Body Integrity Identity Disorder and Cyborgs: An Exploration of the Ethics of Elective Amputation and Enhancement Technologies

Abstract

The question of whether healthy limb amputation is an ethically and legally viable treatment option for those suffering from Body Integrity Identity Disorder (BIID) has received a modicum of attention and attracted a significant amount of controversy within both the bioethical community and beyond. In this thesis, I examine this question, taking as a foundational position that merely because the desire for healthy limb amputation is unusual, this is not ipso facto symptomatic of a catastrophic impairment to one's capacity to make healthcare decisions. I then explore the plethora of arguments employed by opponents and proponents of such operations from both a philosophical and jurisprudential approach. Following this, a justification for the narrowing of this thesis' focus will be provided. Then, in my thesis articles, I take a normativist approach to the phenomenon of disability. I question whether the harms associated with being disabled are necessarily intrinsic, and thus, challenge whether intentionally causing someone to become disabled is, by its nature, a harmful action and one which should be prohibited. In Paper One, I ask whether the practice of healthy limb amputation is antithetical to the goal of medical treatment, that being health's restoration and maintenance. Drawing on Georges Canguilhem's work, I refute a naturalistic dismissal of such operations and argue that by employing a nuanced model of health, therapeutic, healthy limb amputation can indeed conform to what one may consider the 'inner morality of medicine'. Paper Two explores the relationship between the ethical evaluation of healthy limb amputation and the supposed harm of causing someone to become disabled. Through surveying the question via a lens of disability studies, and expressly according to the Social Model of Disability, I challenge the prima facie harms assumed to be inherent in limb amputation. Taking this detachment of disability and impairment further, in Paper Three, I investigate the impact that neuroprosthetics will have on the ethical viability of healthy limb amputation for BIID. I explore how the development of sophisticated artificial limbs could dramatically impact the ethical debate around treatment for BIID, and especially, how arguments based on the harms of conferring disability on the previously non-disabled could lose their persuasive power. In my final paper, I turn to the legal consideration of healthy limb amputation. I detour from the typical, theoretical, legal defence from GBH for a surgeon facilitating such an operation, built upon the 'medical exception'. Instead, I explore the lack of ontological clarity regarding the concept of harm within English law. From here, I propose that with a more developed idea of what harm is, the act of therapeutic, healthy limb amputation may not be harmful, and thus, a surgeon's actions would not qualify them for a charge of GBH. Ultimately, this leads me to tentatively conclude that the practice of healthy limb amputation is a potentially ethically and legally viable treatment option for those with BIID. However, such a conclusion is only preliminary. A substantial amount of work still needs to be done regarding the disorder to take this conclusion from a cautious, circumstantial endorsement to a full-blown, unrepentant advocation.

Date of Award	1 Aug 2021
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Margaret Brazier (Supervisor) & Soren Holm (Supervisor)