Rethinking the Body: An exploration of Patient's Autonomy and Body Integrity Dysphoria in the Czech Republic

Leandro Loriga, M.Sc.

Doctoral thesis

Abstract:

Introduction Body Integrity Dysphoria (BID) is a rare condition defined by a spectrum of symptoms. The ICD-11 mentions an intense desire to become physically impaired, which is persistent through time. Such desire is so overwhelming that some actors self-mutilate. In such cases, both abstention and intervention may lead to severe ethical complications for doctors and patients. Over the years, symptoms similar to those of BID have been classified under various names: Body Identity Integrity Disorder, Body Dysmorphic Disorder, Xenomelia, and Amputee Identity Disorder. However, only the ICD-11 has provided an official definition that makes BID a fully legitimised condition without having any recognised therapeutical approach. Methods The present research project explores the intricacies of patient autonomy through qualitative and quantitative investigation and data analysis. The scope is to shed light on the extent to which an individual can dispose of one’s own body within the medical setting. Results The results obtained show that no ethically nor morally relevant differences exist as of today between BID’s amputation request and other similar types of invasive and non-reversible surgical practices, such as Sex Reassignment Surgery. Despite such a correspondence, BID’s amputation is still rejected as a possibility of care, which defies the logical workflow utilised to assess the legitimacy of similarly invasive and non-irreversible types of procedures. Such a gap in logical consistency is rooted in pre-established beliefs about the inviolability of the human form, which create a one-to-one correspondence between an ideal type of bodily integrity and optimal physiological and psychological functionality. When such a view is challenged, the patient’s autonomy is nullified. Conclusion Overall, the study reveals that BID has all the characteristics to be considered a non-elective type of medical intervention in the same fashion as SRS is today. Similarly, no elements suggest that the BID individual is not an autonomous agent. Despite such elements, BID today is still considered an anomaly, which calls for a re-evaluation of the condition itself within the medical setting to comprehend better and assist those affected by it.

Keywords

Body Integrity Dysphoria (BID), Amputation, Limb Amputation, Gender Incongruence, Bioethics, Justice, Sex Reassignment Surgery, Autonomy

Language used: English

Date on which the thesis was submitted / produced: 5. 4. 2024

Thesis defence

• Date of defence: 10. 6. 2024
• Supervisor: doc. PhDr. Iva Šmídová, Ph.D., doc. Mgr. Radim Bělohrad, Ph.D.
• Reader: doc. Mgr. Eva Šlesingerová, Ph.D., Dr. Wendy Drozenová, Ph.D., Univ. Prof. Dr. Florian Steger

Masaryk University

Faculty of Medicine

Doctoral programme / field:
Bioethics / Bioethics