Blog > Thoughts > Sean's Thoughts > A Question Of Morals
A Question Of Morals
Written by Sean on Saturday, October 10, 2009
In a recent article in the Dakota Voice, a Dr. Theo used Body Integrity Identity Disorder (BIID) as an example to explain why he finds it unethical to provide in-vitro fertilisation for lesbian couples. I won’t comment on in-vitro fertilisation, that’s not the purpose of this blog. I will say, however, that Dr. Theo appears to me to be pretty narrow minded and to be a typical Western doctor, who doesn’t look at "health" in a holistic manner. Dr. Theo has a negative bias towards disabilities.
Dr.Theo says:
Robert suffers from a little-known psychiatric disorder called Body Integrity Identity Disorder or BIID.
There is evidence that BIID is *not* purely psychological. Recent studies show that there is a neurological aspect to the condition.
He continues:
This is a condition where the individual desires the removal of a perfectly healthy limb, usually one or both legs but sometimes arms.
Once again, a doctor who has obviously not done his research all that well. BIID also expresses itself by a need to be paralysed, or blind, or deaf. Considering the very limited understanding Dr. Theo seem to have about the condition, how can he make decisions about how to treat, or not, someone with BIID.
He later asserts:
Doctors are loathe to amputate normal limbs simply at the patient’s request.
This is where the crux of the problem lays, for me. What is "normal"? I don’t much believe in the concept of "norm", but in this context, I imagine that the doctor means to say that the limbs function the way nature designed them to work. That the limbs function like most everyone else’s. Could we rephrase that sentence and say "healthy limb"? I would say "yes". Because the doctor would not hesitate to remove a cancerous leg, which is abnormal, and unhealthy.
So looking at it from a *health* point of view, we can further ask "is health defined only by physical factor?". That is, are you healthy if your body functions "normaly"? It appears that for many people, including in the medical community, that is the preferred view.
Which totally ignores the balance between health and mind. The body cannot operate without the mind. If my mind is not healthy, I am not healthy. To me health is something to be considered much more holistically. In almost simplistic terms, one could look at the following equation:
PHYSICAL HEALTH (Ph) + MENTAL HEALTH (Mh) = HEALTH (H)
Let’s add numbers here:
Ph: 50 + Mh: 50 = H 100
I would estimate that my Physical health is around 45, in general. I’m physically healthy, "normal", but have a few niggles that make it not quite a perfect score. I would further estimate my Mental health to be around 10. Not because BIID is a mental illness, but because of the anguish, despair, and depression related to BIID. That gives me a total of Health = 55.
Let’s say that after surgery, my Physical health went down to 20 (which is quite a bit lower than I would estimate the average para to be at). But that my Mental health goes up to 45. That gives me a total Health = 65.
There’s a net gain there. Isn’t the aim to be as well as we can be? Isn’t a 10 point increase worth it? Especially considering that most paras aren’t unhealthy, they just can’t walk (ok, there are complications, but in general, most paras don’t encounter them all at once).
Dr Theo then says:
Can you see that we must allow physicians the “right of conscience” when we are asked by patients to do something that we cannot be a part of out of deeply held moral or religious convictions?
I can’t disagree, physicians should have that right of conscience. If they are uncomfortable doing a particular procedure, they should not be forced to do so. But the issue here is that those physicians who are NOT opposed to surgery for BIID should not be forbidden to do it.
You can’t have it both ways. You can’t refuse to do a procedure on the basis of moral objection, and then deny *all* access to the procedure to an individual who is suffering. Doing so equates to forcing a "patient" to suffer, which surely should be viewed as immoral, shouldn’t it?
But where does the moral objection come from? Doesn’t it come from the fact that it is thought immoral to "handicap" someone? What does that say about society’s values, about the physician’s value? I would not be surprised if they thought life with a physical disability offers an extremely low quality of life. That seems to be par for the course according to research I’ve read. Yet other research shows that most people with a physical disability say their quality of life is equal or better than before their disability. And that is for people who did not seek their condition out!
So the "moral" decision of refusing to provide surgery is based on a value judgement that is off base.
No, I don’t want to force a physician to act against his conscience or religion. But perhaps they need to have a serious look at issues. Because there was a time not so long ago when African Americans were unable to get treatment from "white" doctors, on the ground it was immoral.
Tags: BIID, Conscience, Disability, Discrimination, Doctor, Moral, Physician
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10 Comments
2 On 10 October, 2009, Phil said:
Hi Chloe,
are you referring to the Piaget/Kohlberg theory of moral development? They have found that the ethical/moral concepts of people follow a certain development pattern. They and others even have found on which of the 6 stages how many people stand. Very interesting.
I think that BIID has intensified my interest in spirituality and religion a lot. Because BIID poses questions that cannot be answered without some sort of metaphysical considerations or rather a standpoint.
Without this standpoint, no judgement is possible. And that is, I think, not the worst philosophy: that only one’s heart and one’s autonomous conscience (together with the necessary information) can lead to a decision about what is “good” or rather appropriate to do for me (!) in a concrete situation (considering as many possible consequences as I can). I cannot talk or think for others, nor can I judge them.
But I often fail to follow my own philosophy and judge. It’s just so easy. Although even the Bible says: don’t judge, so you won’t be judged.
I think there is also much fear that makes people reject the idea of “voluntary” surgical body change. And one who never was allowed to follow his/her own impulses and deep desires might feel envious deep inside, hiding this envy behind moral outrage.
In Benjamin Britten’s opera “Billy Budd” (based on Melville’s short novel “Billy Budd Sailor”) I found these lines:
“O beauty, o handsomeness, goodness! Would that I never encountered you! Would that I lived in my own world always, in that depravity to which I was born. There I found peace of a sort, there I established an order such as reigns in Hell. But alas! the light shines in the darkness, and the darkness comprehends it and suffers. O beauty, o handsomeness, goodness! would that I had never seen you!
Having seen you, what choice remains to me? None, none! I am doomed to annihilate you, I am vowed to your destruction…
With hate and envy I am stronger than love.
If love still loves and grows strong where I cannot enter, what hope is there in my own dark world for me?” (Act II, Scene 2).
Often who lacks freedom cannot admire free persons and animals. Often who lacks love hurts when seeing lovers kiss (I had this feeling before I came out and was openly gay.)
And because of that, we shouldn’t judge or condemn those who judge and condemn us, because maybe they suffer more, and more hidden, than we know.
3 On 10 October, 2009, Phil said:
I forgot to mention that the text (libretto) of the opera was written by Edward Morgan Forster and Eric Crozier. Sorry.
Hi Phil,
I wasn’t aware of referring to any particular theory. I have no training in psychology. However I have spent a LOT of time hanging out with psychologists, so it is possible I might have vaguely picked up something along these lines. I’m sure the three stages I mention are overly simplistic. But it is amazing how many people I come across who are stuck in this thinking error of believing that other people should be like themselves.
Your last sentence is profound. I do indeed feel compassion for those who judge, because I understand how much they must be suffering inside. It reveals a lack of self love.
I am somewhat familiar with the Bible, even though I’m not religious… I’m pretty sure that it doesn’t say anything about wanting to be paralysed, blind, what-have-you, nor does it say anything about being different. For all I can see, you need to get married before having sex, don’t kill people, don’t kill yourself, and be kind to others… I find the Bible has some good pointers on how a civilisation should behave, but it doesn’t say anything about everyone being the same, or even believing the same things. I think somewhere, and correct me if I’m wrong, it implies that the best Christian is one who finds God on their own, not being swallowed by the masses.
This is an interesting analysis and discussion. My point had to do with the demand by some that doctors should do what we are told even if it violates some personal values or beliefs.
I was simply using BIID as an example of something that most doctors would not wish to be a part of. I did not express an opinion about whether some physicians should be allowed to do such procedures when asked by their patients. That is a question that is irrelevant to my point.
The Bible tells us in Matthew 18:9: “And if your eye causes you to sin, gouge it out and throw it away. It is better for you to enter life with one eye than to have two eyes and be thrown into the fire of hell.”
How would some of you feel about a doctor removing a normal, functioning eye when asked by a patient who took this passage literally? Does it change your position any if the request is based upon religious conviction? Just wondering.
“L” said “I think somewhere, and correct me if I’m wrong, it[the Bible] implies that the best Christian is one who finds God on their own, not being swallowed by the masses.”
I can’t imagine what teaching of Jesus’ could be interpreted that way. In fact, Jesus tells us that we cannot find God on or own, saying “I am the way the truth and the light. No one comes to the Father except by me.”
I think the Bible does indeed have something to say on the issue of self-mutilation:
Leviticus 19:28
“You shall not make any cuts on your body for the dead or tattoo yourselves: I am the Lord.”
Deuteronomy 14:1
“You are the sons of the Lord your God. You shall not cut yourselves or make any baldness on your foreheads for the dead.”
1 Corinthians 6:19-20
“Or do you not know that your body is a temple of the Holy Spirit within you, whom you have from God? You are not your own, for you were bought with a price. So glorify God in your body.”
7 On 10 November, 2009, Sean said:
Dr. Theo, while I am far from a theologian, and readily admit to not being religious, I think the quotes from Leviticus and Deuteronomy are a bit misleading as they appear taken out of context. That is, they appear to be ancient funeral rituals.
There are many things the Bible says that are not acceptable anymore. Most really need to be taken as analogy, not literaly. And the moment you start questioning one part, the whole becomes a bit shakey. Please note I am NOT attacking the Bible, nor Christianity – your beliefs are your own, mine are mine. What works for you is good. My problem comes when your beliefs impact my ability to find peace of mind.
Matthew 24:46
Blessed is that slave whom his master will find at work when he arrives.
Ephesians 6:5-6
Slaves, obey your earthly masters with fear and trembling, in singleness of heart, as you obey Christ; not only while being watched, and in order to please them, but as slaves of Christ, doing the will of God from the heart.
Corinthians 14:34-35
Let your women keep silent in the churches: for it is not permitted unto them to speak; but they are commanded to be under obedience. And if they want to inquire on any thing, let them ask their husbands at home: for it is disgraceful for women to speak in the church.
Judges 21:1-24
So that is what the men of the Lord did. While the girls were dancing, each man caught one and carried her off and raped her as his wife. Then they returned to their inheritance and rebuilt the towns and settled in them.
Numbers 25:4
And the LORD said to Moses, Take all the heads of the people, and hang them up before the LORD against the sun, that the fierce anger of the LORD may be turned away from Israel.
Deuteronomy 2:32-34
When Sihon and all his army came out to meet us in battle at Jahaz, the LORD our God delivered him over to us and we struck him down, together with his sons and his whole army. At that time we took all his towns and completely destroyed them–men, women and children. We left no survivors.
Psalms 137:9
Happy shall he be, that taketh and dasheth thy little ones against the stones.
Samuel 12:11
Before your eyes I will take your wives and give them to your neighbor and he will rape them in broad daylight. You sinned in secret, but I will do this in the presence of all with the sun looking down.
Numbers 31:17-18
And kill every woman who has slept with a man, but save for yourselves every girl who has never slept with a man.
Jeremiah 50:21-22
“Pursue, kill, and completely destroy them, as I have commanded you,” declares the Lord. “Let their cries be heard in the land, a noise of great destruction
Leviticus 25:44-46
Your male and female slaves are to come from the nations around you; from them you may buy slaves. You may also buy some of the temporary residents living among you and members of their clans born in your country, and they will become your property. You can will them to your children as inherited property and can make them slaves for life, but you must not rule over your fellow Israelites ruthlessly.
A literal sentence-by-sentence reading of any document that comes out of the cultural context of the Middle East two or three millennia ago, without looking either at its internal context or the differences between the world it came out of and the one we live in, will lead nowhere. Any discussion of what God wants of us based on such a literal verse-by-verse reading of the Bible is a waste of time. I certainly do believe in a physician’s right to refuse to do a particular decision as a violation of his/her conscience, but only because of the inviolability of the right of conscience, not because of what the Bible (or the law) might or might not dictate.
9 On 12 November, 2009, Sophie said:
One doesn’t come to God on their own no, but it isn’t through following the masses either. It’s through conviction of the holy spirit. Christians merely sow the seed (or point the way to the path depending on how you want to put it).
10 On 12 November, 2009, Phil said:
The Bible is not the only holy scripture in the world. What about these? Do they lie?
It has been written by humans long ago, in languages we don’t speak, in a culture we are not living in. Parts of it have been suppressed, parts may have been added later, partially for good reasons, partially for reasons of power and politics.
Who will be able to sort out what really is the word of God?
But IF the Bible is a word of God, why don’t we rely on this:
“For I am convinced that neither death nor life, neither angels nor demons,[a] neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord”. (Romans 8, 38)
Nothing, not even BIID or “mutilating” one’s own body.
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1 On 10 October, 2009, Chloe said:
One gets a pretty good idea of what is going on here if you follow the link that Sean provided. The first comment states “this fellow (the person with BIID) is clearly infested with demons”.
Now why didn’t I think of that before? Obviously I have a demonic infestation. All I need is an exorcism and I’ll be cured!
It is a mystery to me why so many people get stuck in an early stage of childhood development.
The first social stage is that baby imagines that the entire world revolves around themselves. An important stage in social development comes when a child realises that other people are like themselves. This forms a guideline for healthy social interactions. But why do people get stuck here and never take the next step?
The next step is the realisation that everybody is different from each other. The full realisation of this can take some time.
I was in my twenties when I was discussing the rise of Nazism with a friend from Germany. He made the comment that some people like being told what to do. It was an astonishing revelation to me. I immediately knew that he was right, but it was simply something that had never before occurred to me as a possibility. There were indeed people out there who were more different from me than I could possibly have imagined. Now a lot of things made more sense.
Some people seem to have immunity from lessons such as this, and carry on into old age the idea that other people are, or should be, or are supposed to be, like themselves. One of the common examples of how this manifests is in religion. People find what they believe is the one true religion for themselves. Then they somehow jump to the conclusion that it must therefore be the one true religion for everybody else in the entire world. I find this absolutely extraordinary. I have my religion. I am not antagonistic towards religion. But I would find myself ridiculous if I tried to convince anybody else that they should follow my religion. I recognise that other people have different needs from myself.
This is all applicable to BIID at several different levels. It may seem simplistic, but I guarantee there are people out there who think along these lines: “I don’t wish to be paralysed. Therefore nobody else should wish to be paralysed”. There really are people who are that naive.
Somehow religion seems to find its way into discussions about BIID. When I recently gave a talk to a clinical psychology class, one of the questions was about my religion. I stated what it was, and went on to explain it when some people clearly had not heard of it before. After a pause I said “However, I don’t believe my religion has anything whatsoever to do with my BIID”.
The author of the article referenced by Sean is clearly coming from a particular religious standpoint. I absolutely respect that. And I respect his decisions as to what he is or is not going to do. The danger lies when someone tries to impose their values and belief system on someone else. The reality is that there ARE physicians out there who would be willing to treat BIID. The problem is that other people are telling them what they should or should not do.
The bottom line is that different people have different moral values. It is unfortunate that so many don’t have the maturity to recognise that they don’t have a monopoly on the one true set of moral values. As I read a long time ago: “The basis of ethics is personal autonomy”.