In the case under consideration though, the long way in providing a defence to that sort of action. Limb Amputation There are already numerous examples in medical practice where healthy body parts are removed for In a related argument Johnston and Elliot suggest that perceived benefit, without serious ethical dissent. There are two problems with this argu- healthy breasts or ovaries, so as to diminish their risk ment. First, the authors seem to have an unrealistic of developing cancer and to reduce the anxiety view of the way medicine proceeds when dealing associated with living with their high cancer risk.
In with rare or unusual disorders. While it is obvious that the closest parallel to BIID, those suffering gender rigorously controlled studies into treatment efficacy identity disorder are offered sex reassignment surgery; are to be preferred, such studies are only available so that their bodily appearance might better match the when illnesses are sufficiently common to make such sex that they believe represents their true self.
When illnesses occur infrequently, treatment decisions and even clinical guidelines are The Possible Illegality of Amputation often based merely on small case series and published of a Healthy Limb case reports, very similar to those I am outlining for BIID. When faced healthy limb is, or may be, illegal and that therefore it with these syndromes, doctors base their treatment should not be conducted.
Surgeons should not, as a decisions on the results of published case reports and general rule, break the law, but legal questions should case series and on analogy with other similar not be confused with ethical questions.
If amputation conditions for which stronger evidence exists. Doc- of a healthy limb were illegal, but in some circum- tors cannot afford to wait for rigorous research when stances the most ethical treatment approach, then deciding how to treat many rare illnesses, because if efforts should be made to have the law changed. Even without good evidence, treatment illegality are not strong. As has possibility of gathering the data that would be needed been demonstrated above, however, there is some to allow it.
A lack of available evidence is an evidence of therapeutic benefit and the hope of argument for therapeutic caution and for careful achieving this would be the motivation for surgery. Out on a limb: the ethical management of BIID 29 That We Should Err on the Side of Caution legitimisation of BIID within a diagnostic lexicon, will somehow lead to either the creation of new actual Although no author explicitly posits this argument it sufferers or will persuade people who do not have is easily derivable from the argument from the paucity BIID, that they would like an amputation anyway.
To of current knowledge. Rather than embarking on this support their argument Johnston and Elliot cite an sort of radical and irreversible treatment, we should anecdotally reported increase in the prevalence of stay our hand and hope that something better comes gender identity disorder GID and the desire for sex along. In this context, this argument would not merely reassignment surgery, in the years after GID become urge that the patient be advised that it might be better officially recognised [37].
Bayne and Levy [4] are to await future developments, it would insist that, also troubled by this argument. Two arguments would counter this stance. First, at The argument would only have force if it entails this point there is no particular reason to expect a more than simply facilitating the access of current breakthrough in the treatment of BIID anytime soon.
Official recognition of Its aetiology is still unknown, and the promising BIID would almost certainly lead to more people who advances toward discovery of its cause, suggest that it currently see themselves as sufferers announcing may be a congenital brain disorder. Assuming themselves to a medical profession that finally vestibular caloric stimulation comes to nothing, there appears to be taking their concerns seriously.
If is no other obvious treatment modality upon the amputation were to prove to be an effective treatment horizon. Second, it is difficult to underestimate the for the suffering of BIID, an increase in actual degree of suffering that at least some sufferers of sufferers accessing it would be a good thing, not a BIID seem to endure.
It takes enormous load of bad thing. A call for an to some people, who would otherwise not have been err toward caution appears to unreasonably minimise affected by BIID, to now seek amputation, then there the consequences of doing nothing, and the inevitable would be a prima facie argument for prohibiting the suffering that this will entail for some BIID sufferers.
However, there are several reasons to doubt that this The Possibility that Formal Recognition would occur. The only way range of people to see their own psychic distress as one could answer this question would be by reference a problem that can be relieved only by amputation….
Even if amputation were Second, it is likely that many people, who might morally acceptable for genuine sufferers of BIID, come to identify themselves as having the new once that door is opened, others, not current sufferers syndrome, still suffered symptoms before its recogni- of BIID, will begin to want their limbs off too.
Ryan part of the new diagnostic entity. Exactly what this. Some sufferers also and one might expect a similar time frame to be report systemic manifestations such as fatigue, mental observed with BIID.
The Center for Disease formalisation of BIID as a diagnosis might see its Control has recently launched an investigation into prevalence grow, or demand for amputations increase, Morgellons, because of concerns of an apparent seems to rest on nothing more than fanciful speculation. If prevailing medical opinion is to be believed, we may be fairly confident that no one suffered from Morgellons before the term Arguments Directly Supporting Amputation was coined and widely publicised in This is for BIID because prevailing medical opinion holds that the disease does not really exist.
Most doctors believe The most obvious argument in support of amputation that the only factor that truly groups sufferers of in BIID is that, once reasonable alternatives have been Morgellons, is that they mistakenly believe they have exhausted, it offers the best chance of relieving the Morgellons. Assuming this is true, it is quite likely suffering of those with the condition [4].
This that many, and possibly most people who identify argument is implied in most of the above. Two other themselves as sufferers of Morgellons, actually suffer arguments are also worth brief mention. The Autonomy invention of Morgellons may not have lead to any more suffering, it may simply have changed the way The argument from autonomy is the strongest of the that people badge the suffering they already had. It is our of this issue. Amputation in BIID is assume that sufferers must be mad.
It defies belief that just one example; others include, requests for eutha- legitimisation of BIID would somehow convert nasia, refusals of blood transfusions and the decision normal people into BIID sufferers or persuade non- to go bungee jumping.
While a full recounting of his sufferers, swept up in a new cultural paradigm, that thinking is beyond the scope of this paper, he focuses they should amputate a healthy limb [41].
Good normative decisions of recognition envisaged here. The analysis of the first half of this paper to amputation, should not mean that we should allow reveals little reason to think that this applies to ourselves to be strongarmed into providing access to sufferers of BIID. If, however, as I have argued, amputation is not unethical, then the prospect that Harm Minimisation denying access to it will cause harm, provides further support for it being made available on simple The current lack of ethical direction in the literature is utilitarian grounds.
As is the case for many rare disorders, the internet provides sufferers of BIID with unprecedent- ed opportunities to support each other and share Other Ethical Issues information. Numerous websites proffer information on the disorder and academic papers are added to Three further issues warrant some discussion. It is probably more likely that you, dear reader, have A Duty to Perform Amputation or to Refer On downloaded this paper via a BIID site than you have from the site of the original journal.
Despite all argument above, many doctors will still The lack of a consistent ethically informed find themselves unable to agree that the amputation of approached to BIID will be noted by its sufferers a healthy limb is ethically sound, even if all the and they will not be able have confidence that their caveats outlined are met.
As is the case in termination distress will be taken seriously, let alone acted upon. While it A Duty to Report the Results of BIID Treatment is clear that there is no ethical consensus regarding amputation, there is simply no evidence that elective While the lack of scientific knowledge about the surgery is not available in the West. No western treatment of BIID, does not, as Johnston and Elliot jurisdiction explicitly forbids such surgery and while had argued, represent a reason to prohibit treatment, it it is certainly true that any surgeon would be cautious does present a duty to those who embark on treatment before embarking on elective surgery, this hardly strategies to report the results of their efforts to the translates into total unavailability.
There is no realistic Unfortunately though, sufferers, reading such state- possibility that there will ever be a properly controlled ments and finding no authoritative counters to them, trial of interventions in BIID—it is just too rare.
Ryan result most of our knowledge of what will help to future sufferers of BIID who wanted amputation to relieve the suffering occasioned by the disorder will become limb donors, if they wished.
In effect, all attempts at treatment should be considered experimental and when possible all cases should be Conclusion written up, whether the trialled intervention is successful or not.
When faced with a patient requesting the amputation Unfortunately the small numbers of BIID sufferers of a healthy limb, clinicians should make a careful complicates this duty somewhat. When most medical diagnostic assessment. If the patient is found to have cases are written up, the patients described can usually be body integrity identity disorder, amputation of the assured that their identities will be obscured and their healthy limb may be appropriate after a trial of confidentiality preserved.
In BIID however, the commu- selective serotonin reuptake inhibitors and after nity of sufferers is small, but Internet-savvy and new case careful consideration of the risks, benefits and reports will likely be picked up quickly and posted on unknowns of all possible treatment alternatives. The web sites. In these circumstances, attempts to mask the results of treatment trials should be published to allow identity of particular patients may prove impossible. These concerns about confidentiality need to be weighed Sufferers of BIID might be relieved to know that against the duty to report treatment results and patients members of the medical profession will take their should be fully informed of the risks to confidentiality as concerns seriously and that, after careful delibera- part of gaining consent to write up cases.
The Possibility of Transplant Bizarre as it may sound, it is worth briefly reviewing the possibility that in future sufferers of BIID, who References are allowed access to upper limb amputation, might become donors to those who have lost their own 1. Dotinga, R. Out on a limb. Salon [August 29]. Such is the quality of prosthetic legs, 2. Dyer, C. Citizen Claudia Rankine. The Myth of Sisyphus Albert Camus.
Slouching Towards Bethlehem Joan Didion. Tacky Rax King. Fear No Evil James Patterson. Mercy David Baldacci. The Awakening Nora Roberts. From This Moment Melody Grace. Your Rating:. Your Comment:. Read Online Download. Fans of the actress's earlier works will be aware of her love of the journey. Her descriptions of her travels from Stockholm to Hawaii to Peru will stimulate even the most sedate armchair traveler wanting to see more of the world.
MacLaine's exploration of life with her lover Gerry requires that she question lifelong relationships with close friends, giving new definition to the phrase "soulmate. There are no reviews yet. The main characters of Out on a Limb novel are John, Emma. The book has been awarded with Booker Prize, Edgar Awards and many others.
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