After all, what is really wrong with apotemnophilia?

Michael Cook*

Barbara Millucci, Flickr

Apotemnophilia is one of those words which may be useful in Scrabble© but seldom come up in day-to-day discourse, let alone medical practice. However, it is an increasingly contested issue in bioethics, though better known as BIID, Bodily Integrity Identity Disorder, or the amputation of healthy limbs.

BIID is a rare psychiatric condition in which people know that their leg (for instance) is normal and healthy, but still feel that it is not part of their identity; they want it cut off, even though they realise that they will become disabled. Oddly enough, however, they often do not seem to mind wearing a prosthesis to recover some of the limb’s functionality.

In a provocative article in The New Bioethics, Richard Gibson, of the University of Manchester Law School, in the UK, asks whether ultimately there would be anything wrong with BIID if a prosthesis provided equal or better functionality. "If these cause an amputee no additional hardships or place in their way no discriminative barriers, then they would not experience any disabling effects of their atypical bodily construction. They would have a mere-difference from the majority of other people, not a bad-difference."

Prostheses are rapidly becoming better, providing not only support, but sensation; they can even be controlled by the brain. At some point they might even be better in some respects than a natural limb. If that happens, Gibson asks, can we really say that BIID is ethically wrong? It would no longer be an instance of "maleficence" – which doctors are enjoined from doing.

once such neuroprosthetics can function at a level equivalent to that of their biological counterparts, the arguments against providing healthy limb amputation in cases of BIID that rest upon the supposed harms of disability generation will begin to lose their persuasive power.

In other words, the universal condemnation of BIID rests on "shaky foundations".

Although Gibson does not mention this, his argument is an example of the crisis of "naturalness" in bioethics. Once having abandoned the idea of a human nature, and of a natural state of health, it is hard to withstand pressure to reconfigure the human body. The debate over transgenderism is another good example.

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