Apotemnophilia is the arousal based on the image of one’s self as an amputee or strong desire to amputate a healthy limb. It is considered a neurological disorder and often associated with body integrity image disorder (BIID).
The question was raised in class about the difference between people that have this desire to amputate a viable limb and plastic surgery as acceptable modes of body modification. For many, apotemnophilia does not seem comparable to plastic surgery, specifically cosmetic surgery. The ladder are usually considered to be forms of augmentation or reduction to the physical self, whereas the former is considered to be a loss of function and self-destructive. With the amputation of a viable limb one must seriously consider future quality of life.
One of the basic tenants of bioethics is respecting the ability of a patient to exercise his or her autonomy. It’s believed that a person’s conception of their good should be respected in the context of medical decision-making. Therefore, one of the main arguments considered is that in order to comply with this well-entrenched maxim, it is permissible for a surgeon to respect and act on this request. The surgery could also be considered the least of all evils, where forcing an individual to keep the limb could cause more indirect harm than good (i.e. suicide, severe depression).
One objection to the premise of autonomy is that a person that wants to amputate a limb is not a full rational agent and therefore not capable of giving informed consent. It is plausible to think that the logical response to a conflict between one’s subjective experience of embodiment and one’s body would be to change the experience of embodiment rather than change the structure of the physical self. However, this does not appear to be the case with one who desires to be an amputee. He or she is not able to change the way they experience their body. However this argument fails when one considers the case of gender reassignment. In this case it is permissible to allow a biological man or woman to transition into a woman or man, respectively—allowing them to realize their ideal body type and true self.
Perhaps the real dilemma lies in the social problems and failures surrounding issues of disability. Major institutions have failed in being able integrate and accommodate every single one of its members both socially and medically. The overwhelming desires to cut costs, unwillingness to provide needed services, and a desire to perpetuate normative values (ableism) has rendered a subset of our population with inadequate resources. Through this lens, it is possible to understand why many would advocate for regulation and illegalization or react in opposition of such a procedures.