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Ashley Revisited: A Response to the Critics

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Abstract:

The case of Ashley X involved a young girl with profound and permanent developmental disability who underwent growth attenuation using high-dose estrogen, a hysterectomy, and surgical removal of her breast buds. Many individuals and groups have been critical of the decisions made by Ashley's parents, physicians, and the hospital ethics committee that supported the decision. While some of the opposition has been grounded in distorted facts and misunderstandings, others have raised important concerns. The purpose of this paper is to provide a brief review of the case and the issues it raised, then address 25 distinct substantive arguments that have been proposed as reasons that Ashley's treatment might be unethical. We conclude that while some important concerns have been raised, the weight of these concerns is not sufficient to consider the interventions used in Ashley's case to be contrary to her best interests, nor are they sufficient to preclude similar use of these interventions in the future for carefully selected patients who might also benefit from them.

Keywords: cognitive impairment; developmental disability; estrogen; ethics; growth; handicapped; puberty

Document Type: Research Article

DOI: http://dx.doi.org/10.1080/15265160903469336

Affiliations: 1: University of Washington School of Medicine, 2: University of Wisconsin School of Medicine and Public Health,

Publication date: January 1, 2010

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