I have heard from one of the authors of the journal article supporting the right of doctors to amputate healthy limbs for sufferers of a new mental health disorder known as Bodily Integrity Identity Disorder (BIID). He is unhappy with me. Neil Levy claims I misrepresented his and co-author Tim Bayne’s work in an article I wrote for the Center for Bioethics and Culture. (Here is the link to my original article.)

Levy wrote: “You write that we advocate ‘abandoning the patient’ by acceding to their request to amputate a healthy limb. First, as you fail to mention, we conclude that the question is difficult, but we think that ‘in some cases’ it ‘might’ be acceptable to accede. Second, you misprepresent our views by taking them out of context. You say that we write, ‘in full post modernist mode, just because a limb is biologically healthy, does not mean that the leg is real. Indeed, they argue, “a limb that is not experienced as one’s own is not in fact one’s own.” If we had implied anything such thing, we would deserve your mockery. But it should be clear, from even a cursory reading, that we intended to claim not that if the patient believes the limb is not theirs it is not. We couldn’t be claiming any such thing, because we distinguish between somatoparaphrenia, which is a delusion in which the patient denies ownership of the limb, and BIID, in which there are no false beliefs. The claim, rather, is that acknowledging ownership is normally a necesary condition for full ownership. Think of disowning a child. This is an act which does not alter the biological relationship, but alters the lived relationship. There is nothing ‘postmodernist’ about this. If you were familiar with norms in analytic philosophy you would hesitate to make such an accusation: no one is more vocal in denouncing facile relativism about truth.

Third, we do not advocate abandoning the patient. Once again, a careful reading of the article would indicate that amputation is recommended only as a last resort: so long as there is genuine and significant suffering and there is no alternative treatment that is effective. If there is such an affective treatment developed, than it is obviously preferable.”

My response was as follows:

“Thank you for writing.

It was a 550 word opinion piece. It is very clear that the term abandonment was mine and not yours, as was the opinion and interpretation that cutting off a healthy limb would be an act of abandonment. I never claimed you believed in abandoning a patient.

I quoted you accurately about the healthy limb not being the patient’s, an amazing statement in my view. Whether or not a patients “owns” the limb, does not make it any less real. And the point I was making is that autonomy is getting recklessly out of control in bioethics advocacy, and in jurisprudence as well, ergo the quoting of the Montana court case. I probably should have said that “as a last resort,” you would permit amputation. But you would still allow amputation.

I certainly had no intention of misrepresenting your article. I don’t believe I did. I believe the essence of what I wrote is true.”

(I would also note that the abstract of the article, which the authors wrote, states that they argue, “BIID suffers meet reasonable standards for rationality and autonomy: so as long as no other effective treatment for their disorder is available, surgeons ought to be allowed to accede to their requests,” in other words, cut off healthy limbs.)

Anyone interested in investigating this matter more fully, the cite is Journal of Applied Philosphy, Vol.22, No. 1, 2005.: