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Loriga L. Body integrity dysphoria and moral responsibility: an interpretation of the scepticism regarding on-demand amputations. Med Humanit 2024:medhum-2023-012811. [PMID: 38195241 DOI: 10.1136/medhum-2023-012811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/11/2024]
Abstract
A patient who requests an amputation deemed medically unnecessary by professionals is disqualified per se from being regarded as having medical decision-making capacity. This decision is based on the assumption that there is an option to pursue something other than amputation; such an assumption in many cases overflows into therapeutic obstinacy. This is the case for individuals who have ill or damaged body parts and who wish to avoid recurrent and painful medical treatment designed to save the limb, as well as for individuals affected by body integrity dysphoria (BID). BID is a condition that is recognised by the WHO and is included in the International Classification of Diseases, 11th edition. Individuals who are affected develop an intense feeling of overcompleteness of their body configuration, which leads to the development of a strong sense of dysphoria and consequently the desire to amputate in order to remove the source of such discomfort. In the few cases in which amputation has been carried out, the results have proved successful; the individual's quality of life has improved and they have had no new amputation desires. No medical therapy, including medical amputation, is available currently for individuals affected by the condition. This situation leads many with BID to mutilate themselves. Such events create a challenging ethical dilemma for the medical world.The present paper is focused on the capacity of the individual with BID to do other than request amputation and the implications that this carries regarding moral responsibility. It is proposed that the autonomy of the patient cannot be disqualified by default based on the amputation request, despite its oddity, and that any scepticism demonstrated by the physicians is based on a false preconception of ill will or ignorance, which results in a blaming attitude towards the requesting person.
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Affiliation(s)
- Leandro Loriga
- Medical Ethics, Masaryk University, Brno, Czech Republic
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Sattin D, Parma C, Lunetta C, Zulueta A, Lanzone J, Giani L, Vassallo M, Picozzi M, Parati EA. An Overview of the Body Schema and Body Image: Theoretical Models, Methodological Settings and Pitfalls for Rehabilitation of Persons with Neurological Disorders. Brain Sci 2023; 13:1410. [PMID: 37891779 PMCID: PMC10605253 DOI: 10.3390/brainsci13101410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Given the widespread debate on the definition of the terms "Body Schema" and "Body Image", this article presents a broad overview of the studies that have investigated the nature of these types of body representations, especially focusing on the innovative information about these two representations that could be useful for the rehabilitation of patients with different neurological disorders with motor deficits (especially those affecting the upper limbs). In particular, we analyzed (i) the different definitions and explicative models proposed, (ii) the empirical settings used to test them and (iii) the clinical and rehabilitative implications derived from the application of interventions on specific case reports. The growing number of neurological diseases with motor impairment in the general population has required the development of new rehabilitation techniques and a new phenomenological paradigm placing body schema as fundamental and intrinsic parts for action in space. In this narrative review, the focus was placed on evidence from the application of innovative rehabilitation techniques and case reports involving the upper limbs, as body parts particularly involved in finalistic voluntary actions in everyday life, discussing body representations and their functional role.
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Affiliation(s)
- Davide Sattin
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
| | - Chiara Parma
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
| | - Christian Lunetta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department-ALS Unit, Via Camaldoli 64, 20138 Milan, Italy;
| | - Aida Zulueta
- Istituti Clinici Scientifici Maugeri IRCCS, Labion, Via Camaldoli 64, 20138 Milan, Italy;
| | - Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
| | - Luca Giani
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
| | - Marta Vassallo
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Mario Picozzi
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Eugenio Agostino Parati
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
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Weijs ML, Ho JT, Roel Lesur M, Lenggenhager B. Is this my foot? Experimentally induced disownership in individuals with body integrity dysphoria. Conscious Cogn 2022; 106:103432. [PMID: 36372053 DOI: 10.1016/j.concog.2022.103432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/07/2022] [Accepted: 10/14/2022] [Indexed: 11/12/2022]
Abstract
In body integrity dysphoria (BID), otherwise healthy individuals feel like a part of their physical body does not belong to them despite normal sensorimotor functioning. Theoretical and empirical evidence suggested aweakened integration of the affected body part into higher-order multisensory cortical body networks. Here, we used a multisensory stimulation paradigm in mixed reality to modulate and investigate multisensory processing underlying body (dis)ownership in individuals with BID of the lower limb. In 20 participants with BID, delay perception and body ownership were measured after introducing delays between the visual and tactile information of viewed stroking applied to affected and unaffected body parts. Unlike predicted, delay perception did not differ between the two body parts. However, specifically for the affected limb, ownership was lower and more strongly modulated by delay. These findings might be following the idea of a stronger dependency on online bottom up sensory signals in BID.
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Affiliation(s)
- Marieke L Weijs
- Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland.
| | - Jasmine T Ho
- Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Marte Roel Lesur
- Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Computer Science and Engineering, Universidad Carlos III de Madrid, Madrid, Spain
| | - Bigna Lenggenhager
- Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychology, University of Konstanz, Konstanz, Germany
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Saetta G, Ruddy K, Zapparoli L, Gandola M, Salvato G, Sberna M, Bottini G, Brugger P, Lenggenhager B. White Matter Abnormalities in the Amputation Variant of Body Integrity Dysphoria. Cortex 2022; 151:272-280. [DOI: 10.1016/j.cortex.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/11/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
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Saetta G, Ho JT, Bekrater-Bodmann R, Brugger P, Dijkerman CH, Lenggenhager B. Limb apparent motion perception: Modification by tDCS, and clinically or experimentally altered bodily states. Neuropsychologia 2021; 162:108032. [PMID: 34600001 DOI: 10.1016/j.neuropsychologia.2021.108032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 08/26/2021] [Accepted: 09/21/2021] [Indexed: 12/24/2022]
Abstract
Limb apparent motion perception (LAMP) refers to the illusory visual perception of a moving limb upon observing two rapidly alternating photographs depicting the same limb in two different postures. Fast stimulus onset asynchronies (SOAs) induce the more visually guided perception of physically impossible movements. Slow SOAs induce the perception of physically possible movements. According to the motor theory of LAMP, the latter perception depends upon the observer's sensorimotor representations. Here, we tested this theory in two independent studies by performing a central (study 1) and peripheral (study 2) manipulation of the body's sensorimotor states during two LAMP tasks. In the first sham-controlled transcranial direct current stimulation between-subject designed study, we observed that the dampening of left sensorimotor cortex activity through cathodal stimulation biased LAMP towards the more visually guided perception of physically impossible movements for stimulus pairs at slow SOAs. In the second, online within-subject designed study, we tested three participant groups twice: (1) individuals with an acquired lower limb amputation, either while wearing or not wearing their prosthesis (2) individuals with body integrity dysphoria (i.e., with a desire for amputation of a healthy leg) while sitting in a regular position or binding up the undesired leg (to simulate the desired amputation); (3) able-bodied individuals while sitting in a normal position or sitting on one of their legs. We found that the momentary sensorimotor state crucially impacted LAMP in individuals with an amputation and able-bodied participants, but not in BID individuals. Taken together, the results of these two studies substantiate the motor theory of LAMP.
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Affiliation(s)
- Gianluca Saetta
- Department of Psychology, University of Zurich, Switzerland; Department of Experimental Psychology, Utrecht University, the Netherlands.
| | - Jasmine T Ho
- Department of Psychology, University of Zurich, Switzerland
| | - Robin Bekrater-Bodmann
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Peter Brugger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry (PUK), Zurich, Switzerland; Neuropsychology Unit, Valens Rehabilitation Centre, Valens, Switzerland
| | - Chris H Dijkerman
- Department of Experimental Psychology, Utrecht University, the Netherlands
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Chakraborty S, Saetta G, Simon C, Lenggenhager B, Ruddy K. Could Brain-Computer Interface Be a New Therapeutic Approach for Body Integrity Dysphoria? Front Hum Neurosci 2021; 15:699830. [PMID: 34456696 PMCID: PMC8385143 DOI: 10.3389/fnhum.2021.699830] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/09/2021] [Indexed: 12/11/2022] Open
Abstract
Patients suffering from body integrity dysphoria (BID) desire to become disabled, arising from a mismatch between the desired body and the physical body. We focus here on the most common variant, characterized by the desire for amputation of a healthy limb. In most reported cases, amputation of the rejected limb entirely alleviates the distress of the condition and engenders substantial improvement in quality of life. Since BID can lead to life-long suffering, it is essential to identify an effective form of treatment that causes the least amount of alteration to the person's anatomical structure and functionality. Treatment methods involving medications, psychotherapy, and vestibular stimulation have proven largely ineffective. In this hypothesis article, we briefly discuss the characteristics, etiology, and current treatment options available for BID before highlighting the need for new, theory driven approaches. Drawing on recent findings relating to functional and structural brain correlates of BID, we introduce the idea of brain-computer interface (BCI)/neurofeedback approaches to target altered patterns of brain activity, promote re-ownership of the limb, and/or attenuate stress and negativity associated with the altered body representation.
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Affiliation(s)
- Stuti Chakraborty
- Occupational Therapy, Department of Physical Medicine and Rehabilitation, Christian Medical College and Hospital, Vellore, India
| | - Gianluca Saetta
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Colin Simon
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin, Ireland
| | | | - Kathy Ruddy
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin, Ireland
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Zahid A, Poulsen JK, Sharma R, Wingreen SC. A systematic review of emerging information technologies for sustainable data-centric health-care. Int J Med Inform 2021; 149:104420. [PMID: 33706031 DOI: 10.1016/j.ijmedinf.2021.104420] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Of the Sustainable Development Goals (SDGs), the third presents the opportunity for a predictive universal digital healthcare ecosystem, capable of informing early warning, assisting in risk reduction and guiding management of national and global health risks. However, in reality, the existing technology infrastructure of digital healthcare systems is insufficient, failing to satisfy current and future data needs. OBJECTIVE This paper systematically reviews emerging information technologies for data modelling and analytics that have potential to achieve Data-Centric Health-Care (DCHC) for the envisioned objective of sustainable healthcare. The goal of this review is to: 1) identify emerging information technologies with potential for data modelling and analytics, and 2) explore recent research of these technologies in DCHC. FINDINGS A total of 1619 relevant papers have been identified and analysed in this review. Of these, 69 were probed deeply. Our analysis found that the extant research focused on elder care, rehabilitation, chronic diseases, and healthcare service delivery. Use-cases of the emerging information technologies included providing assistance, monitoring, self-care and self-management, diagnosis, risk prediction, well-being awareness, personalized healthcare, and qualitative and/or quantitative service enhancement. Limitations identified in the studies included vendor hardware specificity, issues with user interface and usability, inadequate features, interoperability, scalability, and compatibility, unjustifiable costs and insufficient evaluation in terms of validation. CONCLUSION Achievement of a predictive universal digital healthcare ecosystem in the current context is a challenge. State-of-the-art technologies demand user centric design, data privacy and protection measures, transparency, interoperability, scalability, and compatibility to achieve the SDG objective of sustainable healthcare by 2030.
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Affiliation(s)
- Arnob Zahid
- Department of Accounting and Information Systems, College of Business and Law, University of Canterbury, Christchurch, New Zealand.
| | | | - Ravi Sharma
- College of Technological Innovation, Zayed University, Abu Dhabi, United Arab Emirates.
| | - Stephen C Wingreen
- Department of Accounting and Information Systems, College of Business and Law, University of Canterbury, Christchurch, New Zealand.
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