Full Answer
What is the objective of Ashley Treatment?
EP: In 2007, you said that the objective of the Ashley treatment, which you devised together with specialist doctors from Seattle's children's hospital, was to improve Ashley's own quality of life, with no consideration paid to your own needs as her parents caring for her.
Why did Ashley’s father make a slide about the treatment?
Here is a slide, apparently made by Ashley’s father, which explains the theory behind the treatment: Among the dozens of issues this controversial treatment raised was the lack of a court order authorizing the treatment.
How did Ashley's Treatment change her personality?
The treatment accelerated Ashley's puberty rather than inhibit it. In girls, puberty is caused by a surge of estrogen; the Ashley treatment added estrogen so that Ashley's growth would conclude at an earlier age and a smaller size. Today at 14, Ashley is still an infant cognitively, as she was at birth and five years ago.
When did Adad announce the treatment for Ashley?
AD: We didn't exactly announce the treatment. Ashley's endocrinologist, Dr Gunther, wrote about her in the Journal of Pediatrics in October 2006. The media picked up the story, and the controversy exploded, which motivated us to tell Ashley's story in January 2007 through a blog, now at pillowangel.org.
What is wrong with the Ashley treatment?
Opponents argue that the treatment and surgery are nonbeneficial because Ashley is not suffering, the treatment is untested and has potential adverse effects, and the surgery is unnecessary because there are viable options. Physicians are ethically bound to do no harm to a patient.
When was the Ashley treatment?
In 2004, When she was six and a half years old, Ashley's parents and the Seattle Children's hospital physicians who had been treating her sought to perform on Ashley a novel medical intervention that would include hormonal treatment for growth attenuation, surgical removal of her breast buds, and a hysterectomy.
What is growth attenuation therapy?
Growth attenuation is an elective medical treatment which involves administering estrogen to cause closure of the epiphyses of the bones (Epiphyseal plates), resulting in a reduced adult height.
What is the Ashley treatment and why was it undertaken?
Ashley X. Born. 1997 (age 24–25) Seattle area. The principal purpose of the treatment was to improve Ashley's quality of life by limiting her growth in size, eliminating menstrual cramps and bleeding, and preventing discomfort from large breasts.
How does growth attenuation work?
Growth attenuation therapy involves the administration of estrogen to close the epiphyseal plates of bones, leading to a halt in their growth. The therapy grew in popularity in the 1940s and 1950s, when girls and young women would receive it to stop their growth before becoming 'too tall.
Is growth attenuation ethical?
After a lengthy discussion, the committee reached consensus that both the requests for growth attenuation and hysterectomy were ethically appropriate in this case.
Is growth attenuation legal?
'This article explores the legal and ethical implications of Ashley's "treatment." Although there is no explicit legal prohibition on growth attenuation, the fact that doctors are capable of performing a particular intersvention does not neccssarily mean thcy should.
What is Ashley X's condition?
Consultation with all relevant specialties could identify no specific cause for her condition, resulting in a diagnosis of “static encephalopathy ...
How tall is Ashley?
Over a period of the ensuing 3 years, Ashley received high doses of estrogen, a growth attenuation treatment that has resulted in her remaining relatively small in stature, likely to never be larger that 4 feet 6 inches (1.37 m) tall, and weighing about 65 or 70 pounds (29–32 kg). Ashley also underwent a hysterectomy and breast bud removal ...
Why has the controversy not gone away?
One reason the controversy has not gone away is that the Treatment has not gone away; it is being administered in additional cases (at least 12 worldwide), and perhaps thousands of families around the world are exploring it.
Is the Ashley treatment controversial?
The Ashley Treatment has been, and remains, controversial. It has been over 5 years since the Ashley Treatment was first described in a medical journal, but it remains a lively topic, for several reasons.
Is helping Ashley be a small woman a failure?
If so, helping Ashley be a small woman is not a failure of love and acceptance, but an act OF love and acceptance. In defending the availability of the Ashley Treatment, my intention is to privilege, not “reason”, but “feeling”, as a way of being in the world.
Is Ashley the same as most people?
Dr. Asch and Dr. Anna Stubblefield have written that “Ashley is the same as most people. She is the same in deserving to be accepted by and respected by and loved by her family for who she is and what she will become, with no modification required” (Asch). I think that is exactly (or at least mostly) right as well.
What is Ashley treatment?
EP: It has been five years since you went public with what you called the "Ashley treatment", the use of medical procedures to attenuate your daughter's growth and inhibit the onset of puberty. The treatment was, unsurprisingly, massively controversial.
What is Ashley's condition?
Ashley has scoliosis, a frequent co-condition in children with similar brain injury. Before the treatment, the scoliosis bent her spine a few more degrees each year. The scoliosis has been stable throughout the last five years, since the Ashley treatment was completed.
Why did Ashley get her puberty?
In girls, puberty is caused by a surge of estrogen; the Ashley treatment added estrogen so that Ashley's growth would conclude at an earlier age and a smaller size. Today at 14, Ashley is still an infant cognitively, as she was at birth and five years ago.
How tall is Ashley's sister?
As a contrast, Ashley's 12-year-old sister is 66in (168cm) tall and 120 lbs (55kg) and still growing. Ashley's health is also stable, she is on a single prescription drug for reflux.
Why are there ethics committees in hospitals?
When it comes to medical issues, ethics committees at leading children's hospitals exist to scrutinize issues like the Ashley treatment. The ethics committees have medical and ethical training and must uphold the child's interest and wellbeing in their decision. Their decisions are particular to each specific case.
What is meaningful to Ashley?
What is meaningful to her is to be as pain free and physically comfortable as possible. What is meaningful to her is to be able to enjoy those things she can enjoy: being with family, hearing music, cuddling. Ashley shows enjoyment for being included in family activities.
What is Ashley's human right?
Ashley's most important human right is not to be blocked from receiving a treatment that her parents, doctors and ethics committee all agreed is of benefit to her. Depriving her of the treatment's benefits, thus causing her preventable pain and suffering, would be taking away from her human rights.
What are the rights of the Ashley treatment?
Just as individual constitutional liberty and privacy rights are affected by the invasive and irreversible procedures, in such as involuntary psychosurgery, ECT, antipsychotic medications, and sterilization, the portions of the “Ashley Treatment” that involve breast bud removal and the administration of high doses of hormones also impose on the constitutional rights of the individuals for whom such interventions are sought. These treatments are highly invasive and irreversible, particularly when implemented together as the “Ashley Treatment.” Additionally, these procedures, along with the hysterectomy, affect an individual’s common law right to be free from bodily invasion. 138
Why is Ashley treatment discrimination?
The implementation of the “Ashley Treatment” and sterilizations on individuals with developmental disabilities also raises discrimination issues because, if not for their developmental disabilities, this set of interventions would not be sought. Discrimination against individuals because of their disabilities is expressly forbidden by state and federal law. 139 If individuals such as Ashley are denied their full constitutional protections to liberty and privacy because of the severity of their disabilities, such a denial would not only be unconstitutional but also in violation of state and federal anti- discrimination laws.
What are the corrective actions for sterilization?
These corrective actions will include design and implementation of appropriate forcing functions within computer systems to prevent scheduling any such procedure unless the requirements of Children’s policies have been met. Children’s will also undertake educational activities to inform members of its medical staff and employees about a) the legal requirements in the state of Washington for court review and order before sterilization of a developmentally disabled individual; b) Children’s policy prohibiting growth-limiting medical interventions for individuals with developmental disabilities without court order; and c) bioethical considerations in limiting the physical growth of individuals with developmental disabilities.
What is the Washington Protection and Advocacy System?
The Washington Protection and Advocacy System ( WPAS) is the federally mandated protection and advocacy (P&A) agency for the state of Washington. The P&As, which exist in every state and territory, are “watchdog” agencies with legal authority under federal statutes to investigate allegations of abuse and neglect of persons with disabilities and to advocate for their legal and human rights.
Who is the attorney for Ashley's parents?
Following the Ethics Committee meeting, Ashley’s parent’s consulted with an attorney, Larry Jones, who has experience advocating for parents of children with developmental disabilities. 55 The parents’ attorney wrote a letter to Ashley’s father informing him that while courts have ruled that parents cannot consent to the sterilization of children with cognitive disabilities without a court order, he did not think Ashley’s parents needed to get a court order in Ashley’s case. 56 The parents’ attorney opined that because sterilization was not the sole purpose of the treatment, there is an exception to the rule that a court order is necessary before the sterilization of a minor with a developmental disability can proceed. 57 As discussed below in Section IV.B.1., the legal opinion offered by the parents’ attorney is not supported by a reasonable interpretation of pertinent law. A copy of the letter from the parents’ attorney was provided to Ashley’s doctors by Ashley’s father. 58 The surgeon also received a copy of the Ethics Committee’s written recommendation. 59 Although the Ethics Committee stated that a “court review” was necessary before the proposed procedure could proceed, the doctors reported to WPAS during interviews that they relied upon the opinion of the parents’ attorney whom they have stated to WPAS staff, they believed to be well versed in disability law. 60 The surgeon subsequently stated to WPAS staff during an interview that at the time the parents presented him a letter from their attorney, he believed the letter satisfied the requirement for “court review.” 61 Before beginning the surgery, however, the surgeon reported that he also contacted the doctor serving as the Medical Director of Children’s Hospital at the time of the “Ashley Treatment” was performed to confirm his understanding that the requirement for a “court review” had been satisfied and get final approval to proceed with the hysterectomy. 62 The surgeon reported to WPAS that he received final approval from Children’s Hospital’s Medical Director, and proceeded with the hysterectomy and breast bud removal without a court order authorizing the sterilization or any other part of the “Ashley Treatment.” 63
Can a person refuse treatment in Washington State?
Under Washington State law , competent adults have the legal right to refuse treatment and make treatment decisions under the informed consent statute . 85 The question of how decisions should be made in regards to medical treatment of an individual who is not competent to make such decisions for him or herself, however, depends upon the specific situation. For example, in the case of making end-of-life treatment decisions for a person who is incompetent to do so, the Washington Supreme Court has held that a court need not be involved before such a decision can be made. 86 Rather, in such cases, the court has held that it is for the legislature to establish guidelines and held that, in Washington, a guardian of the person appointed by a court following the full due process procedures required for appointment of a guardian under Washington State law, 87 can make these end-of-life treatment decisions. 88
Did WPAS take action against Ashley?
As part of its investigation, WPAS staff inquired as to whether Children’s Hospital had taken any disciplinary action against the doctors or anyone else for proceeding with sterilization and breast bud removal procedures on Ashley without a court order. 68 Children’s Hospital, through its attorneys, informed WPAS counsel that no such action had been taken, because the hospital did not feel it was warranted. 69 The Hospital, through its counsel, did, however, state that it believed that a systemic failure had occurred and that appropriate corrective action would be taken to prevent its occurrence in the future. 70