon, but not to go about doing so out of philosophy "lab."

Anyway, I thought that you were looking for contingent influences.

[Neu Mejican]

Pigwiggle,

"Now, what if she is more at peace crippled than tormented by the disorder; isn't she better off? You know she is, and that's all there is to it."

So, all those frontal lobotomy cases that ended up more at peace were better off? The ethical issues go beyond your simple calculus, and you know it.

Efficacy is only one parameter in the multidimensional decision process here, and it gets trumped by the "do no harm" framing of medical intervention.

[MattXIV]

I'm for allowing her to get her legs removed. The comparison with transexuals is relevant, since it involves not only a change of gender, but also a loss of reproductive function as well, in order to satisfy the desire to fix having the "incorrect" morphology, but the main reason I support it is the lack of an effective alternative option. The preference has been present for most of her life and she wants her legs off enough to try to amputate them herself, which implies that she's probably going to persist in being miserable as long as she has legs. If it comes down to institutionalizing her, which will be expensive, most likely ineffective in actually curbing the desire to be legless, and cause her great personal suffering, and letting her have her legs removed and get on with living a mostly normal life, I don't see how forcing her to keep her legs makes sense, even if you consider the desire to be without legs indicative of mental illness.

[Madpad]

But that is exactly backwards. The gatekeepers should need to be convinced that she is insane before they take the power of choice from her.

Good point...but I don't think it's too far out to assume at first blush that someone wishing to cut off their own legs may have some serious emotional and mental issues.

Since that is my starting point, I don't think it's too much to expect people to try and prevent someone who might very well be mentally imbalanced from doing themselves irreperable harm.

Hence, (again based on some variety of clinical experince with mentally unbalanced folk) I'm fine with Ms. Smith being asked to delay her descent (please forgive me for that one, God)in order to verify that she's, in fact, sane and rational.

In other words, placing aside libertarian virtues for a moment, lets err on the side of caution where mental instability and irretrevable loss of limbs cross paths.

[NoStar]

One advantage of elective amputation is the Handicapped Parking Card. It sure would make finding a parking space easier.

[Neu Mejican]

Grotius,

"aren't based on objective reality, but instead are based on contingent influences"

I was inquiring about why you placed objective reality and contingent influences on opposite ends of a causal pole.

[highnumber]

This article begs to be linked to this one.

Not only would some of you deny the poor woman her happiness, but you don't think of the people who would appreciate the use of her discarded limbs.

[Neu Mejican]

Highnumber,

Nice catch.

Now, does Dave have BIID?
Or does Ryan? or both?

Or is this something different?

Why might it be different?

Notice that these guys don't seem to have any torment surrounding the issue... they see it as an art project...

So for Warren, this may be an example of "desires strange and frightening" that may not involve issues of whether the individuals are choosing freely (due process would decide if the people who assisted ever come to light).

Notice, however, that they don't even consider this a medical procedure, and don't see the activity as healing them in any way (or even acceptable). This seems to contrast starkly with the BIID case.

[Madpad]

I wonder what Smiths husband got her for Christmas. Maybe the director's cut of Boxing Helena.

[Madpad]

We've got some genital work planned that's pretty exciting.

The mind reels...

[Neu Mejican]

So,

The issue of conjoined twins as art project.

Are these guys just working towards that end piecemeal?

And who gets more chicks, the one armed, 9 fingered brother, or the three armed 15&1/4 fingered brother?

[Neu Mejican]

The date of the twins article is important, but doesn't get past the issues it brings up for discussion...

[Neu Mejican]

http://www.bmezine.com/news/people/A10101/addsub/fools.html

Has reader response to Dave and Ryan.

[Neu Mejican]

http://www.bmezine.com/news/pubring/20061011.html

Has a nice opEd on the topic.

[Anonymous]

Out of curiosity, has no one considered the fact that years before transgender operations became relatively safe and effective people would be using these very same arguments?

Claiming that it was "indicative of mental illness" to wish to "permanently damage one's genitalia and reproductive function" despite the fact that it was usually a person's lifelong desire to do so?

The arguments that "this is a chemical issue in her brainmeats" are not compelling, as in many cases there are suggestions that the brains of transgender patients show structural features of the opposing gender.

[Neu Mejican]

"the brains of transgender patients show structural features of the opposing gender."

I would love to see some citations on that claim. The ability to distinguish gender by looking at a brain is not one that I have seen demonstrated.

[sudha]

The difference between this case and transgender operations is that the latter doesn't fall under the Americans with Disabilities Act. That's a signficant difference. Can we stop with the false analogies now?

[Anonymous]

Neu Mejican:

http://cercor.oxfordjournals.org/cgi/content/abstract/11/6/490

http://web.mit.edu/msalib/www/writings/classes/9.00/paper2.pdf

http://www.symposion.com/ijt/ijtc0106.htm

It is, of course, far from a settled area of study. And you could always just look at the chromosomes of the closest neuron...

Sudha:

If that is so, then it's not really about whether or not voluntary amputation is ethical but the monetary liability for such. That's no fun.

[Not That David]

I'd like to note that it still can be indicative of mental illness to want to permanently reconfigure one's naughty bits. That's why candidates for gender reassignment have to go through a battery of tests and trials before they get the surgery. Obviously we can't diagnose Susan Smith's mental state through a magazine article (insert Bill Frist joke here), but that doesn't mean that a real live doctor shouldn't check her out first to make sure she really is capable of rational decisions, medically speaking.

[Anonymous]

I concur. It is, after all, a very serious change. But there were arguments above that the desire to remove one's legs automatically means the person isn't making a rational decision. I'm just curious as to why one can be the result of a rational decision but not the other.

[pigwiggle]

So, all those frontal lobotomy cases that ended up more at peace were better off? The ethical issues go beyond your simple calculus, and you know it ? Efficacy is only one parameter in the multidimensional decision process here, and it gets trumped by the "do no harm" framing of medical intervention.

Well, I don't know about the cases you are referring to, but if whatever terrible affliction these folks had was, again on balance, worse than the treatment, then yes. And I didn't frame it only in terms of efficacy. If you'll read back I wrote about the likelihood of the patient injuring themselves beyond the amputation, the likelihood of a future cure, and so forth.

Where does this "do no harm" business come from? Most medical treatments do harm. The trick is balance.

[Madpad]

Out of curiosity, has no one considered the fact that years before transgender operations became relatively safe and effective people would be using these very same arguments?

That's a little specious...but let's say there is a connection.

At this point its worth mentioning that changing ones sex involves years of psychiatric counseling and strict guidelines to ensure the mental health of the transgender candidate and to guard against regrets over the procedure. And even then some wind up regretting the surgery.

If you don't see BIID as any different from transgenders, I don't see any reason to demand a lower standard of care to ensure the overall happines of the patient.

[Madpad]

But there were arguments above that the desire to remove one's legs automatically means the person isn't making a rational decision.

Since I was one of those, let me be clear...my argument is that it's likely someone wishing to remove perfectly healthy limbs is not fully rational. As such, I think it's not asking too much for them to be evaluated to determine that they are sane and mentally healthy.

I am also dubious that someone wishing to cut off their legs can BE evaluated as sane and mentally healthy. But I did agree that it was up to the medical professionals and the patient.

Warren disagrees with me and suggests that it's up to everyone else to prove they're not crazy.

[Single Issue Voter]

I realize the question has no bearing on gamefowl contest issues other than the basic property right- you own your legs, you can own chickens-but I can't resist commenting on anything "Szaszian".

Dr Szasz is my primary intellectual libertarian influence. Not Rand, not Hayek,there I was a college freshman stoner perusing the library stacks for drug books when I cam across "Ceremonial Chemistry".I was transformed instantly and read everything they had by him. My liberal, leftist tendencies diminished rapidly and I got an excellent education in the philosophy of liberty. It is a shame so many people are hung up on his "controversial" views on psychiatry and don't pick up on the Big Theme.

Enough of my poorly worded tribute to the Great Doctor....

The libertarian correct answer is C

I'll answer as I wish most Americans would,
the first four words of A followed by the whole of D

[Grotius]

highnumber,

If anything that example illustrates the futility of regulating this sort of activity.

[Single Issue Voter]

skimming the comments.......

You can't "change your sex" you are born that way. I thought anyone with grade school science
knew that. That is why the pc term is "gender reassignment".I'd agree with Szasz's wording-
"mutilation".

[Madpad]

It is a shame so many people are hung up on his (Szasz's) "controversial" views on psychiatry and don't pick up on the Big Theme.

Anyone who throws their lot in with Scientologist deserves some scrutiny.

While I admit his views are thought provoking, he often oversimplifies and makes sweeping generalizations about psychiatry.

Classifying mental illness as "behaviors society doesn't approve of" doesn't account for depression. Calling mental illness a myth doesn't account for the very real physically identifiable aspects of schizophrenia and bipolar disorder.

He rails against phychiatry because the very nature of mental problems are sometimes not very scientifically isolated. Some of his opinions are worth considering...and he makes good points about the weaknesses of psychiatry.

But there's more science behind both psychiatry and psychology than he will admit. His proposals would make us more ignorant of the processes of the mind.

I applaud his desire to separate sociopolitical aspects from common notions of mental health. But ultimately, he comes off as an argumentative crank.

[Jon H]

Szasz is a nut who formed his opinions as a teen and spent his entire career confirming his warped preconceptions.

I'm guessing he or someone he knew had a bad experience in some nightmarish Soviet Bloc psych ward. That isn't remotely applicable to modern norms of practice. It *might* have been relevant to mid-20th century practice when voodoo Freudian analysis and primitive blunt-force treatments like lobotomy were still used simply because they had so little else to work with.

But for the most part, Szasz is like a guy subjected to British dentistry as a youth who then goes on to denounce dentistry in general for the rest of his life.

[Jon H]

Here's a spin on the original question:

What about a person with a third, somewhat-functional arm?

Such things are regularly removed during infancy without so much as a quibble.

[thoreau]

I think everybody should be presumed sane unless they do something to prove otherwise.

Like insist that they would be happier without their legs.

[Single Issue Voter]

Madpad,

Speaking of oversimplifying......

Society approves of depression?

and don't forget "Mental illness as metaphor"

Despite what the Doctor says in Sullum's interview as his major contributions I was much more impressed by the ideas he based his arguments on rather than what he was against.
The truth and soundeness of those underlying ideas do make a pretty good case for his more obvious theme.

[Single Issue Voter]

"modern norms of practice"

OK at what point in history or science did psychiatrists leave behind all that bad old stuff and become the scientific healers they are today?

Was it a gradual process ? Or did everything change with the discovery of......?

Szasz repeatedly states he has no problem with voluntary relationships between doctor and patient.

Aside from all that I still see Szasz' work as a contribution to liberty rather than a debunking of quackery.

[Karen]

thoreau, I agree with you that this woman is clearly a nutjob. I have no idea what good public policy is in such cases, and I'm deeply grateful not to have to decide what it should be, but this case does have one of the highest ick factors I can remember.

madpad, I agree with you about Szasz, too. I've done a few criminal court appointment cases, and all of my clients, which I'll be the first to admit is a very small number, were, well, cracked. They did not think like the rest of us, and not just that they were different or eccentric or simply creative. They were dangerously weird. It was perfectly acceptable in their universe to try to bash someone's brains out because he cut in front at the jukebox line or squeezed too close trying to through a corridor to the bathroom. (A friend of mine had an attempted murder case based on her client beating a total stranger unconcious because stranger made slight eye contact at the urinal in a bar.)

I really have a hard time explaining this, and of course I have no special training, but I have spent more than my share of time around people who have strayed far beyond the bounds of normal, and I cannot agree that their problems were just because they were odd. They were, using the magic legal formula, "dangerous to themselves or others." I've even suffered from clinical depression, and believe me, the pain from that is NOT because society disapproved of me moping around all day. Living hurt, and would have hurt even if the entire world accomodated to my dark moods. I had an uncle who committed suicide while in a lucid interval after hallucinations. I also appreciate that pschiatry has abused people, but just because the Soviet Union thought that dissidents were crazy doesn't mean crazy doesn't really exist.

[tad2]

I'm going to second Madpad's assertion that this only proves taht the hardcore "libertarians" are closed minded because they are too blinded by their ideology to see that his person is sick. Her decisions aren't subject to freedom of choise.

[Madpad]

Aside from all that I still see Szasz' work as a contribution to liberty rather than a debunking of quackery.

It's a lot easier to parse out the intersections of liberty with taxes, social policy and international relations than it is with mental illness.

A host of side issues come into play and no matter how simple the liberty advocates want to make it, it ain't never gonna be that simple.

That hardcore libertarians can't reconcile that sometimes a crazy person is actually crazy is a weakness in hardcore libertarianism...not a weakness in advocates for mental health. Despite protestation to the contrary, it's typical of a one-size-fits-all mentality.

Unlike the ignorants who pooh pooh suicide, body mutilation and schizophrenia as "lifestyle choices", I don't pretend to have all the answers. But then the science of the study of mental health is less than a century old. I'll be the first to be suspicious of mental problems de jour and what not. But I'm not gonna chuck the only structured approach to mental health just because libertrians get rankled.

In the end, sane rational people don't cut their legs off. Pretending they do doesn't make it so. Tell yourself whatever you have to to get up in the morning. But playing apologist for a loony in order to prove some sort of pathetic "individuality issue" is a sad testament to the virtues of liberty. Especialy when the woman's illness is so obvious.

As I said before, I believe it has less to do with a sincere desire for Ms. Smiths happiness and more to do with a rationalization for remaining uninvolved and disengaged.

[thoreau]

If somebody says "I want to cut off my legs", my first thought will NOT be "Shit, somebody might try to stop her! That's wrong!"

I can see some good reasons for not using the law to stop her, but I am still bothered by the insistence that there's nothing wrong with her.

[Warren]

tad2
Well I'm sure we're all grateful to have you around. Because you can spot sick people, just like that, and have them all locked up. For their own good of course.

[GreginOz]

I can not believe I wasted ten minutes of my 'beautiful mind' on this. Gimme the freakin' axe...

[The answer]

She's obviously nuts. The correct answer is that she should be allowed to remove her own leg, but that anyone who aids her should be thrown in prison.

[Madpad]

Well I'm sure we're all grateful to have you around. Because you can spot sick people, just like that, and have them all locked up. For their own good of course.

I don't know about that, Warren...but it's apparent that you CAN'T spot a sick person.

And for the record, no one suggested Ms. Smith be locked up...just that her desire to have her legs cut off was not rational or evidence of obvious sanity and probably should not be honored without serious assessment by qualified medical personnel.

[Warren]

If somebody says "I want to cut off my legs", my first thought will NOT be "Shit, somebody might try to stop her! That's wrong!"

That wasn't my first thought either. My first thought was more like "Why would anybody want to do that"?

It wasn't until I heard people say "She's a nut case, no way should this be allowed", that the hairs on the back of my neck stood up.

Who are you to deem someone insane? Where do you get off telling someone else how to live their life. This doesn't infringe on your rights or property. No No No.

Now in spite of what you may have read (or just read even) I am not an extremist here. I make room for the possibility that this person should not be allowed to decide on her own treatment. BUT I insist that this is not an easy call. It should NEVER be an easy call.

However, when it comes to attitudes like "she's a wacko let's lock her up" I am a libertarian absolutest. Fuck you you fucking fucks. This is someone's life we're talking about. You should never be allowed to dismiss someone so flippantly when you're depriving them of their liberty.

[Warren]

I don't know about that, Warren...but it's apparent that you CAN'T spot a sick person.

Oh is it? Because I disagree with you I must be deficient. Well that's certainly consistent of you. But of course I never claimed that I could, I'm just doubtful of your ability. Doubly so on your willingness to diagnose on such scant evidence.

[Madpad]

This is someone's life we're talking about. You should never be allowed to dismiss someone so flippantly when you're depriving them of their liberty.

The day my posting on a blog thread results in someone being locked up is the day I'll get worried. But since there's obviously no star chamber reading this board for guidance on forming social policy, I'm not too worried.

In the end - as I've said before - this situation seems to be working out just fine for both Ms. Smith and the medical community involved. So I'll sleep pretty well tonight, thank you.

[Madpad]

Because I disagree with you I must be deficient.

Lighten up, Francis. I'm yankin' yer chain. You threw out the f-bombs. You can't expect to call people names and not expect them to launch some kind of defense. At least I tried wit over profanity.

[Warren]

The day my posting on a blog thread results in someone being locked up is the day I'll get worried.

Fair enough, but that's not what I'm worried about. I worried that when someone is locked up, the people in power will say "it's OK he was crazy" and you will say "Oh well, that's alright then".

[Warren]

Lighten up, Francis. I'm yankin' yer chain.

Oh hey, my bad. Got a little carried away. Thanks for bringing me back.

I think that we owe
a big round of applause...
...to our newest, bestest buddy...
...and big toe...
...Sergeant Madpad Hulka.

[Madpad]

I worried that when someone is locked up, the people in power will say "it's OK he was crazy" and you will say "Oh well, that's alright then".

You're right to worry but in this case, Ms. Smith's ability to calmly and rationally articulate her position AND orchestrate a clever solution have made this moot.

People will be locked up for all manner of things we don't agree with. Philosphically speaking, there's only so much influence we have over these things.

And please understand, I admire your conviction and hope if I'm ever in an unfortunate and misunderstood situation, I have someone with your passion on my side.

[sudha]

"Who are you to deem someone insane? Where do you get off telling someone else how to live their life. This doesn't infringe on your rights or property. No No No."

It may very well affect us. They could take advantage of handicapped parking. They could apply for assistance under the ADA. They could add to the log jam in the courts over various legal tussels (maybe they sign some waiver saying they won't seek assistance but then change their mind, maybe they decide to sue the doctor either because they have changed their mind about the surgery - and the courts could very well rule that they weren't in their right mind when they signed a liability form - or the doctors didn't do a good job or cut off more or less of the leg than they wanted, etc.), they could add to demands that various businesses must cater to their needs and people like them, etc.

Suppose someone wanted to have an operation to reduce their mental status to that of a lizard (a large talking lizard, David Icke style). Would anyone argue that is no different from a transgender change?

[Andrew Ian Dodge]

I got for selection D. As long as I don't have to pay for it who gives a damn how she gets her jollies?

[thoreau]

I don't want her locked up, Warren. I just don't think the doctors should cut off her legs.

[pigwiggle]

What about a person with a third, somewhat-functional arm?

The Dark Backward

I have this disorer where I can't stand thoreau's legs. Look out, kid.

[Warren]

Madpad, thoreau,

Not sure if anyone is still reading this thread. I think maybe we could all agree if the medical community adopted (as Madpad suggested) a protocol similar to that of sex change. With years of evaluation, therapy, and preparation to precede the operation.

This satisfies me because it's doctors deciding on the standard of care and not the state dictating to doctors (especially on the "we all know he's nuts" pretext).

And we'll leave aside the discussion of licensing doctors and the regulatory authority of the AMA.

[Neu Mejican]

Warren,

I am with Dr. T. No one said the women should be locked up... we said the doctor shouldn't cut off her healthy leg. I didn't even suggest said dr. be locked up, simply loose the government stamp of approval (medical license) as happens with extremem malpractice.

Pigwiggle,
Where does this "do no harm" business come from? Most medical treatments do harm. The trick is balance.

Give me a break. From the Hippocratic oath "will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone."

the whole thing is here.
http://en.wikipedia.org/wiki/Hippocratic_Oath

Interestingly it has a proscription against abortion in the original version.

From the declaration of Geneva:
"I will practice my profession with conscience and dignity;"

From Duties for Doctors (GMC)
"Protect and promote the health of patients"

Or from Medical Ethics... you have several basic principles (not number 2)

"Six of the principles commonly included are:

* Beneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
* Non-maleficence - "first, do no harm" (primum non nocere).
* Autonomy - the patient has the right to refuse or choose their treatment. (Voluntas aegroti suprema lex.)
* Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment.
* Dignity - the patient (and the person treating the patient) have the right to dignity.
* Truthfulness and honesty - the patient should not be lied to, and deserves to know the whole truth about his/her illness and treatment.

Principles such as these do not give answers as to how to handle a particular situation, but guide doctors on what principles ought to apply to actual circumstances. The principles sometimes contradict each other leading to ethical dilemmas. For example, the principles of autonomy and beneficence clash when patients refuse life-saving blood transfusion, and truthfulness may not always be upheld regarding the use of placebos in some instances."

This is how the issue is framed for the practice of medicine.

Many patients would be happier if their doctor fucked them... that doesn't mean they should oblige without losing their license.

Professional ethics are an important part of any profession where the conducting business can cause great potential harm (like the amputation of your legs, fur instance...)

[Neu Mejican]

"not number 2" = note number 2

[Warren]

No one said the women should be locked up

Yeah, I got a little over arching there. Sorry about that.

My comments on this thread are a result of my visceral reaction to what I perceived as a caviler invoking of "She's nuts". I'm afraid I played a little fast and loose with the specifics of this case and people's comments, and a more big-picture, fundamental (in my view) problem.

[pigwiggle]

Give me a break. From the Hippocratic oath "will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone."

I'm sure the thread's dead, but ... my wife took the modern "hippocratic oath". The original hippocratic oath is a bizarre mashup of deity worship and pledges of edification. I guess you would know this had you bothered to read the wiki article you linked to. In fact, the original hippocratic oath explicitly forbade surgery. What doctors pledge today is very different. Anyway, my wife has assured my that nowhere in any of her medical ethics classes did they insist that "first do no harm". Rather, does the benefit outweigh the harm. So - pound sand.