Thursday, April 26, 2007

the Ashley Treatment

Ashley is a nine year old girl from Seattle. According to a recent Hastings Center Report, she has "a severe brain impairment that leaves her unable to walk, talk, eat, sit up, or roll over. According to her doctors, Ashley has reached, and will remain at, the developmental level of a three-month-old."

The Ashley Treatment refers to the medical treatment recently given to this girl, at the request of her parents. She has had her uterus and breast buds removed. She is given high-dose estrogen. All of this was done to improve the quality of her life. The estrogen keeps her small (currently 4 ft 9). She will never have the discomfort of menstruation. She will not be the target for sexual abuse, her parents believe, because she will never have mature breasts. It will be easier to move her around, easier to strap her in a wheelchair.

Her parents have publicized the Ashley Treatment because they believe it might benefit other parents caring for severely disabled children. I have extreme sympathy for her parents, and I agree that the treatment may have benefits for Ashley because she will be easier to care for, and that can't help but lengthen her life. And frankly,they deserve to ease their burden.

I am concerned about the medical ethics of the doctors who agreed to perform these procedures. When a patient cannot make decisions for themselves, doctors have some degree of responsibility to ensure that the best interests of the patient are being served. All of their interests, not some. Ashley is mentally a three month old. This makes her no different than a 3 month old infant, or a 90-year old with advanced Alzheimer's. Would we remove the breasts of a 90 year old woman, out of convenience to her caregivers? Would we put a 3 month old baby through elective surgery to remove her uterus so she never has the discomfort of menstruation? Ashley might be easier to care for without arms and legs, which she doesn't use anyway. But no one is arguing for amputation.

It is a slippery slope that the doctors are going down. Elective surgery for the convenience of caregivers has a whole host of implications. Does anyone remember lobotomies -- they made mental patients much easier to care for.

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