Giving a leg up part 2: the ethical challenges of Body Integrity Dysphoria

Abstract

Introduction Body Integrity Dysphoria (BID) is a diagnosis, newly described in ICD-11, “characterised by an intense and persistent desire to become physically disabled in a significant way… accompanied by persistent discomfort, or intense feelings of inappropriateness concerning current non-disabled body configuration”. Patients with BID may request the amputation of healthy limbs but this raises multiple ethical challenges. Objectives By the end of the presentation, participants 1) will better understand the new diagnosis of Body Integrity Dysphoria; 2) will be able to have some landmarks to evaluate and manage this rare condition 3) will discern the ethical challenges raised by an elective or emergent amputation request. Methods We present a complex case we faced in Quebec City, Canada. A young adult admitted to the intensive care and burn unit was referred to our Consultation Liaison (CL) team. For the second time in a year, the individual deliberately burned his leg, with the intention of having an amputation. Based on the available literature and our experience, we explore the ethical aspects of this case. Results For this situation, the multidisciplinary team faced uncertainty and ambivalence toward the best treatment options. Deontological concerns and ethical issues emerged from the patient’s request for amputation. Conclusions We outline how ethical concepts helped us to gain a shared comprehension of the patient’s extraordinary request, both during treatment and afterwards. Disclosure No significant relationships.

Keywords

• Rare condition
• Body integrity dysphoria
• Ethics
• Consultation-Liaison psychiatry