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Body Integrity Identity Disorder (BIID) – Lassen sich Amputationen gesunder Gliedmaßen ethisch rechtfertigen?

Body Integrity Identity Disorder (BIID) – Is the amputation of healthy limbs ethically justified?

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Zusammenfassung

Unter Body Integrity Identity Disorder (BIID) versteht man das sehr seltene Phänomen, dass jemand die Amputation einer oder mehrerer gesunder Gliedmaßen oder die Beibringung einer Querschnittslähmung verlangt. Manche dieser Menschen verstümmeln sich selbst; andere fordern von Chirurgen eine Amputation oder die Durchtrennung des Rückenmarks. Von Psychologen und Psychiatern gibt es unterschiedliche Erklärungsansätze für dieses Phänomen; bisher ist aber keine erfolgreiche psychotherapeutische oder pharmazeutische Therapie bekannt. Betroffenenvertreter erklären den Amputationswunsch in Analogie zu dem Verlangen von Transsexuellen nach chirurgischer Angleichung an ihr Wunschgeschlecht. Unter Medizinethikern ist die Amputation gesunder Gliedmaßen höchst umstritten; einerseits wird aus dem Autonomie-Prinzip das Recht auf Körpermodifikation abgeleitet, andererseits wird angenommen, dass der Amputationswunsch aus innerem Zwang oder Wahn resultiert. Neurologische Befunde legen nahe, dass BIID wahrscheinlich eine hirnorganisch bedingte Störung des Körperbildes ist, vergleichbar mit bestimmten Schlaganfallfolgen. Wenn BIID eine neuropsychologische Störung ist, zu deren Symptomen fehlende Krankheitseinsicht und eine durch inneren Zwang eingeschränkte Fähigkeit zu vernünftigen Entscheidungen gehören, sind die von BIID-Aktivisten und einigen Medizinethikern geforderten Amputationen kontraindiziert und stellen Körperverletzungen an Menschen mit einer neuropsychologischen Störung dar. Statt des Kurierens an einem Symptom sollte eine kausale Therapie entwickelt werden, mit dem Ziel der Integration des als fremd empfundenen Körperteils in das Körperbild.

Abstract

Definition of the problem

The term Body Integrity Identity Disorder (BIID) describes the extremely rare phenomenon of persons who desire the amputation of one or more healthy limbs or a paralysis. Some of these persons mutilate themselves; others ask surgeons for an amputation or the transection of the spinal cord.

Arguments

Arguments Psychologists and psychiatrists offer quite different explanations for this phenomenon; but currently no successful psychotherapeutical or pharmaceutic therapy is available. Lobbies of persons with BIID explain the desire for amputation in analogy to the desire of transsexuals for surgical sex reassignment. Medical ethicists discuss controversly about elective amputations of healthy limbs: on the one hand, the principle of autonomy is used to deduce the right for body modification; on the other hand, the autonomy of BIID patients is doubted. Neurological results suggest that BIID is a brain disorder producing a disruption of the body scheme, for which parallels in stroke patients are known.

Conclusion

If BIID is a neuropsychological disturbance which includes missing insight into the illness and a specific lack of autonomy, then amputations would be counterindicated and would have to be evaluated as bodily injuries of mentally disordered patients. Instead of only curing the symptom, a causal therapy should be developed in order to integrate the alien limb into the body scheme.

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Authors and Affiliations

  1. Aachen, Germany

    Sabine Müller

  2. Institut für Geschichte, Theorie und Ethik der Medizin, Universitätsklinikum Aachen, Wendlingweg 2, 52074, Aachen, Germany

    Sabine Müller

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  1. Sabine Müller
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Correspondence to Sabine Müller.

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Müller, S. Body Integrity Identity Disorder (BIID) – Lassen sich Amputationen gesunder Gliedmaßen ethisch rechtfertigen?. Ethik Med 20, 287–299 (2008). https://doi.org/10.1007/s00481-008-0581-3

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  • DOI: https://doi.org/10.1007/s00481-008-0581-3

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