PEOPLE suffering from a bizarre body image disorder where they crave having a limb removed should be able to opt for amputation, a Sydney psychiatrist says.
These so-called "amputee wannabes" have a very rare condition in which they feel one of their limbs is not truly their own, and they become obsessed with cutting it off.
Dr Christopher Ryan, a psychiatrist at the University of Sydney, says there is a good argument for allowing patients with body integrity identity disorder (BIID) to have their unwanted limb removed.
"I am not saying we should unthinkingly cut off people's legs," Dr Ryan said.
"I realise that the idea strikes almost everyone as lunatic when they first hear it. However, there are a small number of people who see themselves, and have always seen themselves, as amputees," he said.
"They are often miserable their whole lives because of their 'extra limb', and we know that at least some of them feel much better if it is removed."
The disorder hit news headlines in 2000 when it was revealed that a surgeon in Scotland had amputated a healthy leg from two patients with the disorder.
At the time, appalled Scottish politicians called the procedure "obscene" and tried to ban such operations.
Dr Ryan has examined the ethics of the issue in the international philosophy journal Neuroethics and says doctors have a moral duty to amputate for the health and safety of the patient.
He said one 30-year-old patient of his lived his whole life feeling he was truly an amputee, but was so ashamed of how he felt he did not tell anyone.
"Eventually he took the only step he thought he had open to him and placed his leg in a bucket of dry ice until it died and had to be removed," Dr Ryan said.
"Now, a year later, he is living happily as an amputee and getting on with his life."
The paper said the operations should be likened to plastic surgery, with elective amputation offered to BIID sufferers only.