I guess since I have now heard this "argument" several times, it is worth tackling head on. First, BIID is vanishingly rare, there is really no prospect of anyone making any money out it. Second, I and most psychiatrists like me, who would see people with BIID are paid as academics. I get paid the same amount no matter how many people I see. Third, even if I (and others) were to profit from BIID, that, in and of itself, hardly constitutes an ethical argument against the proper management of the condition. Appendicectomies generate income for surgeons, but no one thinks they are unethical. I am not, by the way, particularly committed to classifying BIID as an illness. I think there are good arguments on both sides of this question. Speaking purely practically however, safe amputation requires a surgeon. Surgeons are much more comfortable helping people with illnesses. Also, there are a range of conditions, not usually disputed as illnesses, that mimic BIID. Psychiatrists have expertise in those other illnesses.

It is quite hard to know exactly what my student objected to, and the specifics probably matter little. It was a long and rather ramblingly complaint, ranging over numerous sins. (My lecture also contained a swear word used an adjective. A pretty common practice among Australian lecturers, but not appreciated by my correspondent). I think the main thrust was that my out of hand rejection of creationism as a theory to explain the development of species was "disrespectful" to those who believed that creationism was a successful theory in this regard. My reply was that I had no desire to offend, but the fact is creationism is a lousy explanatory theory and if some medical students thought otherwise they were just plain wrong. To tackle Neil's point: being wrong about one thing, hardly makes you stupid. Presumably I am wrong about heaps of things, possibly this thing, but I'd think it unfair to be characterised as stupid on that evidence alone. (We just don't let any old body into medicine; I assume she ain't stupid). It also seems to me to be more disrespectful not to take up this point head on. We know creationism is a stupid theory. To pretend we might think otherwise, or to pussy-foot around, in this context at least, seems to me to smack of a sort of paternalistic head-patting, implying that the other person is "stupid" - too stupid to see what most smart people can see.

Thanks Samantha - You make two interesting points. First, you are right (to an extent) about my treatment of people who desire (perhaps need is a better word) other losses of function - paraplegia, blindness, deafness etc. I did deliberately ignore these groups in my paper, but only because I was reluctant to comment on something I had little understanding of. Since the paper's publication, I have met with one person and had correspondence with several others, who "need" to be paraplegic and I find it hard to differentiate them from people who "need" to have an amputation. Whether this equates to the medical profession having a duty to provide elective spinal cord transsection is another issue, that readers may want to take up. Second, though we can argue legitimately about what might or might not constitute an illness, there is preliminary evidence that people with BIID (amputation variety) may have brains that are wired differently from those of us that do not. Specifically, their superior parietal lobule does not light up when observed with functional neuroimaging. See http://precedings.nature.com/documents/2954/version/1 for these very interesting results from Paul McGeoch and his group.