Medical Ethics

[Gregory Matthews]

Physicians in Seattle are reported to have removed the uterus and breast tissue from 9 year-old Ashley. In addition, she has been given a massive dose of hormones that are intended to stop her growth at her current 4 foot, 5 inch height.

Ashley is a severely disabled female with static encephalopathy. This has left her bed-ridden, severe brain damage, and significant developmental disability. The rationale for the above medical intervention was so that her parents could continue to care for her at home.

Art Caplin (a foremost medical ethicist in the USA) has called this troubling. Joel Frader, another medical ethicist, has suggested that the intervention was probably appropriate, but that it ignores larger social issues.

NOTE: I am a member of a hospital ethics committee. I do not believe that our committee would approve of the above.

I have taken this story from an AP story in the DILY TIMES-CALL, of January 5, 2007.

[cricket]

Could you provide the link to the actual article. I'd like to know more about the medical necessity of removing these organs/glands.

[Nan]

Personally I do not have a problem with the decisions that were made to treat this unfortunate girl. The issue has been reported in quite a lot of detail in Australia. Her growth will be stunted because the oestrogen (female hormone) given will cause the fusion or hasten the maturation of the growth plates in her bones. Having the surgery (hysterectomy and removal of breasts) before giving the hormones which would have sent her into puberty, averted those problems.

These cases are extremely delicate. In Australia and probably in the US, it is not legal to perform any sterilisation procedure (that includes ligation of fallopian tubes or hysterectomy) on any impaired person without approval from the a Guardianship Board, a government authority. Obviously in this case a number of consultations were held before proceeding. I believe that generalisations are not possible in decisions of this nature, that every case needs to be considered individually by impartial persons, and that we are all aware for the potential for abuse.

I can only admire the parents who want to go on caring for their daughter instead of placing her in institutional care.

[Amelia]

http://www.cnn.com/2007/HEALTH/conditions/01/04/ashley.treatment.ap/index.html

[bevin]

Sounds to me like the parents have made a considered and rational decision in consultation with medical professionals.

Ethics boards are very good at sharing burdens so that the individuals directly involved can get good objective advice.

I don't mind the idea of people thinking in general terms about ethics and situations.

I don't think people without a strong vested interest in a case should have a say in its treatment. For example, most of the people the news media gave voice to in the Terry Schiavo case had no vested interest in the case, and should have kept their opinions to their own circle, leaving the involved parties do what needed to be done without putting even more burden on them.

In this current situation, I am glad that the decision was made and implemented locally, and actually done before the case came under wide-spread scrutiny.

/Bevin

[Nan]

Sounds to me like the parents have made a considered and rational decision in consultation with medical professionals.....In this current situation, I am glad that the decision was made and implemented locally, and actually done before the case came under wide-spread scrutiny./Bevin

Very well put, Bevin

[Gerr]

I wonder by what ethical/moral principle Mr. Caplin was having reservations on? I can almost bet the farm that he is of the same religion as those that were adamant on keeping Terry Schiavo around, no abortion under any circumstances, no sterilization for drug addicts & mentally retarded who are totally dependent on society.

Gerry

[Dr. Shane]

How big is the farm?

[Jeannieb43]

Personally I do not have a problem with the decisions that were made to treat this unfortunate girl. The issue has been reported in quite a lot of detail in Australia. Her growth will be stunted because the oestrogen (female hormone) given will cause the fusion or hasten the maturation of the growth plates in her bones. Having the surgery (hysterectomy and removal of breasts) before giving the hormones which would have sent her into puberty, averted those problems.

These cases are extremely delicate. In Australia and probably in the US, it is not legal to perform any sterilisation procedure (that includes ligation of fallopian tubes or hysterectomy) on any impaired person without approval from the a Guardianship Board, a government authority. Obviously in this case a number of consultations were held before proceeding. I believe that generalisations are not possible in decisions of this nature, that every case needs to be considered individually by impartial persons, and that we are all aware for the potential for abuse.

I can only admire the parents who want to go on caring for their daughter instead of placing her in institutional care.

How well explained for all of us, Nan.

And to Bevin, I appreciate your summary too. I'd read of this case in the news and I feel I'd have wanted the same if it had been my daughter. I know of some cases in which estrogen was given to girls in puberty to stunt their growth when they started reaching 5'11" in height. That was back in the days before tall was considered beautiful. I don't believe we should second-guess anybody who goes about these things with a due amount of professional advice and approval.