This “current controversies” contribution describes the recent case of a severely disabled six year old girl who has been subjected to a range of medical interventions at the request of her parents and with the permission of a hospital clinical ethics committee. The interventions prescribed have become known as “the Ashley treatment” and involve the performance of invasive medical procedures (eg, hysterectomy) and oestrogen treatment. A central aim of the treatment is to restrict the growth of the child and thus make it easier for her parents to care for her at home. The paper below discusses the main objections to the treatment. It concludes that the most serious concern raised by the case is that it may set a worrying precedent if the moral principle employed in justification of the treatment is applied again to endorse it in similar circumstances. Finally, it raises the possibility that that same moral principle may even be invoked to justify more radical interventions than those that were actually performed in the Ashley treatment.
- Ashley treatment
- rights of disabled people
- carers of disabled people
- the Ashley principle
- the revised Ashley principle
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Competing interests: None.
↵i In this discussion, rather than use the term “Ashley treatment” to describe the medical procedure and regime prescribed to Ashley, I will instead refer to the “Ashley interventions”. This is because it would beg an important question, I think, to regard these interventions as constituting a medical treatment.
↵ii Proponents of the social model of disability must be concerned that the Ashley case may set back the understanding of disability by at least two decades. For it reinforces the view that disability is caused by features internal to the person, rather than the social context.
↵iii Further development of the case that the Ashley interventions were not in her best interests might exploit the point that the interventions are legitimately regarded as experimental. Gunther and Diekema state “Because we have no direct experience with high-dose oestrogen treatment in young children, the possible adverse effects and risks are difficult to assess with certainty”.1