Ethical issues with medical interventions occur in situations other than at the end of life. The following case illustrates ethical issues with a non-life-sustaining treatment. (Source: Gunter, D. F., & Diekema, D. S. (2006). Attenuating growth in children with a profound developmental disability. The Archives of Pediatrics & Adolescent Medicine, 160(10), 1013–1017.) Examine the following case.
Ashley is profoundly developmentally disabled due to static encephalopathy.
She is unable to speak or otherwise make her wishes known.
She cannot walk and requires constant care.
When Ashley was six years old, her parents asked the Ethics Committee at Seattle Children’s Hospital to approve a series of treatments designed to shorten her stature and make her sterile.
These treatments consisted of high-dose estrogen therapy to mature her epiphyseal growth plates and a hysterectomy. They also requested the removal of her breast buds.
The rationale for the estrogen treatment was that as Ashley grew, it would be physically harder for her parents to care for her. Her shorter stature would ease their ability to continue care for Ashley at home. The hysterectomy would prevent hygiene issues and discomfort related to menstruation and pregnancy from rape. Breast bud removal was due to a family history of cancer.
The Ethics Committee approved the request and the interventions, now called “Ashley’s Treatment,” went ahead.
1. Is Ashley’s treatment ethical? Explain your answer, drawing on the topics about harming versus wronging, optional and obligatory treatment, and quality of life consideration for children with serious illness or disabilities.
2. Review the five prima facie rules of obligation. Do the prima facie rules of obligation align with the theory of beneficence in fulfilling the proposed medical treatments for Ashley?
0. Protect and defend the rights of others.
1. Prevent harm from occurring to others.