For the majority of us, the amputation of a limb is something from our nightmares – the result of a horrific accident or debilitating illness, perhaps a birth defect – something to be avoided at all costs. It's certainly not something we would choose to do. Approximately 185,000 [1] people in the US experience the amputation of a limb every single year but surprisingly, more and more people are opting for an elective amputation, an amputation that is not the result of a life-threatening defect but is voluntary, and one that is taken upon for a variety of different reasons. But why do people choose to have such a life-changing procedure? And what implications does that have for the rest of us?

 Elective Amputation of Problematic Limbs

Currently, the majority of elective amputees are those who are suffering from problematic – though not life-threatening – issues, such as damaged foot or a mangled knee. Although many doctors and surgeons still oppose the idea, these patients choose amputation as a way of improving their lives. It often ends painful suffering, can improve mobility, and offer a higher quality of life in general. Hugh Herr, double amputee and biophysicist in the biomechatronics department of Massachusetts Institute of Technology (MIT), is one such person [2] and he believes that as time goes on, people will increasingly choose to amputate in order to replace their "heavy and stupid" [3] legs with high-concept, technological prostheses.

Following an accident in 1982, Herr went on to have both legs amputated and has since developed a range of his own prostheses, including those specially designed for mountain climbing, such as small bladed devices to fit into tiny gaps, and longer limbs for higher reaching. He even created microprocessors to emulate real muscle movements so that to him, his limb-replacements feel just like the real thing – but lighter, better, and stronger [4] . Herr is not alone either. A quick Google search is enough to discover numerous anecdotes and case studies of people who chose to amputate after an accident and have gone on to live much better lives as a result.

Herr's bio-mechanical devices certainly seem somewhat of an upgrade, if a little reminiscent of science fiction's cyborgs. However, he's in the minority. Most people who choose to amputate are left to rely on traditional, low-cost, and basic prostheses and not the likes of Herr's several-billion-dollar limbs [5] . Of course, that doesn't necessarily mean that such amputations do not improve the quality of life of those who choose it. Replacing a damaged and painful ankle with even the most basic prosthetic can and often does help those who have elected amputation.

The Amputation of Healthy Limbs

Although clearly an extremely difficult decision, the elective amputation of problematic limbs is at least understandable. What may come as a surprise, however, is that there are a number of people each year who choose to amputate perfectly healthy legs and occasionally arms. Body Integrity Identity Disorder (BIID) and its sexually motivated sister-illness apotemnophilia (the erotic desire for amputation) are extremely rare but debilitating mental illnesses in which patients crave and seek out the amputation of healthy limbs, sometimes doing irreparable damage to themselves in their quest to become amputees.

The fixation, which tends to start in childhood, leaves sufferers obsessing over the idea of having one or more limbs amputated, despite their overall well-being. Many are unsure why they crave it, simply stating that they don't feel they are in the 'right' body, that they feel (perhaps ironically) incomplete, and that amputation would leave them with a contentment and satisfaction that they otherwise would not be able to find [6] .

For the most part, doctors consider it medically unethical to amputate a healthy limb, but there are those who are willing to perform the surgery. In the UK in the late 1990s, Dr. Robert Smith amputated the legs of two healthy men who were suffering from BIID. Although he has now been banned by the UK's National Health Service from performing such surgeries, Smith argues that, far from damaging these patients, he was in fact protecting them from potential self-harm. The mental illness, he claims, can leave them so desperate to become an amputee that "they may take the law into their own hands. They may lie on a railway line and get runover by a train. They may use shotguns and shoot off their limbs," [7] and that is surely worse.

The Ethical Dilemma

Robert Smith faced a huge backlash over his decision to amputate the limbs of those BIID sufferers, but there are in fact some doctors who agree with his decision. A 2012 study into the illness found that the "amputation of the healthy body part appears to result in remission of BIID and an impressive improvement in quality of life" [8] , suggesting that amputation would actually be the correct course of action. Besides, is there really much different between this and the decision to undertake gender reassignment? Professor of medical ethics Kenyon Mason thinks not. "As long as you can say that people can have a sex change for what is a severe psychological disease," he argues, "then it is difficult to say you cannot have an amputation for this psychological disease" [9] .

As prostheses become more technologically advanced and more financially realistic, however, will more and more healthy people choose to amputate in order to upgrade their hardware and improve their bodies? Perhaps. Just as cosmetic surgery started life as reconstructive surgery and later branched into vanity services, it seems likely that in the future, we will see assistive technology such as prosthetic legs move in the same direction. Ed Boyden at MIT says "we have to go beyond what nature intended, a future where technology and what it is to be human are blurred. A new nature that will give us new bodies and where disability is no more" [10] .

An Unfair Advantage and The Great Divide

We already use many forms of assistive technology, such as hearing aids and wheelchairs, but as they become more impressive, we could potentially find that those who have been augmented will have an advantage over those able-bodied people who have not chosen to replace their limbs. We've already seen the beginnings of this. Hugh Herr's mountain climbing prosthetic adaptations, for example, give him a clear advantage over those who use their biological arms and legs, and it's unlikely that competition organizers would allow non-amputees to use strap-on devices that liken to Herr's adaptations.

Olympic runner Oscar Pistorius faced similar allegations during the 2012 Olympics. Despite his disability, critics claim, Pistorius had an unfair advantage over the other runners as his J-shaped Flex-Foot Cheetah prosthetics allowed him to preserve energy, prevent stress fractures, continue without tiring, train for longer, and move in ways that he otherwise couldn't [11] .

Of course, for the time being, these highly technological and advantageous prosthetics are out of reach for the average person, but their rapid development means that in the future, more and more people may find them affordable, achievable, and desirable. Perhaps we are facing a future in which what was once a disability becomes an advantage, and where humanity is divided into two – the augmented and the unaugmented. To make matters worse, it's likely to be a wealth divide too, as only the rich will be able to afford such adaptations, leaving those in poor socio-economic conditions to fend for themselves with only what nature has given them.

[1] Amputee Coalition, 2017, Limb Loss Statistics, online. Accessed 12.13.2017

[2] Jemina Kiss, 2015, What is a bionic leg is so good that someone chooses to amputate? Online. Accessed 12.13.2017

[3] Ibid.

[4] Ibid.

[5] Ibid.

[6] ABC News, 2006, What Drives People to Want to be Amputees? Online. Accessed 12.13.2017

[7] Ibid.

[8] Jamie Wiles, 2017, Here's Why Some People Decide to Amputate Healthy Limbs, online. Accessed 12.13.2017

[9] Gerard Seenan, 2000, Healthy limbs cut off at patients' request, online. Accessed 12.13.2017

[10] Cited by Jemima Kiss, op. Cit.

[11] Rose Eveleth, 2012, Does Double-Amputee Oscar Pistorius Have an Unfair Advantage at the 2012 Olympic Games? Online. Accessed 12.13.2017