On a Doctor's Moral Duty To Cut Off Limbs, or, It's a Szasz, Szasz, Szasz, Szasz World


Interesting report from Australia that triggered a big "Paging Dr. Szasz":

TO most people, the thought of amputating a perfectly healthy limb is unimaginable.

But for at least three Australians, possibly dozens more, cutting off their leg has felt perfectly normal.

These so-called "amputee wannabes" have a very rare condition in which they feel one of their limbs is not truly their own, and they become obsessed with cutting it off.

And people suffering from the bizarre body image disorder should be able to opt for amputation, a Sydney psychiatrist says.

Christopher Ryan, a psychiatrist at the University of Sydney, says there is a good argument for allowing patients with body integrity identity disorder (BIID) to have their unwanted limb removed.

"I am not saying we should unthinkingly cut off people's legs," Dr Ryan said.

"I realise that the idea strikes almost everyone as lunatic when they first hear it. However, there are a small number of people who see themselves, and have always seen themselves, as amputees," he said.


Dr Ryan has examined the ethics of the issue in the international philosophy journal Neuroethics and says doctors have a moral duty to amputate for the health and safety of the patient.

He said one 30-year-old patient of his lived his whole life feeling he was truly an amputee, but was so ashamed of how he felt he did not tell anyone.

"Eventually he took the only step he thought he had open to him and placed his leg in a bucket of dry ice until it died and had to be removed," Dr Ryan said.

"Now, a year later, he is living happily as an amputee and getting on with his life."

The paper said the operations should be likened to plastic surgery, with elective amputation offered to BIID sufferers only.

That last sentence is my favorite–make sure you are only cutting off the limbs of those who are "BIID sufferers." How can you tell? Well, you know, they are the ones who keep asking you to cut off their limbs.

Thomas Szasz, a reason contributing editor, is famous, and infamous, for arguing that most of what is called "mental illness" in our culture is not in fact the result of an actually diseased organ, but merely an artifact of bizarre, difficult, or even stupid choices. (Some favorite Szaszian epigrams: "A berserk lunatic may claim to be Jesus or kill his wife. The point of such a person's behavior, I dare say, is to be revered like Jesus or be rid of his wife." "The patient's delusion is a problem to the patient's family, employer, and friends; to the patient it is a solution to the problem of the meaning(lessness) of his life.")

Szasz would point out that it gains us nothing to refer to people who express the desire to have healthy limbs cut off as suffering from a "condition" and medicalizing it and giving it a pseudo-scientific name–except for the cultural ratification of the desire, and the cultural and legal ratification of those professionals who want to help gratify it. (***And, as R.C. Dean points out in comment thread, it also gains the potential for private and public insurers to cough up for the procedure.***)

He'd say–and I say–if someone can find someone willing to help them cut off their limb as a commercial service, God bless 'em, I guess (the joke in a student skit at his old school had it that the only two categories in the "Szasz Diagnostic Manual" were "Crook" and "Bum," and I think the doctor would slot so-called BIID sufferers in the latter category, largely)–but that doesn't mean the rest of us have any duty to be supportive, understanding, or claim that weird desire should be dignified by being called a "medical condition."

As Szasz once wrote: "Without informed and uncoerced consent by the patient, no medical or psychiatric intervention is justified, while with consent every such intervention is justified, even if there is no illness and even if the intervention is considered to be harmful by its critics."

With that libertarian wisdom under his belt, Dr. Ryan could feel justified in cutting off (willing) people's limbs without the unnecessary multiplication of entities like the bogus "condition" of BIID.

Jacob Sullum interviewed Szasz in our July 2000 issue.