The Ashley Treatment: Best Interests, Convenience, and Parental Decision-Making

Abstract

story of Ashley, a nine-year-old from Seattle, has caused a good deal of controversy since it appeared in Los Angeles Times January 3, 2007. (1) was born with a condition called static encephalopathy, a severe brain impairment that leaves her unable walk, talk, eat, sit up, or roll over. According her doctors, has reached, and will remain at, developmental level of a three-month-old. (2) In 2004, Ashley's parents and doctors at Seattle's Children's Hospital devised what they called Ashley Treatment, which included high-dose estrogen therapy stunt Ashley's growth, removal of her uterus via hysterectomy prevent menstrual discomfort, and removal of her breast buds limit growth of her breasts. Ashley's parents argue that Treatment was intended to improve daughter's quality of life and not convenience her caregivers. (3) They also decided share thoughts and experience ... help families who might bring similar benefits their bedridden 'Pillow Angels,' which means that this treatment has public policy implications. In case of incompetent children like Ashley, parents are custodians of child's interests and are required make decisions that protect or promote those interests. Doctors should also offer treatments that are in Ashley's best interests. It would be wrong offer a treatment that was against interests of child but in parents' (or others') interests. central questions in medical ethics in relation this case are: Were these treatments in Ashley's best interests? Do they treat her as a person with dignity and respect, and were they likely make her life go better? Ashley's parents argue that they sought treatment in order alleviate Ashley's discomfort and boredom. Their contention that stunting Ashley's growth was done for sake of improving our daughter's quality of life and not convenience her caregivers is controversial. According her parents, keeping small--at around seventy-five pounds and four feet, five inches tall--means that can be moved considerably more often, held in their arms, be taken on trips more frequently, more exposure activities and social gatherings, and continue fit in and be bathed in a standard size bathtub. All this serves Ashley's health and well-being because, so parents argue, the increase in Ashley's movement results in better blood circulation, GI functioning (including digestion, passing gas), stretching, and motion of her joints, which means that will be less prone infections. Undoubtedly, parents are right that will benefit in manner they have proposed if they can do all these things for her. claim about value of small size in a particular social circumstance is certainly not unique. Dwarves have given same argument as a justification for preferring have short children. They have argued that parenting dwarves is desirable for them because of their own size and because they have made modifications their homes and their surroundings take into account their short stature. (4) As a general point, it is entirely conceivable that in some natural, social, or psychological circumstances, having a normal body may be a disadvantage. In H.G. Wells' short story The Country of Blind, Nunez, a mountaineer in Andes, falls and comes upon Country of Blind. Nunez has normal vision, but in this society of blind people, he is disadvantaged, and he eventually consents have his eyes removed. Similarly, in a world of loud noise, being able hear could be a disadvantage. In case of apotemnophilia--a body dysmorphic disorder in which patient feels incomplete possessing all tour limbs--doctors justify amputation by reasoning that patient's psychology demands it. In Ashley's case, having a normal-sized body could be a disadvantage. …