Should we prevent non-therapeutic mutilation and extreme body modification?

Bioethics

Volumn 22, Issue 1, 2008, Pages 8-15

  Schramme, Thomas ^a  

^a SWANSEA UNIVERSITY   (United Kingdom)

Author keywords

Body modification; Duties to oneself; Harm to self; Mutilation; Paternalism; Voluntariness

Indexed keywords

ARTICLE; AUTOMUTILATION; BEHAVIOR; BIOETHICS; BODY MODIFICATION; DECISION MAKING; HUMAN; MENTAL DISEASE; MORALITY; PERSONALITY;

HUMAN BODY; HUMANS; PERSONAL AUTONOMY; PHILOSOPHY; SELF MUTILATION; SOCIAL CONTROL, FORMAL;

EID: 37249089887     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2007.00566.x     Document Type: Article

References (32)

1. In order to be able to disregard obvious objections, which are not important for what I am trying to establish, I presuppose that Ms B is competent, medically informed and prepared to bear the costs of the intervention and possible consequential disadvantages. I also presume that the surgeon does not see the amputation as a violation of his professional duties.
2. I do not distinguish between voluntary self-mutilation (maiming) and mutilation by others on grounds of informed consent.
3. T. Bayne N. Levy. Amputees By Choice: Body Integrity Identity Disorder and the Ethics of Amputation. J Appl Philos 2005 22 : 75 85).
4. G. Bataille. 1992. Orig. 1954. Sovereignty. Transl. Robert Hurley. The Accused Share. Vol. 3, New York: Zone Books.
5. S.R. Cummings K. Stone. Consequences of foot binding among older women in Beijing, China. Am J Public Health 1997 87 : 1677 1679.
6. S. Sheldon S. Wilkinson. Female Genital Mutilation and Cosmetic Surgery: Regulating Non-Therapeutic Body Modification. Bioethics 1998 12 : pp. 263 285.
7. F. Musafar. 1996. Body-Play: State of Grace or Sickness? In Bodies Under Siege: Self-Mutilation and Body Modification in Culture and Psychiatry. Second Edition. A.R. Favazza. Baltimore: Johns Hopkins U.P.: 325-334. Examples of these practises can be seen on the website of the Body Modification Ezine: http://www.bmezine.com [Accessed: 21 March 2006].
8. M. Benecke. First Report of Nonpsychotic Self-Cannibalism (Autophagy), Tongue Splitting, and Scar Patterns (Scarification) as an Extreme Form of Cultural Body Modification in a Western Civilization. Am J Forensic Med Pathol 1999 200 : 281 285.
9. 'We believe in the possibility of an incalculable number of human transformations, and without a smile we declare that wings are asleep in the flesh of man.' F.T. Marinetti. 1991. Orig. 1911. Multiplied Man and the Reign of the Machine. In Let's Murder the Moonshine: Selected Writings by F.T. Marinetti. R.W. Flint, ed. Los Angeles: Sun and Moon Press: 90-93. Another famous slogan of the Italian Futurists reminds of Julien Offray de La Mettrie's study Machine Man (Cambridge: Cambridge U.P. 1996. Orig. 1747): 'We feel mechanically. We feel made of steel. We too are machines, we too are mechanized!' E. Prampolini, I. Pannaggi & V. Paladini. Mechanical Art: Futurist Manifesto (1922). Available at: http://www.futurism.org.uk/manifestos/ manifesto57.htm [Accessed 31 March 2006].
10. Apart from the bill on Female Genital Mutilation, I was not able to track down any legal regulations concerning extreme voluntary body modifications. Since so far most cases only concern minor interventions like piercing and tattooing, there still seems to be no need for regulation, besides already regulated issues of safety, hygiene, and consent. In Britain, and other countries, the common clause of 'grievous or actual bodily harm' may apply in some cases, because it even rules out interventions which are done by consent. Germany has a peculiar paragraph in its penal law (§228) that prohibits acts that 'offend good morals' (wider die guten Sitten), i.e. are contra bonos mores. This paragraph also applies to consentient acts. The state of Illinois planned to ban tongue splitting unless performed for therapeutic or clinical reasons. This clause was dropped and the only proviso now is that a person from the medical profession performs the act. Available at: http://ilga.gov/ legislation/publicacts/fulltext.asp?Name=093-0449. [Accessed 30 March 2006].
11. Favazza, op. cit. note 7; p. xix.
12. V.L. Pitts. Body Modification, Self-Mutilation and Agency in Media Accounts of Subculture. Body and Society, 1999 5 : 291 303 Singer. On Duties to Oneself, Ethics 1959 69 : 202 205.
13. Kant, op. cit., note 15, p. 547 [6:422].
14. A. Reath. 2002. Self-Legislation and Duties to Oneself. In: Kant's Metaphysics of Morals: Interpretative Essays. M. Timmons, ed. Oxford: Clarendon Press: 356.
15. Kant, op. cit. note 15, p. 547 [6:422f.]. The formulation that a person, in committing suicide, is using himself as a mere means, is in line with the respective claim in the Groundwork (Kant, orig. 1785, op. cit. note 15, p. 80, [4:429]). I refer to the Metaphysics of Morals, because his account of self-regarding duties in this later text is more detailed and because I fail to make sense of the idea that someone - while doing something self-regarding - may fail to treat himself (also) as an end.
16. Denis (L. Denis. 2001. Moral Self-Regard: Duties to Oneself in Kant's Moral Theory. New York/London: Garland: 101) explains Kant's analogy between killing oneself and self-maiming by his premise that he 'considers the person to be a whole composed of physical and rational aspects'. But that does not make Kant's claim more agreeable, since the self-maimer is still a whole person after performing the act.
17. The reference to human nature ought not to be interpreted in a biological way.
18. Kant, op. cit. note 15, p. 516ff. [6:384ff.]
19. Kant seems to draw two distinctions which make the same point in analogous fashion: Firstly, he differentiates between negative worsening, or even removal, of the ability to morally self-improve, which is a violation of a perfect, negative duty to oneself, and the further enhancing of one's own moral abilities, which is an imperfect, positive duty to oneself (Ibid: p. 544f. [6:418f.] and p. 566f. [6:446f.]; Denis, op. cit. note 20, p. 110, also mentions Kant's notions of 'moral health' and 'moral prosperity' as objects of the respective duties). He secondly distinguishes between perfection in a quantitative (material) and a qualitative (formal) sense. I take it that the duty to perfection in the qualitative sense implies the non-neglect (negative) of specific capacities which are necessary for a certain end, i.e. becoming a moral person (see esp. Kant, op. cit. note 15, p. 517f. [6:386f.]). Kant explicitly says that moral perfection is - in terms of the qualitative interpretation - a perfect duty, but - in terms of its degree (i.e. quantitatively) - an imperfect one (Ibid: p. 241 [6:446]).
20. Ibid: p. 522f. [6:392].
21. Aristotle. 2000. Nicomachean Ethics. R. Crisp, transl. and ed. Cambridge: Cambridge U.P.
22. 'One very simple principle, as entitled to govern absolutely the dealings of society with the individual in the way of compulsion and control, whether the means used be physical force in the form of legal penalties, or the moral coercion of public opinion. That principle is, that the sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number is [.] to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant. He cannot rightfully be compelled to do or forbear because it will be better for him to do so, because it will make him happier, because, in the opinions of others, to do so would be wise or even right. [.] Over himself, over his own body and mind, the individual is sovereign.' (J.S. Mill. 1998. Orig. 1859. On Liberty and Other Essays. Oxford World's Classics. John Gray, ed. Oxford: Oxford U.P.: p. 13f). Mill explicitly refers to the concept of duties to oneself on p. 87.
23. One might argue that other people may be shocked by seeing people with severe body-mutilations, hence are harmed. I agree that Mill's theory is not specific enough on cases like these, but I would like to mention two rejoinders anyway: Firstly, squeamishness is not a good basis for prohibitions. People also used to be shocked by gay people kissing in public. Secondly, there are people with severe disfigurations which also shock others by their mere physical appearance. Should they consequently be excluded from appearance in public?
24. Mill extensively deals with the common objection that every act might affect other people by giving a bad example. To my mind, he rejects it convincingly, Ibid: p. 88ff.
25. 'Human beings owe to each other the help to distinguish the better from the worse, and encouragement to choose the former and avoid the latter.' Mill, op. cit. note 26, p. 84.
26. This does not apply to children and mentally impaired people, according to Mill.
27. D. Lyons. 1994. Rights, Welfare, and Mill's Moral Theory. Oxford: Oxford U.P.: p. 132ff.
28. Mill, op. cit. note 26, p. 113ff.
29. The 'basis' referred to here is the material precondition of self-determination, namely a functioning body. It is not enough to reject this argument by referring to body modification as expression of one's own freedom.
30. B. Gert, C.M. Culver & K.D. Clouser. 1997. Bioethics. A Return to Fundamentals, Oxford: Oxford U.P.: p. 26ff. and 93ff. The term prudential value stems from James Griffin (J. Griffin. 1986. Well-Being: Its Meaning, Measurement, and Moral Importance. Oxford: Clarendon Press).
31. It is maybe worth stressing again that I do not argue in favour of public funding for these interventions, so there is no problem of unreasonable claims on resources involved. What is more, body modifications do not raise the issue of possible long-term unfairness, which is often seen in relation to other privately funded treatments, e.g. enhancements, since the interventions I discussed hardly bring about any individual advantages.
32. I should like to thank Steve Edwards, Hugh Upton, and the anonymous reviewers for valuable suggestions and comments.