The debate surrounding this treatment contrasts those who argue that the Ashley Treatment violates the child's human rights and is for the sake of convenience for the parents versus those who argue that this treatment is not only in the best interest of the child because it will provide a better quality of life but is also in the best interest of the parents and society as a whole.
Full Answer
Is Ashley’s life good?
No parent ever wants a child to be unhappy, uncomfortable, or ill. The Ashley treatment made her far more likely to be comfortable, healthy, and happy. Given the limitations imposed by her medical condition, her life is as good as we can possibly make it.
Is the Ashley Treatment in my child’s best interest?
Proponents argue that the Ashley Treatment is in her best interest for a number of reasons. First, being a smaller child it will be easier for her caregivers to lift her and care for her general hygiene, which should reduce the risk of bedsores, pneumonia and bladder infection that plague patients like Ashley.
What are the results of Ashley Treatment?
She has soft dark brown hair, beautiful blue eyes, long eyelashes, and is at a stable height and weight, that of an average nine-year-old, her age upon conclusion of the treatment. No parent ever wants a child to be unhappy, uncomfortable, or ill. The Ashley treatment made her far more likely to be comfortable, healthy, and happy.
What was the purpose of Ashley's breast reduction treatment?
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.
Why is Ashley treatment unethical?
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.
What is wrong with the Ashley treatment?
Background. Ashley was born with a severe brain impairment of genetic cause, termed a "static encephalopathy" because it does not improve. Although she sleeps and awakens, and breathes on her own, she is unable to raise her head, sit up, hold an object, walk, or talk, and must be tube-fed.
What is the Ashley treatment and why was it undertaken?
Together with Ashley's parents, he devised a course of therapy designed to keep the child permanently small. For three years from the age of six, Ashley was administered high doses of the hormone estrogen to bring to a close her growth, effectively freeze-framing her body at the size of a child's.
What form of treatment would be provided for Ashley?
Ashley is a girl with developmental disabilities who was six years old at the time the interventions began. The intervention included surgical removal of her uterus and breast buds, as well as high-dosage hormone therapy to limit her growth and physical sexual development.
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.
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 the importance of preventive dentistry in pediatrics?
Preventative pediatric dentistry aims to keep your child's teeth free from plaque buildup, gum disease and tooth decay before any serious treatments are needed. By preventing problems from ever happening, you are protecting your child in a way that has positive effects throughout his or her whole body.
What is non pharmacological Behaviour management?
Definition: The means by which the dental health team effectively and efficiently performs. treatment for a child. The aim is to instil a positive dental attitude. ( Adapted from.
What types of patients are seen in a pediatric practice?
Pediatricians focus on the physical, emotional, and social health of infants, children, adolescents, and young adults up to age 21. Because they work with so many aspects of children's health, they're highly trained in assessing, detecting, preventing, and managing issues that affect children.
Why is Ashley treated?
Proponents of the Ashley Treatment, and in particular Ashley’s parents, argue that this treatment is in Ashley’s best interest because it will allow her to have a better quality of life and will assist them as caregivers in being able to give her the best possible care.
Why is Ashley treatment important?
First, being a smaller child it will be easier for her caregivers to lift her and care for her general hygiene, which should reduce the risk of bedsores, pneumonia and bladder infection that plague patients like Ashley.
What are the principles of Ashley treatment?
To determine if the Ashley Treatment is ethical, the principles of respect for persons, beneficence, nonmaleficence and justice will be applied to this treatment and its consequences. Respect for Persons.
Why did Ashley get her uterus removed?
The removal of Ashley’s uterus raises real ethical concerns about sterilization. Directly sterilizing Ashley by removing her uterus because she does not need it can have wide-ranging consequences . The United States has a history of not always protecting the rights of the most vulnerable.
What is Beneficence in medical ethics?
Beneficence includes nonmaleficence, which prohibits the infliction of harm, injury, or death upon others. In medical ethics this principle has been closely associated with the maxim Primum non nocere: “Above all do no harm.”. Proponents argue that the Ashley Treatment is in her best interest for a number of reasons.
Why did Ashley have an appendectomy?
Ashley also had an appendectomy for preventative reasons4. This treatment has now been named the “Ashley Treatment.”. The debate surrounding this treatment contrasts those who argue that the Ashley Treatment is for “creating a 21st century Frankenstein and for maiming a child for the sake of convenience” versus those who argue ...
Why did they remove Ashley's uterus?
However, besides the high-dose estrogen treatment, physicians removed Ashley’s uterus, to prevent potential discomfort from menstrual cramps and pregnancy in the event of rape, and removed her breast buds because of a family history of cancer and fibrocystic disease . Ashley also had an appendectomy for preventative reasons4.
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.
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.
How much did Ashley's surgery cost?
There are cases were families had to go to other countries and to other states. Ashley's treatment cost under $40k, which was mostly due to the surgery and was fully covered by our insurance. As far as we know the other treatments are covered by insurance as well.
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.
Why is Ashley treatment discriminatory?
The implementation of the “Ashley Treatment” also raises discrimination issues because, if not for the individual’s developmental disabilities, the interventions would not be sought. Such discrimination against individuals because of their disabilities is expressly forbidden by state and federal law.
What was Ashley's parents' counsel's opinion?
an opinion of Ashley’s parents’ counsel that no court order was required. This legal opinion was not supported by Washington law; reliance upon that opinion by doctors at Children’s Hospital and the mistaken belief that the opinion of Ashley’s parents’ counsel constituted a “court review;” and.
How old was Ashley when she had her hysterectomy?
The child was later identified by her parents as “Ashley.”. [13] The collection of interventions began when Ashley was only six years old and included a hysterectomy, high-dosage hormone therapy, and removal of her breast buds. [14] .
Why did Ashley's family and doctors ask for an ethics committee?
[45] Because the “Ashley Treatment” was a new and unique application of this collection of medical procedures, there was no established procedure or specific policy about whether it would be appropriate to conduct this set of interventions. Ashley’s parents and doctors, therefore, asked Children’s Hospital’s Ethics Committee to provide its opinion and make recommendations regarding the proposed interventions. [46] The Ethics Committee at Children’s Hospital is comprised of a multidisciplinary group of providers and community members with training in medical ethics and one of Children’s Hospital’s lawyers. [47] This Committee provides non-binding recommendations to practitioners and family members looking for guidance regarding procedures or practices that appear to raise ethical concerns. [48]
Who is Ashley's attorney?
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]
Where was Ashley treatment performed?
The “Ashley Treatment” was conducted by physicians at Children’s Hospital, at the request of Ashley’s parents and after review by the Hospital’s Ethics Committee. There was, however, no court order sought or obtained before the sterilization portion of the “Ashley Treatment” was performed.
Do you need a court order to sterilize a child in Washington?
Washington law clearly states that a court order is required when parents seek to sterilize their minor or adult children with developmental disabilities for whom they are legal guardian whether the sterilization is being sought as part of the “Ashley Treatment” or alone. As discussed above in Section III.C, Ashley’s parents’ attorney wrote in his legal opinion letter to the parents (attached hereto as Exhibit N), that no court order was necessary to proceed with the interventions proposed in Ashley’s case; including the hysterectomy.
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 are the rights of a person with developmental disabilities?
73 These rights include, but are not limited to, the substantive due process liberty and privacy rights protected by the Fourteenth Amendment. Courts have found, for example, that there is a constitutionally protected liberty interest in making personal procreation choices. 74 Similarly, the courts have also found constitutionally protected liberty interests in the rights to be free from involuntary invasive medical procedures and treatment, such as involuntary civil commitment, 75 the administration of involuntary treatment with antipsychotic medications, 76 the right to refuse life-sustaining care,; 77 and involuntary sterilization, 78 among many other protected liberty interests. Courts have also found that there is a constitutionally protected privacy right derived from the penumbras of the Fourteenth Amendment to make decisions about contraception, 79 abortions, 80 and the right to be free from involuntary sterilization. 81
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
Do you need a court order to sterilize a child in Washington?
Washington law clearly states that a court order is required when parents seek to sterilize their minor or adult children with developmental disabilities for whom they are legal guardian whether the sterilization is being sought as part of the “Ashley Treatment” or alone. As discussed above in Section III.C, Ashley’s parents’ attorney wrote in his legal opinion letter to the parents (attached hereto as Exhibit N), that no court order was necessary to proceed with the interventions proposed in Ashley’s case; including the hysterectomy.
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