Moral Status and the Treatment of Dissociative Identity Disorder1

Abstract

Many contemporary bioethicists claim that the possession of certain psychological properties is sufficient for having full moral status. I will call this the psychological approach to full moral status. In this paper, I argue that there is a significant tension between the psychological approach and a widely held model of Dissociative Identity Disorder (DID, formerly Multiple Personality Disorder). According to this model, the individual personalities or alters that belong to someone with DID possess those properties that proponents of the psychological approach claim suffice for full moral status. If this account of DID is true, then the psychological approach to full moral status seems to entail that the two standard therapies for treating DID might, on occasion, be seriously immoral, for they may well involve the (involuntary) elimination of an entity with full moral status. This result should give proponents of the psychological approach pause, for most people find the claim that current treatments of DID are ethically suspect highly counter-intuitive.

Animalism, Dicephalus, and Borderline Cases

“…These cognitive and behavioral therapies promote the disappearance of secondary personae, either by eliminating them altogether (restoration), or by assimilating them with the subject's dominant personality (integration). But according to my critic, since moral status carries with it the right to continued existence, such therapies would involve a moral violation, and thus ought to be stricken from the psychiatrist's repertoire-even though, as Bayne (2001) notes, there appears to be ''little concern within the psychiatric community, or indeed the general public, over the ethical probity of restoration and integration'' (p. 99).…”

“…[15] I am indebted here both to Bayne (2001) and to an anonymous referee for directing me to Bayne's work.…”

Divided Minds and Divine Judgement:

“…66 Whether this happens with alters in this case is dependent on key metaphysical questions. When alters are integrated, one has the difficulty of 63 See Bayne (2002), 97-99, for discussion of this approach. 64 I am grateful to an anonymous reviewer for raising this response.…”

Dissociative Identity Disorder, Ambivalence, and Responsibility

“…This is because it is difficult to understand what it would mean to integrate multiple selves or persons. Would all the alters be eliminated only to be replaced by a new person, or would the alters jointly survive as that new person (Bayne : 98)? However, we have a fairly clear idea of what it means for a single person to become more psychologically integrated.…”