Abstract

Body Integrity Identity Disorder (BIID) is a condition in which individuals experience a persistent mismatch between their bodily self-image and their intact physical body, leading to a desire for limb amputation. Surgical amputation in BIID is usually rejected on ethical grounds, particularly on appeals to non-maleficence and the claim that removal of a healthy limb necessarily creates disability and therefore constitutes serious harm. This article critically examines that assumption. It argues that much of the ethical opposition to amputation in BIID rests on an unexamined conflation of physical impairment with disability. Using the social model of disability, the paper distinguishes the immediate surgical harms of amputation from the longer-term harms commonly attributed to disability, many of which arise from social and environmental factors rather than from impairment itself. Once this distinction is made, the claim that elective amputation is intrinsically harmful becomes less secure. The article does not offer an unqualified endorsement of surgical intervention but instead reframes the ethical debate by clarifying what kinds of harm are at stake and where they originate. It concludes that, in carefully selected cases, where decisional capacity is intact, suffering is substantial, alternatives have failed, and safeguards are in place, elective amputation in BIID cannot be dismissed as inherently unethical and deserves a more nuanced ethical appraisal.