The Ethics of Apotemnophilia
Introduction
Apotemnophilia, a disorder that involves both neurology and psychiatry, involves fantasies (mostly sexual) of being an amputee. This disorder primarily involves patients that suffer from a body dysmorphic disorder in which certain parts of their bodies feel “foreign” to them. Obviously, there are many debatable questions relating to the issue of apotemnophilia, including patient and doctor consent, autonomy, medical laws, and more, but here I focus on the ethical questions of apotemnophilia, from a constructivist and utilitarian perspective in which I argue that patients do have the right to do what they will with their bodies in their own pursuit of happiness, since knowledge and what is or isn’t
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This “alien” sentiment has been echoied by other pateints suffering from this disorder:
“In that instant, that very first encounter, I knew not my leg. It was utterly strange, not- mine unfamiliar. I gazed upon it with absolute non-recognition [...] The more I gazed at that cylinder of chalk, the more alien and incomprehensible it appeared to me. I could no longer feel it as mine, as part of me. It seemed to bear no relation whatever to me. It was absolutely not-me – and yet, impossibly, it was attached to me – and even more impossibly, continuous with me” (Sacks, 1991, p. 7)
This was the sentiment of the patients Dr. Smith operated upon successfully who reported being much happier after the fact. However, when a third patient requested the same surgery, the hospital administration became involved and the surgeon and his patients became the source of public and media disputes.
One of the biggest argument concerning this case and others like it, is that these patients, considering their mental conditions, could not actually have given informed (i.e., sane) consent because the request itself is considered “wrong” by society’s standards.
Of course the question of competency and whether or not someone is able to make rational decisions is the real question here and one to which a definitive answer just cannot be obtained.
According to author Carl Elliot (2007) in his book, A New Way to be Mad, just because someone wants a healthy limb removed does not make them
Katz states this about informed consent, “to suggest that informed consent with remain a fairy tale as long as the idea of joint decisionmaking, based on commitment to paint autonomy and self-determination, does not become an integral aspect of the ethos of medicine and the law of informed consent” (222).
Treatment without consent - Charlotte, the nurse on duty, had forced James into getting the injections therefore causing him emotional distress. Treating a competent patient who has validly refused treatment could constitute an assault or battery. The legal provisions supporting a competent patients’ right to refuse treatment in Australia can be found in both legislation throughout all the States and common law. The Australian Charter of Healthcare Rights is also a helpful source of guidance as it reinforces the common law position that is based upon the principle of patient autonomy. The High Court of Australia first articulated the principle or refusal of treatment in Marion’s case, stating that a legally competent person has a right “to choose what occurs with respect to his or her own person.” Under the NSW Health Patient Charter, consent in regard to an operation, procedure or treatment is both a specific legal requirement and an accepted part of good medical practice. Medical practitioners are also expected to clearly explain proposed treatment, and adequately inform their patients on significant risks and alternatives associated with the treatment.Failure to do this could result in legal action for assault and battery against a practitioner who performs the procedure. Charlotte made no effort to explain or gain a consent from James.
In this assignment I will be discussing Adult Nursing and Mental Health Nursing and issues regarding consent. Consent is important within all fields of nursing as it is essential to conduct any medical procedures. The Nursing and Midwifery Council Code of Conduct (NMC,2008) states that all healthcare professionals must presume that all patients have the mental capacity to accept or deny medical treatments after being given all information which may be needed. However there may be some instances where consent cannot be obtained. An example of this is if the patient is in a medical emergency and may be unconscious or if the patient lacks the mental capacity to make a knowledgeable choice. In this situation treatment would be
Henderson, a well known transplant specialist. Dr. Henderson believes medicine in the United States has become a repetitive system of doctors who prescribe patients with similar symptoms generic prescriptions, whether it is surgery or just a medicine, instead of focusing on the individual patient’s needs. He believes the inflation of medical care costs are associated with doctors doing the same thing over and over again. I can personally relate to this because, in February of 2015, I was emitted into the hospital due to excruciating stomach pains. The doctors did not know what was wrong with me, but after I was in the emergency room for over 48 hours, they decided to take out my appendix. Before I went into the surgery, the surgeon reassured me and my parents by saying she has done this surgery hundreds of times, proving an appendectomy is a go-to surgery for stomach pain. The uncertainty of the success of the surgery resolving the problem worried me and my family. Luckily, the surgery did eliminate the preexisting pain. If it had not, however, my parents would have been out thousands of dollars that would go directly to the surgeon’s pockets. Socialized medicine would be able to resolve problems like this one by increasing the quality, safety, and outcomes of each procedure. Dr. Henderson uses the example of Scotland to explain how socialized medicine increased the quality, safety, and outcomes of each procedure. Compared to the United States, Scotland is a lot more advanced medically. The United States can get to Scotland’s level of healthcare by adopting a program of socialized medicine similar to
The doctors in this story preyed on the ignorance and emotions of others when consent was necessary. For
In our day today lives we make complex decisions, continually weighing up the risks and benefits of our actions. However in the hospital environment, the Doctor knows best attitude has prevailed for many years, patients deemed unable to be involved in decisions regarding treatment. Development in law relating to consent has been slow, based on paternalistic approach and therapeutic privilege to decide treatment choice for patients. Whilst health care practice moved towards informed consent, the law lagged behind. In 2015 informed consent has finally been recognised in Law. The author will describe the changing attitude in the law of consent from 1950’s to present day and how these changes affected nurses duty to obtain consent from patients
Informed consent is defined as “permission granted in the knowledge of the possible consequences” and is the backbone to honorable physician patient interactions. Unfortunately, throughout history there have been many cases where physicians have used a patient’s lower socioeconomic status to manipulate the obtaining of informed consent. The AMA Code of Medical Ethics predates back to 1847, yet cases continue to arise directly breaking their key principles. These principles include autonomy, justice, beneficence, non-maleficence; and if followed ensure patients receive a high quality of care. Informed consent prior to any participation in experiments or procedures is essential for physicians to act within these guidelines. Autonomy allows patients to have free will and make decisions without coercion. Justice keeps all individuals in mind so resources are distributed fairly and all individuals are treated the same. Beneficence and Non-maleficence focus on the intent of the procedure to do only good and no harm. Even with these principles established there are discrepancies in on how they unfold in a clinical setting. The American Medical Association states physicians should assess their patient’s understanding of their medical condition, the recommended treatments, and document the physician-patient interaction. The Tuskegee, Abdullah vs Pfizer, and The Skid Row Cancer Studies are a few cases where these principles were ignored so physician and big pharmaceutical
In the article “Amputees by choice”, Elliott talks about two desires that some people have, which are called Apotemnophiliacs and Acrotomopiliacs. Acrotomophilia is expressed for people with a sexual desire towards amputees. And for Apotemnopilia are people who have an attraction towards the idea of being an amputee. Elliott also explains that their culture on the internet, Acrotomphiles are known as “devotees” and Apotemnophiles are known as “wannabes”. The wannabes pretend to be disabled in public using crutches, wheelchairs, and etc to feel disabled. Elliott said in his article “Like Robert Smith, I have been struck by the way wannabes use the language of identity and selfhood in describing their desire to lose a limb. “I have always felt
On the other hand, with the baby girl’s case, the mother ultimately chose assisted suicide as she wished to stop nourishment and refused permission for surgery. The issue here violates the Baby Doe Law, which regardless of the parents’ wishes, sets specific guidelines for treatment of disabled newborns. Since the baby is not competent due to her age, the issue of informed consent is hard to deal with. This also deals with the issue of deciding for others because the mother must give informed consent and decide based off the well-being of her baby. This is another case of vulnerable population because the patient is a ten-month-old baby, and disabled as well. This means the child must not be neglected and be properly spoken for because she cannot speak for herself. Both cases have issues that overlap with each other and need to be broken down more to be understood properly.
This situation is definitely linked to the term competence. Competence is basically the ability to deliver decisions about medical interventions. According to Vaughn, people who are incompetent in this sense cannot give their informed consent (Vaughn, 2013, P. 181). I agree with this because if my sister has Paranoid Schizophrenia she cannot give her informed consent when it comes to her health because she is not in the right state of mind to do so. according to an article I found in the Huffington Post mentally ill patients are like children, and they are not competent enough to make decisions for themselves, and they have to second guess all their decisions.
When Mary found out her son was enrolled in the study, she told Dr. Olson that she didn’t want Dan to participate. As time progressed on there were no signs that he was getting better. On May 8, Dan was found dead in a bathtub. He had stabbed himself multiple times and ripped open his abdomen with a box cutter (Elliot 1). In this paper, I will argue that Dan’s consent to participate in the drug study was not valid because the decision was not made freely and because it was from an incompetent person and therefore the university should have attained a proxy consent from Dan’s mother. I will also argue that the study was unethical due to financial obligations made between AstraZeneca and Dr. Olson, which violated the principle of clinical
Amputee’s go through lengthy obstacles when it comes to getting their prosthesis cover by their insurance carriers. The harsh reality that amputee’s faces is the limited amount of prosthesis they are allowed to have in a lifetime period under their health insurance plan. According to www.politico.com “prosthetic limbs can cost from $5,000 to more than $50,000 for a more advanced leg device that starts above the knee, said Dan Ignaszewski, director of government relations at the Amputee Coalition of America, an advocacy and support organization.”
Consent can be quite tricky, a legal minefield for healthcare teams, this is due to the patients who will give or refuse to give private information about themselves who is legally competent but
Section 14 of the act describes the meaning of capacity to consent to be treated wherein a person can consent if he fully comprehends in general terms his illness, symptoms of illness, nature and purpose of the treatment, its benefits and risks, its alternatives and consequences. In this case, Hai is distracted by his delusions and hallucinations and could not be deemed capable to consent. Although he seems to understand what Mark was saying, he denies any history of mental illness and refuses to take medications. In addition, his claim of medical training was not true. His denial and belief of being medically trained could be indicators of his delusional episode.
Transexualism has scientific basis that is far from unnatural. Surveys show many Transgender people who have Sex change Surgeries to another sex do not experience ‘Phantom Limbs’, an experience that is the ‘feeling’ of a limb that was removed or never there in the first place, such as A MTF (Male to female) Trans-sexual woman getting no longer having any sensation of previous extremities being there. Or in an opposite situation, A FTM (Female to Male) Trans-person who has not undergone hormonal shots having the sensation of an extremity she(he) does not have.