The American Journal of Bioethics, 9(9): W8, 2009
Copyright
c Taylor & Francis Group, LLC
ISSN: 1526-5161 print / 1536-0075 online
DOI: 10.1080/15265160903195378
Correspondence
Response to Müller
To the Editors:
I write in response to Sabine Müller’s Body Integrity Iden-
tity Disorder (BIID)—Is the Amputation of Healthy Limbs Ethi-
cally Justified? (2009). In her article, Ms. Müller attributes to
me arguments and assertions that are far afield of anything
I have ever written about BIID. I feel compelled in the in-
terest of protecting the integrity of my own body of work
to set the record straight, and I hope you will publish my
response to allow me that opportunity.
Ms. Müller writes that I share the view that “surgery
is ethically permissible because it will prevent many BIID
patients from injuring or killing themselves.” I do not share
that view. The view I expressed in my article, Confound-
ing Extremities: Surgery at the Medico-ethical Limits of Self-
Modification (2004, 148), is that the suffering of people who
desire amputation of healthy limbs should be taken seri-
ously by the medical and bioethics communities, because
history has demonstrated the dire personal consequences
associated with self-help. I drew no conclusion in the ar-
ticle about the appropriateness of surgical treatment. In-
stead, I concluded more tentatively that “[t]he debate over
apotemnophilia and its proper treatment represents an op-
portunity that should not be overlooked to examine as-
sumptions within the medical and bioethics communities
about the meaning of bodily integrity, the limits of patient
and physician autonomy, the regulatory process of medi-
cal standard-setting, and the status of the [regulatory ethics
paradigm] as the gatekeeper to innovation in clinical prac-
tice” (155).
Ms. Müller writes that I “argue for the right of arbitrary
decisions about body modifications amputations [sic] with-
out any psychological indication” and that I “speak out for
the right to design one’s own body and put elective am-
putations into a continuum of nose corrections and breast
enlargements.” In fact, I made a point of saying that elective
amputation is meaningfully different from cosmetic proce-
dures like rhinoplasty. The analogy I drew between elec-
tive amputation and elective cosmetic surgery, which was
once viewed by the medical establishment as bodily muti-
lation, was intended to demonstrate that “what counts as
‘self-mutilation,’ or conversely as ‘bodily integrity,’ is nei-
ther universally self-evident nor historically unchanging”
(152). For this reason, I argued, “the transparency of such
terms cannot be taken for granted if the conversation about
apotemnophilia is to be truly interdisciplinary in nature—
as it must be” (152). To represent my position as some sort
of blithe endorsement of elective amputation is at best in-
tellectually careless and at worst intellectually dishonest. I
W8 ajob-Neuroscience
have a very difficult time believing that anyone who has
carefully read my article would attribute that view to me
in good faith. Ms. Müller appears to require a straw per-
son to argue against—someone who believes there are no
complicated ethical issues involved when a person desires
amputation of a healthy limb. I’m not that person.
Ms. Müller writes that I “use the obsolete term
apotemnophile (amputation lovers) of Money et al. (1977),
which describes the amputation desire as a paraphilia.” In
2003, when I wrote the article Ms. Müller cites, the term
“apotemnophile”—a holdover from sexological research
done at Johns Hopkins in the 1970s—was still very much
in play. The term “BID” (Body Identity Disorder) had been
proposed by Furth and Smith, and it was meeting with no
small degree of resistance inside the psychiatric community.
The term “BIID” was not yet in circulation. In my article,
there is an extended discussion of the controversies sur-
rounding both the naming of the condition and the proper
delineation of its symptoms. In proposing the term “BID,”
I argued, Furth and Smith were engaged in a conscious “ef-
fort to redirect the discourse on apotemnophilia from its
historical focus on sexual predilection to a focus on disabil-
ity identification” (150). In retrospect, that effort appears to
have been successful.
I invite you and those of your readers who might
be interested in what I’ve actually written about BIID to
read my article, which is available on SSRN (http://ssrn.
com/author=630766). The article was written at a time
when BIID was more the subject of scandal mongering than
serious scholarly research. I’m gratified to know that time
has passed.
Annemarie Bridy, PhD, JD
Associate Professor
University of Idaho College of Law
April 8, 2009
REFERENCES
Bridy, A. 2004. Confounding extremities: Surgery at the medico-
ethical limits of self-modification. Journal of Law, Medicine and Ethics
32(1): 148–158.
Furth, G. and Smith, R. 2000. Apotemnophilia: Information, Questions,
Answers, and Recommendations about Self-demand Amputation. Author
House.
Müller, S. 2009. Body integrity identity disorder (BIID)—Is the am-
putation of healthy limbs ethically justified. American Journal of
Bioethics (AJOB–Neuroscience) 9(1): 36–43.