Some of the assumptions in this and some other answers need to be challenged. Firstly, dsoltesz seems to be saying that it is unethical for a doctor to perform an amputation which is "cosmetic" in nature. Yet we readily accept countless other surgical interventions performed for purely cosmetic reasons - is it similarly unethical for a doctor to perform breast augmentation (or reduction) on a woman whose breasts are perfectly normal?

Secondly, I have to take offence at the suggestion that people with Body Integrity Identity Disorder be "committed involuntarily to a mental health facility". Without disputing that there are some cases in which people with mental illness do need to be committed, I doubt very much that BIID is such a case. Even if it were, surely one has to weigh the relative ethical merits of incarceration and forced pharmacotherapeutic treatment, which is unlikely to resolve the individual's condition, against surgical removal of an unwanted (and probably unused – read the literature) limb, which might.

I'm not advocating for elective amputation on demand, just pointing to the very real ethical dilemmas faced by doctors dealing with this, fortunately rare, condition.

@paulkidd: The difference between a non-harmful cosmetic body modification, like breast augmentation or ear piercing, and cosmetic limb removal is the fact that the latter handicaps the person. Willingly damaging one's body to the point of intentionally creating a handicap constitutes being a danger to one's self. Because people afflicted with this disorder may literally damage their limbs to force a surgeon to remove them or attempt self-amputation, the danger is considerable. Persons who represent a danger to themselves or others should be provided treatment in a safe environment until they no longer are a threat.

It is their life to lead and everyone should be able to live life free the way they want to without outsiders posing their views on what is normal or correct. You are making up mental disorders just because someone thinks differently than you. He bought a Snickers instead of a Milky Way, he must have a mental disorder. It does not mean that they have a mental disorder just because they want to rid themselves of an appendage that is just hanging around not doing it for them.
What is wrong with being handicapped? I bet you have not even accomplished what half of the people without limbs accomplish. They will run faster than you, hike longer and higher, climb mountains, swim across oceans, etc.

What about the transgenders? They alter their bodies for their own liking too, are they mental?

If they just take one limb.....Poke out one eye and you can still see.

I could go on.

A very challenging answer indeed. :-D
I have a few observations:

"It would indicate this doctor had a deeper understanding of 'health' than most in the allopathic medical field..."

According to whom? It seems you try to attack a general point of view that you consider wrong by generalizing, which is contradictory. To me it seems that enlightening is a discussion about ethical questions, not imposing personal values.

"Those of us who wish to remain in the care of the state, like orphaned children, clinging to the leg of our institutional daddy, may do so. Those of us who are capable of, and demand the right of sovereignty, must remain sovereign."

Although subtle, it might be a bit insulting for some people. Only people who agree with you and think like you are free and sovereign? Whoever thinks different than you is an "orphaned children, clinging to the leg of our institutional daddy"?
It seems like a dead end here, a refusal to any sort of a dialectical process, one where both parties actually listen to the other's arguments. I know it's not really the case because I've read some of your other answers. Still, it seems like a dead end.
Mostly I agree with you in the political aspects, but, being sovereign and not wanting an oppressive system seems in contradiction to wanting the whole world to be according to one's believes.

"If two individuals are willing, it is not the place of society to act as a barrier, and disrupt the freedom of other beings."

If a 45 year old guy wants to have sex with a six years old who AGREES to have sex, should it be allowed, according to the no intervention point of view? I hope you do answer this question, because it brings another question.

Self mutilation is OK by my own standards but not if it implies that one individual will depend on others because of loosing a functional part of his body and, especially, if that person will depend on the State because of being mutilated. In that case someone would have to take care of the individual, again falling into a contradictory loss of freedom.

"Advancement for humanity, as a people, comes never from the masses. These are the naysayers. These are the apathetic, the easily beguiled, concerned more with the direction of "the wind" than their own lives. They do not participate on the stage of life, as it is, but watch from the sidelines, and occasionally jeer or applaud the actors."

According to whom? Nietzsche? Some Übermensch nuts like Hitler, beyond good and evil? I disagree with this because

1) It's an absolute contradiction. You indicate that some people are better than others in the end, people who would, because of their superior skills, be able to manage others, like in a platonic (and tyrannic republic).
2) Thinkers don't come out of nowhere. It has taken thousands of years of accumulated knowledge to get to this point (e.g. using a computer to communicate between us right now), many times with the help from "the masses" and even by exploiting them.

I think anarchism (or being a libertarian) is about being responsible of oneself with as little intervention from the State as possible, not imposing my ideas to others.

Pescina, I've already done enough work on this, do you really need to make me do more? :p j/k

I do consider imposing one's ethics upon those who are unwilling to embrace them to be unenlightened. I hope this doesn't seem ironic... my position is not to argue a new definition of ethics, but to argue against the morality of others being mandated in a way that affects personal liberty with ones own body. In that sense, I think the recognition of one's right to have a surgical procedure that alters the function or appearance of ones body is enlightened. Functionality is a relative thing. To believe a person would be less functional due to the removal of a limb, is presumptive. I'd argue they would be more functional, if that limb is an affront to them for whatever reason. I believe Jesus would agree with me, given the statement in Matthew, "Wherefore if thy hand or thy foot offend thee, cut them off, and cast them from thee: it is better for thee to enter into life halt or maimed, rather than having two hands or two feet to be cast into everlasting fire." Somehow this position seems to have little support among Christians, however. My point in the quote, though, is to demonstrate that the idea there is more to one's wellbeing than the physical is not an unusual concept. It is not for us to determine what is in the best interest of the individual. Such a matter must be decided by the individual. It is hard for those of us who are able to feel sexually gratified without the need for amputation to understand or appreciate the perspective of someone who does not have that luxury. I merely try and empathize with the position that must put one in, and recognize that I, nor anyone else, have a right to subvert another's freedom because it makes me uncomfortable, or seems incomprehensible.

I am not trying to imply only those who think as I do are entitled to sovereignty. Sovereignty, in my view, is a right by nature of existence. The only way to lose it is through abdication. I do believe many people have freely and voluntary yielded their sovereignty in the interest of dependency upon government or society in general. This, I think, may seem unfortunate, but I respect their choice, for it is theirs to make.

Oppression is the last thing I would promote. In fact, it is my primary opposition. I believe, above all, we must respect the rights of the individual to make choices which affect their destiny, whether we agree with them personally or not. Not all of us are meant to follow the same path, so imposing one's own morality on what one wishes to do with their body, their time, their energy, is not appropriate. We can, of course, choose whether or not to be associated with them or enable them, but to restrict them, is to insult their nature, and to presume ours is superior.

I think you're looking at that sentence about two individuals I gave, as an example, out of context. I probably should have worded that better. I do not support the exploitation of an individual for the gain of another. The interactions of one person with another should always be guided by the consent of both involved. A child, incapable of consent, should never be victimized for the gain of another. That would not be representational of freedom to me, but rather of coercion. It would represent the same callous disregard for the will of another being, and selfishness, that would cause an institution or a person to believe they can decide one someone's behalf, in opposition to that person's choice.

You say you do not oppose self-mutilation except where it would lead to the possibility of the state being responsible for that person's survival. That seems reasonable at it's face, since none of us would care to finance the existence of others who, by their own choice, have opted out of society. I don't believe we should bear that obligation. At the same time, it presumes the individual will be less functional due to a missing limb, and overlooks the psychological trauma they endure from being seen as just another cog in the wheel, just another worker ant, just another sheep to be fleeced. My interest can never be what is good for a system that seeks to operate off of the constructive servitude of the masses, when those masses do not serve by choice.

To tell someone they, for example, can not have their arm amputated because they might not consume as much, or expend as much of their energy in service to consumerism, is a frightening lack of regard for their rights. People are more than simply "human resources" to be protected, not out of altruism, but because their ability to work in service to society is valued. And yet, this is precisely the mentality we see from government, which is meant to be in service to the people, rather than the other way around. Somehow we have forgotten who we are, and have been turned against one another. We impose ourselves on others, and believe since we abdicate our rights for the good of productivity, others should do the same. I am opposed to that very notion, but in addition, would wager an individual would likely be more productive, even lacking a limb, if they felt at peace with themselves. That is not something which should be in anyone's interest to oppose. People can serve only voluntarily. That service should be recognized as their gift, not an obligation. Those who decide not to serve, must not be compelled to, but must also risk the dangers associated with their freedom, and not expect to survive on the charity of others. On that point, I think we agree.

I am not a Nihilist, and not overly familiar with Nietszche, except to say that I think it represents another side of the same coin, rather than a true alternative. The Nihilist demanding I assert God is dead, would be just as distasteful to me, as the someone demanding I worship their deity. I believe there absolutely is a purpose to life, I simply believe that purpose is for the individual to manifest their greatness by following their true will, rather than the wills of others.

I don't see a contradiction. I do not believe some people are better, I merely believe all people are different, and that this should be embraced, rather than suppressed in a desire for conformity. All spectrums are necessary... I respect the right of every individual to choose the nature and degree of freedom they decide for themselves. I would be just as quick to support someone's right to lose a limb, as I would be for them to keep a limb. Isn't it funny how the very same people who argue against an individual's right to sever a limb, often preside over institutions that would ignore an individual's right to keep a limb, under other circumstances. Until we can establish that our bodies belong to us, not to the state, and not to society, we possess no further freedom than the livestock we consume. Like them, we have our masters, and our masters keep us... and not for our benefit.

I am opposed to involuntary servitude in all it's forms, and do not assert society has a better claim over my body than I do. For that reason, I am sympathetic to their cause. Their body is their body. I would never imagine I knew better what should be done with it than they themselves do.

EDIT: When I stated the notion about advancement not coming from the masses, I used a rather poor choice of words, and just now realized what you were saying. You are right that the masses contribute to the advancement of humanity. That was a foolish thing of me to state, and I think I see where you were coming from. What I meant to say, but articulated very poorly, was advancement is not initiated by the masses. You are quite right in that the masses provide a support structure for implementation. The masses are the tablet that the law is chiseled into, and every bit as necessary. A play would never be successful without an audience. You have an excellent mind, and I really appreciate your response. It's helped me to think this through in a much more complete manner than I had previously. :) I'll probably be cursed for the long reply, and should have blogged it and then provided a link in retrospect. I didn't mean to go into such length on here. Your feedback was very valuable to me, and I'd love to discuss this further with you.

1) I wrote the example of the 45 year old guy who'd want to have sex with a six years old out of context on purpose. Not to bug you, but because I think it's an interesting side of ethics: will and self determination. When and where do they start and where do they end? I don't have an answer for that but like to think about it when I have nothing else to do. See:

"A child, incapable of consent, should never be victimized for the gain of another. That would not be representational of freedom to me, but rather of coercion."

Why is a child incapable of consent in the first place? I think it has to do with neurological and social development of the individual. But, don't you think that, because of a neurochemical cause, a person might become incapable of consent?

2) Perhaps I should have been clearer about functionality. I didn't mean to be productive by that, but physiologically functional. I decide not to be productive and reject a few jobs that would pay more than what I have because I chose to write and think my own stuff. When I think of being functional I do it from my perspective, of course. I like to take "breaks" (although my life is an endless brake) and walk for a while. From that perspective I think of my legs as something functional and know that if I lost them here, in this country, I'd be in trouble.

By the way, thanks for the feedback. This site seems useful for writing a thesis or an essay.

Hi, I'm one of those users who "likened apotemnophilia to gender reassignment surgery". I said "even in less extreme cases, like change of sex...". First of all, excuse me for not using the most appropriate term, but, like you, I was talking about the ethical issues, more than the medical ones, that are far beyond my knowledge and, of course, are way too complicated.

After reading your response, it appears that we're arguing the same side of the issue. I was referring to another user that used the comparison to gender reassignment surgery to justify amputation. I certainly do not claim to have any real medical knowledge of the issue either, only a superficial understanding of the process.

Also, on second thought, I think the question itself is slightly misleading. It states that someone is "suffering from apotemnophilia" despite the article suggesting that it is something from which pleasure is derived (hence the suffix -philia). I think the way the question is phrased may lead people to believe that it is a mental disorder, which is not how I interpreted the article.

I agree about agreeing on the point of view and also about the misleading part of the question. It does make it appear like a pathological issue and give place to answers that are interesting but go a bit far beyond the question.
Of course, the second question ("What if the doctor knows the person will self amputate if the don't do the procedure?") defines the moral dilemma as a moral dilemma.

I compared gender reassignment to BIID, NOT apotemnophilia. My referring to gender reassignment surgery as removal of the penis may be an oversimplification, but I reassert that the psychological background of BIID and gender reassignment are very similar.

To clarify - I am NOT likening apotemnophilia to gender reassignment.

"Allow me to be cynical. You all are certainly putting a lot of weight on the Hippocratic Oath, which I find rather presumptuous. Are you saying that Ken Lay and Jeff skilling of Enron were incapable of committing fraud because they had a thorough ethics guideline?"

Ethics not always correspond to reality. It is obvious that some doctors perform all kinds of unethical (or questionable) surgeries, like injecting motor oil instead of breast implants. By the way, do you think that injecting motor oil is ethical or should be allowed?

If ethics does not correspond to reality, why are we discussing it? What relevance does it have? To respond, I do not feel that there are any universal morals and therefore no real "ethics," per se. There are societal standards, based on culture, tradition, and common law, with a hint of utilitarianism.

I don't understand your motor oil comment. Silicone has the same consistency as motor oil, so are you talking about Silicone or actual motor oil? Who am I to say whether motor oil injections are ethical or should be allowed? I have no breasts and no interest in such, and it is outside my realm of caring.

If a friend wanted motor oil implants, I would perhaps question her line of reasoning as she would most likely die; I would assume the only reason someone would do this is to commit suicide (in a rather attention grabbing manner) or because they were no longer in control of their mental faculties. Self-preservation is a powerful force, so the decision to do something this radical must stem from either careful consideration or mental incapacity. But who am I to keep her from doing it if it is truly what she feels destined to do? It would be selfish for me to force her into a psychiatric evaluation, but I would perhaps try to encourage her to do so. If a doctor were able to prove to me that she had, for instance, a degenerative brain disease or trauma that led to brain damage, I would perhaps attempt to have her family or the doctor take her to the funny farm, as credible scientific data implied an inability to reason. But if her behavior had not changed dramatically and she was completely in control of herself and there was no medical reason to believe she were incompetent other than her strange and oily request, I would have no choice than to stand aside and allow her to learn from her experiences. Of course, we all have irrational moments, and I may become emotional and attempt to sabotage her appointment and talk "sense" into her, but again, this is rather selfish and she should be able to live - and die - as she wishes.

We are discussing ethics because we are a species that argues all the time! We discuss for the sake of it and we've been going around ethics for more than 25 centuries, perhaps even more without solid answers. People argue about God and religion all the time and there is no conclusion. Ethics not always correspond to reality because there's always a difference between what one thinks, says and does.

You don't mention if you have apotemnophilia and still answered the question, so the part about not having breasts doesn't make much sense (even if it's funny). You can have an opinion about something even if you don't suffer or live under the discussed circumstances.

I do mean motor oil. Injecting it is a relatively common practice in cosmetic surgery in some obscure Latin American "clinics". Some doctors, and people who pretend to be, inject motor oil without the patient's consent because of money. I've also read about some people who just don't care about the deadly consequences. Here is a link about oil and implants, for your "amusement": http://www.buzzle.com/editorials/11-13-2004-61599.asp

Sad but true. By the way, people who get motor oil injected consciously for cosmetic or erotic purposes sometimes regret it, like, I guess, would be the case of an amputated limb. That, to me is reason enough for talking "sense" into someone, even if I interfere a little with that person's will.

You've got style, Pescina.

Thanks, @mrnemo. None of us got the money but it was fun.