Consent, Autonomy, and the Benefits of Healthy Limb Amputation: Examining the Legality of Surgically Managing Body Integrity Identity Disorder in New Zealand


Upon first consideration, the desire of an individual to amputate a seemingly healthy limb is a foreign, perhaps unsettling, concept. It is, however, a reality faced by those who suffer from body integrity identity disorder (BIID). In seeking treatment, these individuals request surgery that challenges both the statutory provisions that sanction surgical operations and the limits of consent as a defence in New Zealand. In doing so, questions as to the influence of public policy and the extent of personal autonomy become important. Beyond legal issues, BIID confronts dominant conceptions of bodily integrity, medical treatment, and ethical obligations. This paper seeks to identify the relevant public policy concerns raised by BIID in New Zealand and the limits of autonomy, before moving on to consider how BIID sufferers may legally seek the treatment they require and how a doctor might be protected from criminal proceedings for assault for performing this treatment. It will be argued that it is possible to legally consent to the amputation of a healthy limb as medical treatment and that public perception should not be allowed to take precedence over this right.

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  1. Bayne, T., and N. Levy. 2005. Amputees by choice: Body integrity disorder and the ethics of amputation. Journal of Applied Philosophy 22(1): 75–86.

    PubMed  Article  Google Scholar 

  2. BBC News. 2000. Surgeon defends amputations. 31 January. (accessed March 12, 2010).

  3. Boyle, G.J., J.S. Svoboda, C.P. Price, and J.N. Turner. 2000. Circumcision of healthy boys: Criminal assault? Journal of Law and Medicine 7(February): 301–310.

    Google Scholar 

  4. Bridy, A. 2004. Confounding extremities: Surgery at the medico-ethical limits of self-modification. Journal of Law, Medicine and Ethics 32(1): 148–158.

    Article  Google Scholar 

  5. Dasti, J. 2002. Advocating a broader understanding of the necessity of sex-reassignment surgery under Medicaid. New York University Law Review 77: 1740–1777.

    Google Scholar 

  6. Dotinga, R. 2000. Out on a limb., (accessed March 19, 2010).

  7. Elliott, T. 2009. Body dysmorphic disorder, radical surgery, and the limits of consent. Medical Law Review 17(2): 149–182.

    PubMed  Article  Google Scholar 

  8. Ellison, J. 2008. BIID: Why sufferers amputate their own limbs. Newsweek, May 28. (accessed March 15, 2010).

  9. English, V., R. Mussell, J. Sheather, and A. Sommerville. 2006. Autonomy and its limits: What place for the public good? In First do no harm: Law, ethics and healthcare, ed. S. McLean, 117–130. Burlington: Ashgate Publishing.

    Google Scholar 

  10. Furth, G.M., and R. Smith. 2000. Amputee identity disorder: Information, questions, answers, and recommendations about self-demand amputation. Bloomington: AuthorHouse.

    Google Scholar 

  11. Marantz-Henig, R. 2005. At war with their bodies, they seek to sever limbs. The New York Times, March 22. (accessed March 16, 2010).

  12. Robertson, B., (ed.). 2010. Adams on criminal law, 3rd ed. Wellington: Brookers.

    Google Scholar 

  13. Ryan, C.J. 2009. Out on a limb: The ethical management of body integrity identity disorder. Neuroethics 2(21): 21–33.

    Article  Google Scholar 

  14. Savulescu, J. 2009. Autonomy, wellbeing, disease and disability. Philosophy, Psychiatry and Psychology 16(1): 59–65.

    Article  Google Scholar 

  15. Science News. 1993 (February 13). When imagination turns ugly. 143(7): 108.

  16. Skegg, P. 2006. Consent to treatment. In Medical Law in New Zealand, ed. P. Skegg and R. Paterson. Wellington: Brookers.

    Google Scholar 

  17. Somerville, M.A. 1980. Medical interventions and the criminal law: Lawful or excusable wounding? McGill Law Journal 26(1): 82–96.

    Google Scholar 

  18. Williamson, K. 2010. Healthy limb amputation, bioethics and patient autonomy. Emergent Australasian Philosophers 3(February): 1–21.

    Google Scholar 


  1. AG’s Reference (No 6 of 1980) [1981] 2 All ER 1057.

  2. Re T [1992] 4 All ER 649.

  3. R v Barker [2010] 1 NZLR 235.

  4. R v Brown [1994] 1 AC 212.

  5. R v Lee [2006] 3 NZLR 42

  6. R v Mwai [1995] 3 NZLR 149.

  7. R v Nazif [1987] 2 NZLR 122.


  1. Canadian Criminal Code.

  2. Crimes Act 1961 (NZ).

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Correspondence to Aimee Louise Bryant.

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Bryant, A.L. Consent, Autonomy, and the Benefits of Healthy Limb Amputation: Examining the Legality of Surgically Managing Body Integrity Identity Disorder in New Zealand. Bioethical Inquiry 8, 281–288 (2011).

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  • Body integrity identity disorder
  • Healthy limb removal
  • New Zealand Medical Law