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The Ashley Treatment

In: Social Issues

Submitted By keepnft
Words 1021
Pages 5
The Ashley Treatment has been, and still remains, controversial. A statement written by Ashley’s mom and dad stated that “Ashley had a normal birth, but her mental and motor faculties did not develop. Over the years, neurologists, geneticists, and other specialists conducted every known traditional and experimental test, but still could not determine a diagnosis or a cause. Doctor’s call her condition ‘static encephalopathy of unknown etiology’, which means an insult to the brain of unknown origin or cause, and one that will not improve.”
The “The Ashley Treatment” is now a generic phrase coined in the health profession that refers to growth-stunting procedures for children with severe disabilities. This name was given in reference to a collection of medical procedures done for the improvement of Ashley’s quality of life. The treatment includes growth attenuation through high-dose estrogen therapy, hysterectomy to eliminate the menstrual cycle and associated discomfort to Ashley, and breast bud removal to avoid the development of large breasts and the associated discomfort to Ashley. The combination of the surgery and the estrogen therapy attracted a ton of public attention and ethical analysis in early 2007, both supportive and judging.
The parents state that they sought such treatment for the best interests of their daughter, namely, to enable them to personally continue constant care for her at home; to maximize her inclusion in family activities; to avoid the cramps and discomfort associated with menstruation; and to avoid the discomfort from large breasts (which runs in Ashley's family) while lying down or strapped in the chest area while in her wheelchair. Furthermore, they cited additional side benefits: to reduce the risk of bedsores; to prevent breast cancer and fibrocystic growth (both of which have occurred in her family); to prevent pregnancy; and to prevent appendicitis, which occurs in 5% of the population and which would be difficult to diagnose in Ashley as she would be unable to communicate the symptoms (The Ashley Treatment).
In support of the Ashley Treatment, an article published in June 2009 on Growth Attenuation, two pediatric endocrinologist and two bioethicists concluded as follows:
“Our analysis suggests that growth attenuation is an innovative and sufficiently safe therapy that offers the possibility of an improved quality of life for non-ambulatory children with profound cognitive disability and their families. Pediatricians and other care providers should include discussion of these options as part of anticipatory guidance around the age of 3 years so that, if elected, potential clinically meaningful benefits of growth-attenuation therapy can be realized.”
In opposition of The Ashley Treatment, a journal written stated that the law failed Ashley. It allowed her parents to alter her body profoundly and permanently for social, not medical, reasons without adequate process or oversight. The lack of process was unacceptable given the magnitude of potential harm to Ashley, the potential conflict of interest faced by her parents, and the potential for abuse of the proposed interventions. While the law currently allows parents a great deal of flexibility in choosing among medical interventions for a child, states may limit parental choice to protect children. At the time Ashley’s case presented itself in Seattle, no state had limited parental discretion to stunt a child’s growth for medical or surgical reasons. Thus, her parents were free to decide that she would be better off in a child-sized body, with surgically removed uterus and breasts (Ouellette, 2009).
It is not clear whether or not the court would have stopped Ashley’s parents from modifying her body in the way they did. It seems likely that, at a minimum, the mastectomy would have been delayed until it was clear that Ashley had in fact developed large uncomfortable breasts, something that was merely speculative at the time of her surgery. It is certain, however, that imposition of limitations and process in her case would have gone a long way toward reducing the risk that the procedures caused Ashley more harm than any benefits they achieved. Obviously, time cannot be turned back for Ashley, but future cases can and should be regulated more carefully (Ouellette, 2009). It has been more than five years since the Ashley Treatment but the topic is still very much alive for a few reasons. One being, that the treatment is still being given (at least 12 given so far in the U.S.), secondly because of the legal issues raised and thirdly due to the moral issues it raises. In my opinion, the moral issues it raises are enough to oppose the treatment in itself.
The justification behind the parents giving their daughter The Ashley Treatment were to improve her the quality of life by keeping Ashley from suffering from menstrual pain, and enabling her to become more mobile due to her lack of weight and height. This argument also states that the lives of the parents will be made easier in caring for their terminally disabled child. These reasons seem minute when considering the major unnecessary surgery Ashley had to undergo. Not only are the parents in the wrong, but so are the doctors who completed the surgery. Each doctor must state the Hippocratic Oath that states “to do no harm” which intended to keep the best interests of the patient at the center of decisions, regardless if the child could or could not speak for themselves. The decisions the parents made seemed to be only for the best interests of the parents, not the child. Although the parents did not break the law in any fashion, it is only because no laws were in place. Due to the continual occurrence of The Ashley Treatment nation-wide, Congress should look into implementing some laws with these special cases in mind so that the ethical decisions can be taken out of the parents and doctors hands.

Bibliography
Allen, David, Kappy, Michael. "Growth-Attenuation Therapy: Principles for Practice". Pediatrics. 2009-06. Web.

Ouellette, Alicia. "Growth Attenuation, Parental Choice, and the Rights of Disabled Children: Lessons From The Ashley X Case.” Law.uh.edu. N.p., 17 Feb. 2009. Web.

"The Ashley Treatment." Pillowangel.org. N.p., 2 Jan. 2007. Web.

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