Sporting Chances and the Justification of Surgery

There’s an interesting story on the front page of the Manchester Evening News about an 11-year-old who has asked that her right leg be removed so that she has a better chance of becoming a paralympian.

Danielle Bradshaw was born with a congenital dislocation of both hips and her right knee.  There appears not to be any therapeutic reason to remove the limb beyond the inconvenience – the condition appears to be stable, and nothing more than (in Terry Pratchett’s wonderful phrase, an embuggerance); but, according to the article,

[t]ired of repeated trips to hospital and having to watch her friends play out without her, and inspired by gold medals, Danielle stunned her parents by declaring she wants to have it amputated. They agreed and she will have the operation in Sheffield in August.

When the wound heals she will be fitted with a prosthetic replacement and friends are already rallying round to raise money for a running blade and sports wheelchair.

[…] She said: “I’m not scared, I’m excited. I can’t wait for it to be done so I can start running and training.”

She said that seeing documentaries about soldiers who had lost limbs overseas and watching Heather Mills on Dancing On Ice helped her make her decision.

She said: “I saw that and it helped make my mind up. And I am sick of all the operations. I just want to be a normal kid. I see people running and I want to know how that feels.”

I can imagine that there’s a number of questions we might want to ask about this.  One would have to do with the difference between consent and demand, and another would concern whether, as an 11-year-old, Danielle is capable of either.  A third would follow from this: if she is not competent in the right ways, could anyone consent for such an operation if it’s not in her medical best interests (which, plausibly, it isn’t).  Finally, we might wonder wether NHS resources ought to be spent on non-therapeutic stuff like this, when it could be spent on saving lives or ending pain.

Well, yeah… but.

See, the thing is, I can’t help but to think that health is valuable inasmuch as it’s required to fulfil our projects, but that it’s the projects that count.  Moreover, and more controversially, I have a sort of Heidegger and Schopenhauer-inspired hunch that a health problem is only ever apparent to us – and so only real – to the extent that it gets in the way of our achieving our projects.  (There’s a passage in Being and Time when Heidegger’s talking about readiness-to-hand and presence-at-hand and he uses the example of a hammer that, when all goes well, isn’t really perceived in its own right; it’s at its most obtrusive when we expect it to be there and it isn’t.  My suspicion – and, no, I don’t have a well-developed argument for this – is that health is also something we notice primarily by its absence, and its absence is made clear to us only by the inability to complete a certain project – rather as Heidegger’s hammer is made clear to him by his inability to complete his hammering project.)

Sooooo… it’s the projects that we have that’re important (or the role that they play in something like a good life).  Medical intervention is one of the tools that we have at our disposal to help us realise our projects.  Overwhelmingly, it’ll do so by being therapeutic.  But I don’t see that there has to be any necessity about that therapeutic criterion; there could be other reasons – sporting or artistic, say – to make use of the medical art (and I’ve argued along similar lines here).

It remains possible that, resources being what they are, the importance of medical interventions like this will always be trumped by more traditionally therapeutic interventions; but that’s for another debate.  It’s also possible that the projects that we have as 11-year-olds are only ever pretty transient, and that this makes a difference to how seriously we should take Danielle’s preference here.  So it goes.  That, too, is for another debate (and it also touches on similar debates that surround gender-reassignment treatments for pre-pubescents – a topic upon which Simona Giordano has been working recently).  Note, though, that it’s not just kids whose projects change, so there’s nothing special about being 11 qua 11 here.

For the time being, this looks like a pretty good use of the medical art to me.

But it does prompt another question.  Imagine a perfectly able-bodied child who watches – say – Oscar Pistorius doing his thing.  “I want to be like him,” the child thinks… and so seeks an amputation.  (Being like Usain Bolt isn’t nearly as attractive, for some reason.)  Would an amputation in this case be morally acceptable?  I guess that many people’s intuition would be that it wouldn’t.  But I’m not sure that the intuition is correct – certainly, based on the thought above, I seem to be committed to the idea that to amputate in this case would not be completely nuts.