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Sporting Chances and the Justification of Surgery

16 Jul, 10 | by Iain Brassington

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.

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  • Mark T

    You mention Usain Bolt as being for some reason unattractive to the able-bodied child. Let’s suppose that’s not the case. If we’re committed to thinking that to amputate here is perhaps justifiable, are we similarly committed to allowing enhancement? If not, why not? It seems to me one way of viewing the young girl’s request is as a request for enhancement. What counts as reasonable enhancement and what as unreasonable? What counts as enhancement and what as alteration?

  • http://www.law.manchester.ac.uk/aboutus/staff/iain_brassington/default.htm Iain Brassington

    Mark –
    Well, there’re plenty of people who do deny the therapy/ enhancement distinction – who think, that is, that therapy is just a form of enhancement, or at least that they’re on the same spectrum.

    But why not allow enhancement? (Face it: we do already when we allow athletes to buy whizz-bang equipment for the sake of perhaps shaving a tenth of a second off their time.) I tend not to share a lot of the common suspicion of performance enhancing techniques in sport: I think that the rules governing their use, and marking the licit from the illicit, don’t make a great deal of sense, and don’t seem especially forceful. They seem to create more problems than they solve, to fetishise the natural (incoherently, since athletes wear running shoes, use swimming pools, and so on), and to ride on an overestimation of what performance enhancement can achieve.

    Now, there are limits to that. I think also that Pistorius isn’t necessarily an enhanced runner; it’s possible that he’s the first person (or one of the first people) to participate in a new kind of sport that is a bit like running, but is importantly different. Similarly, I think that people who do wheelchair marathons aren’t runners-enhanced-by-wheels, but are participants in a distinct support. So there is a point at which “enhancements” cross something akin to a species barrier, which means that there are certain enhancements that a participant in a given sport can’t use on pain of not doing that sport any more. But this point is more teleological than moral (or, if you really want to use a moralistic phrase, then I’d borrow one from Fuller’s jurisprudence, and say it refers to the “internal morality” of sport, but nothing more).

    I don’t know if you’re going to be at the WCB in Singapore next week, but I’m giving a paper on this topic there, and I’m aiming to publish something on it in the future.

  • Sam Lewis

    Interesting counter-point !

    Lets leave aside this child age 11, and consider an Adult, wanting both legs removed so they can use those ‘metal-springs’.. which now actually holds a world sprint-record I believe. So that would be an enhancement ??

    It may be deeply distasteful, but why isn’t it ethical to do what autonomous competent people want us to do to their bodies ?? eg. The rupee-less Indian who wants his leg cut off so the more effectively to beg ??

  • http://www.law.manchester.ac.uk/aboutus/staff/iain_brassington/default.htm Iain Brassington

    Well, it’d be an enhancement to the extent that the person having the operation would presumably believes that it’d make his life better. I don’t see what’s distasteful about it, though – nor why it is “unethical” as a matter of principle. As for the beggar… well, there’s quite a lot going on in your example there that muddies the issue – it demands more thought than I can give it in a reply at the moment. A lot would hinge on the permissibility of a system that allows/ forces people into beggary.

  • Dquigz

    for your information my daughters surgery was necessary as her right knee was collapsing and her leg and foot had stopped growing she was facing years of surgery and maybe stuck in a wheelchair for the rest of her life but instead shes took a positive attitude to get on with her life so this is not a waste of NHS resources at least shes got guts and a life UN like you

  • Darren quigley

    thanks for your kind comments about our daughter danielle bradshaw.some people just dont have a clue about dissabilites do they.

  • http://www.law.manchester.ac.uk/aboutus/staff/iain_brassington Iain Brassington

    I'm not sure I understand you – from the press reports I read, I got the impression that the surgery proposed was not done because it was medically indicated, so much as because it was motivated by a desire to be a paralympian. If the press gave the wrong impression – well, that happens. But even granted that possibility, a necessity for surgery of some kind isn't the same as a necessity for surgery of this kind.

    But since I was defending the surgery, I don't quite see your objection anyway.

    As to the operation being a waste of resources: well, I never said it was. In the post, I claimed that the surgery could be justified; so you would appear to be accusing me of having said the opposite of what I did actually say.

    Note in particular the penultimate paragraph of the post: this looks like a pretty good use of the medical art to me. I'm baffled about how you can construe that as supporting a claim that the operation would be a waste of NHS resources.

  • Dquigz

    danielle is doing well and training hard at the jim has a england flying coach but needs a runnig leg to compete in any games

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