P A Q V olume 26, Number 1, January 2012 1 THE ETHICS OF VOLUNTARY AMPUTATION Peter Brian Barry I n 1999, Scottish surgeon Robert Smith was prevented from amputating a healthy leg of a patient—what would have been his third such amputation—after an ethics committee report was issued and the chief executive of the hospital’s Trust announced a prohibition on such surgery. The announcement of such a prohibition surprised many; some were surprised to learn that medical professionals were in the business of amputating healthy limbs at all, certain that there was no need to entertain the ethical permissibility of deliberately disabling patients. But Smith’s defenders undoubtedly reject this characterization of his practice. While Smith did not amputate in the sort of circumstances in which amputations are normally performed, the removal of his patients’ limbs was intended to relieve their signi- cant suffering and restore their health. Further, the patients who requested their amputation would presumably deny that they were being disabled, maintaining instead that amputation relieved their disability. Much depends, then, on how the issue of “voluntary amputation” is framed. The locution “voluntary amputation” is in some ways unfortunate. Tens of thousands of amputations are performed each year in the United States alone, usually because part of the patient’s body is severely diseased or damaged—as a result of, for example, congenital limb deciency, vascular insufciency, cancer, or traumatic injury—such that a manifestly unhealthy limb is surgically ampu- tated. At least very many of these surgeries are no less voluntary than any other medically invasive medical procedure or operation. So, most amputations are voluntary in some interesting sense. However, in cases of voluntary amputation, I stipulate, a seemingly healthy limb, not a manifestly unhealthy one, is surgically amputated in accord with a patient’s request. 1 But the requests of these patients are not clearly requests for elective surgery if elective surgery is understood as surgery that is not medically necessary, since amputation is arguably the only available means for relieving their signicant suffering. In any event, would-be amputees who desire the voluntary amputation of one or more seemingly healthy limbs have adopted the moniker “wannabes.” 2 Typically, wannabes want a spe- cic limb amputated—more often a leg than an arm and more often a left-sided