Whole

This article refers to the documentary, Whole, by Melody Gilbert. Please check out http://www.whole-documentary.com/main.html for info. Basically, it's about a small population of individuals who suffer from apotemnophilia, an obsession to amputate a healthy limb. These people are compared to people who desire sex-changes as they feel that they were made incorrectly and the only thing to make them "whole" would be to surgically change their body. Some of these individuals stated that if they are denied amputation, suicide would be the next step. There is an obvious psychological problem here, and the patients admit this--but since it is so uncommon and unheard of, there is no psychological treatment at this time. So, the question is, what do they do in the meantime? Some perform self-inflicted injuries to their unwanted limb so a doctor would be forced to amputate, others have found a few willing surgeons that perform the amputation on the healthy limb... but this has been banned in Great Britain shortly after word got out. My article concentrates on this... until psychology catches up with this condition, should the medical community deny the amputation when the patient, hospital, and surgeon are all willing to perform the operation? It is up to philosophy to step in and defend 'em, eh?
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While the documentary, Whole, presents enough psychological issues to keep couches warm for a while, there seems to be one philosophical issue in its forefront: paternalism. Specifically in the medical realm, when should an authority override a patient’s wishes for the patient’s own good? In the case of Whole, if a patient requests the amputation of a perfectly healthy limb for the benefit of his own mental health (sometimes to avoid suicide), should the operation be performed? More importantly, if a doctor is found to be willing, should the operation be prohibited by either the government or the hospital?

The patients in Whole are all people of sound mind. They are self-aware to the point where some can pinpoint the moment that their obsessions with amputation began. (For example, one patient remembers the contrast of his own harsh childhood while seeing an amputee being welcomed by loving children.) For the most part, these people realize that they have a problem—and they realize that amputation will make them at peace. A seemingly obvious solution is to grant their wishes. If person P has a mental disorder X which can be cured by Y, and P found a doctor willing to do Y, and P is willing to undergo Y… why the hell not let Y happen?

Well, Y happens to be amputation—an irreversible operation that has always been viewed as a worst-case scenario operation. Why on Earth would we allow the voluntary amputation of a healthy limb? My argument is: it is a worst-case scenario operation. According to the film, many have tried years of psychological therapy, but their cases are too rare to have an available solution or treatment. Both the patients and the psychologists seem baffled at the issue. After experiencing the daily torment of an unwanted limb with no psychological cure in sight, most patients choose amputation as the last-case option as they can no longer live under their current situations. If a psychological answer presented itself, I am certain that the patients in Whole would welcome it to avoid amputation. As it stands, however, their requests seem justified.
It is hard not to see the parallels with other obsessions. There are many people who are deeply obsessed with food, plastic surgery, the desire to change sexes, buying shoes, etc. The difference here is that each of the listed issues has a mainstream solution. Anyone can get a nose job, a sex change, or ice cream without too much public scorn. When an obsession has to be met by a surgery reserved for those in a literal choice between life and limb, it is quite difficult to grant the surgery to those who are not (seemingly) in such a dire situation. Again, it could be argued that they are. More than one ‘wannabe’ in Whole mentioned that if they didn’t receive the amputation, suicide was the next step.

Philosophically, when all parties are willing to either perform or receive the amputation—it should be done (assuming the attempts of counseling). But all parties must be willing. The doctor has the right to refuse to give an amputation of a healthy limb, but he also has the right to perform it as the Hippocratic Oath can be interpreted either way: you are physically harming the patient if you remove the limb, but you are helping the patient’s mental health by performing it. The private hospitals have the right to either refuse or grant permission for the amputation, but I have a hard time seeing how the government could override the decision of the private business (another issue of paternalism). Using philosophy, we can grant the ‘wannabes’ the right to an amputation under certain situations and we can protect the doctors and hospitals who perform them. It is up to those in psychology to determine if it is the best solution to apotemnophilia.