By Joshua Arnold

In “the first described [case] about digits amputation,” Canadian doctors surgically removed two healthy fingers from a young man experiencing “body integrity dysphoria” (BID). The sad, bizarre account, published March 27 in the open-access journal Clinical Case Reports, is linked to surgical interventions for gender dysphoria. This similar yet distinct case underscores the dangers of gender ideology from a slightly different vantage point, one which circumvents the deceptive veil of civil rights language which conceals the harms of gender transition procedures.

Distress

A 20-year-old man felt “profound distress over his left hand’s fourth and fifth fingers,” according to the case report. He hid his fingers by keeping them flexed, which impaired his dexterity and caused localized pain. He experienced nightmares in which his fingers rotted or burned, as well as “daily intrusive thoughts … provoking a distressing feeling that they do not belong to him.” He couldn’t imagine living with those fingers for years, the doctor wrote.

I can’t imagine what it would be like to have such feelings and desires. I can’t imagine feeling that a part of my body didn’t belong, even though I could intellectually acknowledge it. I can’t imagine what it would be like for such feelings to persist through every attempt to counteract them, causing long-term distress, and causing me to hide from my family in embarrassment. Let us not neglect compassion for people who feel such things, even as we affirm biblical truth about their condition.

Feelings such as BID are the result of the world’s fallen state. They did not originally belong to God’s created order, which was “very good” (Genesis 1:31). They will not belong to the future paradise that awaits God’s people, which will have no “mourning, nor crying, nor pain” (Revelation 21:4). For now, under the weight of sin and death, disease and pain, the whole creation is “subjected to futility” and “has been groaning together in the pains of childbirth until now” (Romans 8:20-22). But such things as BID won’t last forever.

Desires

The young man with BID apparently desired amputation before ever contacting a doctor, due to his independent research on gender dysphoria. “His research led him to draw comparisons between his overall state and that of people undergoing surgery for gender dysphoria,” the case study recorded.

In this case, the health care professionals interacting with this troubled young man at least had the sense not to immediately support the most drastic remedy. They first tried different forms of medication and therapy for at least seven months. Throughout this period, the patient “remained convinced that amputation was ideal but agreed to try first a noninvasive relief.”

For this young man, “The importance [of living] in accordance with his perceived body image was a stronger inner motivation” than concerns about how the amputation would affect his relationships “at work or in sports and leisure.” In other words, he chose to conform to his inner feelings instead of the outer world. These are exactly the same terms in which people with gender dysphoria express their desire to change their bodies to be more like those of the opposite sex.

Both arguments rely on the spirit of our age, expressive individualism. This worldview argues that “everybody is ultimately defined by an inner core of feelings that they have, and authenticity is found by being able to express those feelings outwardly,” according to Grove City College Professor Carl Trueman. This worldview is so pervasive that many people adopt it without realizing it.

In this case, both the young man with BID and the doctor who published the case report seemed to share this worldview unquestioningly. The doctor went on to write approvingly, “This process [amputation of healthy fingers] also taught him [the patient] that he was accepted by people around him as he truly is.” Thus, she offered no rebuttal to the young man’s assertion that his inner feelings define who “he truly is.” With this attitude dominating the culture, no wonder the medical profession has offered so little resistance to harmful, invasive, and irreversible gender transition procedures to treat gender dysphoria.

Deception

One disturbing element of this case report is the ethical gymnastics the medical team performed to rationalize the decision to amputate. The author acknowledged the “ethical concerns” involved with “the elective amputation of non-diseased[,] functional body parts.” She recognized that, “The Hippocratic principle of ‘First, do no harm’ is sometimes cited due to concerns about regret, disability, or financial burden.”

The doctors acknowledged these ethical warning lights, then they sped right past them and amputated the man’s fingers anyway. “Recommending surgery for this young individual was straightforward,” claimed the case report. Why?

The report cited “the patient’s good collaboration, absence of comorbidities, and documented similar cases in the literature,” which would each be mitigating factors rather than a positive reason. According to the report, the fact that the man only wanted two fingers amputated, “as opposed [to] a complete limb in most typical forms of BID reported,” also “eased the decision-making process for the medical team” — again, a mitigating factor only.

The only positive reason to amputate found anywhere in the case report was that “BID sufferers endure significant distress and may seek self-amputation or black-market amputations. Risks include death.”

In other words, the doctor’s logic went as follows: if we don’t give this person the amputation he desires, he might seek to obtain it through more dangerous means. This mode of reasoning will not travel very far before it breaks down: “if we don’t enable this person’s opioid habit, he may obtain black-market drugs laced with other harmful substances,” “if we don’t supply this person with the sex (outside of marriage) that he craves, he might go and rape someone,” “if we don’t give this person more money to gamble with, he might go and rob a bank.” This fallacious reasoning holds that one person is responsible for the actions of another — unless that person becomes complicit in abetting the other person’s wrongdoing.

To weaken this logic further, the case report admitted that the young man with BID “was aware self-harm wasn’t a safe solution and could have repercussions on his relationships, reputation, and health.” In other words, the medical team couldn’t be certain the young man would actually carry out his plan of self-amputation; his own reason may have prevailed.

I assume that an entire team of doctors possesses enough combined intelligence to see through the logical fallacy at play here. That they did not do so — or that doing so did not deter them — points to some other motivation. That motive was likely compassion for the young man, misguided by expressive individualism. This would cause them to go searching for a way to rationalize amputation, which is what they ultimately did. This was willing self-deception.

One remark from the case report indicates that the doctors with a clear moral compass may have done things differently. “The limited literature on this condition [BID] poses challenges in establishing clear guidelines and recommendations,” the author argued. Anyone who is unable to find clear guidelines against amputating healthy body parts is clearly not looking in the right place.

The Bible is clear that God created mankind with bodies that were good and that were made in his image (Genesis 1:27, 31). God will hold accountable those who take another person’s life (Genesis 9:6) or who injure or maim another person’s body (Exodus 21:23-25, Leviticus 24:19-20, Deuteronomy 19:21). God further honored our physical bodies when the Word who was God in the beginning “became flesh and dwelt among us” (John 1:14). Upon Christ’s return, his followers will not part with their bodies; instead, Jesus Christ “will transform our lowly body to be like his glorious body” (Philippians 3:21), so that with an imperishable, immortal body (1 Corinthians 15:53) we will dwell with him forever. God says our bodies are good the way he made them, and no one else’s judgment can stand against his.

Dismemberment

Sadly, neither the young man with BID nor the Canadian medical team paid much heed to what God’s Word has to say about our bodily worth. The medical team proceeded with the amputation. The case report declared that, “following amputation, the patient experienced immediate relief, with nightmares ceasing, emotional distress subsiding, and improved functionality. … During follow-up visits with the physicians involved in his care, he reported that he was now able to enjoy a normal life.” Normal, perhaps, minus two fingers.

Relative to people with BID who want to amputate entire limbs, a man can survive the loss of a couple fingers with relatively little impact on his daily life. I once worked with a retired shop-class teacher who had lost a finger to a power saw; he is still happily married with nine children and successfully launched a second career as a painter and handyman.

However, the question is not whether someone can survive the loss of a few fingers, but whether it is right to amputate healthy body parts at all. If we ever once grant that it is, we will have launched ourselves down a slippery slope with severed brakes. This is exactly the argument made by those who endorse the amputation of healthy breasts and/or genitals as a treatment for a person’s gender dysphoria. The fundamental problem is that it denies the goodness of our bodies according to the way God made us.

The result from this exceptional case elicited an inappropriately glowing analysis from the report’s author. This young man “clearly benefited from elective surgery,” she concluded. “Disseminating knowledge about BID can benefit affected individuals” and “gives an opportunity to … make the healthcare system more inclusive … by broadening the definition of health.” She envisioned a future where people who want their fingers or other body parts amputated “can live with more dignity, respect, and optimal well-being.”

This seems to draw an entirely wrong conclusion from this whole ordeal. Such an ethically mistaken decision is lamentable as an exception, but the author proposed to make it the rule. She endorsed the procedure solely on the basis of its immediate effects and made no attempt to consider any possible long-term implications, such as later regret. Worst of all, everyone involved in this procedure unquestioningly allowed the young man’s internal feelings to override the goodness of his physical body, which is attested to by the infallible Word of God.

Joshua Arnold is a senior writer at The Washington Stand.