Wednesday, May 09, 2007

Update: The Ashley Treatment

I first talked about The Ashley Treatment back on January 5, 2007. Please check out that post for all the background details. The case took an interesting turn Tuesday. According to the Seattle Post-Intelligencer, the hospital was required to obtain a court order before performing surgery on Ashley.
According to a report released Tuesday by a non-profit advocacy group, Ashley's constitutional and common-law rights were violated when she underwent a hysterectomy as part of her treatment. Washington law requires a court order before sterilizing a developmentally disabled child.

The decision for treatment went before the hospital's board of ethics, which agreed with the decision, but recommended it be reviewed in court.

But an attorney told Ashley's parents in a letter they didn't need a court order for the hysterectomy, said Deborah Dorfman, director of legal advocacy for the Washington Protection and Advocacy System, which conducted the investigation.
Ah ha! I knew there would be some kind of legal angle to this story eventually. So, let me get this straight, after the parents of a child come to a treatment decision with their doctor or doctors, they must ask the state if it's ok? Ridiculous!

The hospital is now in a pretty political pickle now, and in the situation of reparing their damaged credibility, and appeasing their critics.
Children's has agreed to appoint a disability rights advocate to its ethics committee and bring in experts as needed to make decisions about medical care for people with disabilities. It will require a court order for growth-stunting procedures, when it involves a child with a developmental disability. The hospital will also give the Washington Protection and Advocacy System notice of any sterilization or other growth-limiting procedures on persons with disabilities so it can act as a watchdog.

Dorfman said the group won't seek legal action against the hospital, but the Washington Department of Health, which is in charge of licensing hospitals and physicians, is planning to investigate further to see what actions, if any, may be taken against the hospital or physicians, said Steven Saxe, director of facilities and services licensing for the department.
Even if this group won't take legal action, I predict that the political hacks out there across the country will be sharpening their knives and getting ready to dive into this case for political points. According to political calculations, it's still ok to go after doctors and hospitals.

Now, I want to clarify, I'm not defending this hospital. Especially from a legal sense, hospitals have the responsibility to make sure that all the details have been taken care of. Someone on the inside dropped the ball, and they should be given the necessary consequences.

However, from a media standpoint, this story will be energized (I can see this now with the hits on my site), and the hype will begin again for this family - That's the real tragedy here...


Pieces of Mind said...

Ordinarily I am not a fan of outside intrusion into people's medical decisions.

But I think whenever a vulnerable person is involved - a child or an elderly person or someone who has a disability - there needs to be someone who is advocating just for them. Someone who does not have a dog in the fight, so to speak.

The question here seems to be: Was there a flawed process that led to the decision to go ahead with the Ashley treatment? If you're going to do something you know will be controversial, you need to make sure your processes are sound, so they don't undermine whatever good you might accomplish. The means should justify the end and all that.

I see this devolving into another giant debate, and it's unfortunate. As usual, the real issues will probably get obscured among all the smoke and flames.

twilite said...

Hi Dr A. Thanks for the update. Having a child with this syndrome is stressful without any of the public 'nuances'!

I hope the debate will not be cold and detached but mindful of the human vulnerability of Ashley's parents and siblings.

I do not know why the blog was removed...perhaps the genuine care from the public has turned to nightmare?

Stephen Drake said...

Dr. A,

Please remember that the "hype" was instigated by the family. When the original article was published in the Archivives of Adolescent and Pediatric Medicine, it got very little attention in the press. The "hype" came when the parents published their blog, wanting, more attention focussed on the "Ashley Treatment."

And please do everyone a favor and share the actual report with them - it's well worth reading - and contains other criticisms not included in the news coverage.

It's available at:

Mimi Lenox said...

Hi Dr. A.

You have been named Peace Blogger of the Day May 9, 2007 at Mimi Writes and BlogBlast For Peace.

Congratulations and thanks for participating.

coaster1robert said...

Well,I understand disability,but don't the parents have any right with medical treatment of Ashley?I don't understand the debate,they just want to stunt her growth,so she never fill out as a normal woman.look at all the midgets out there,are you saying it nature mistake they way the turned out,that their life is not worthy? as far as sex goes,she can't have it,because mentally she will always be three months old.
I don't understand why this a conditional problem. Robert

The Curmudgeon said...

pieces of mind, I think, has the right of it: The law should protect those who can't protect themselves....

When a PI case is settled for a minor in Illinois (for any amount over $10,000, I think) an estate is opened for the minor and the money deposited subject to order of court. That way the parents can't run through the money before the child comes of age. There's a regular call in the Cook County Probate Court in which the parents ask for their kids' money... and most of the time the court says "no" -- not unless the money is clearly being spent for the minor's actual benefit.

Doesn't that make sense?

Anonymous said...

But more times than not, the parents are ALREADY looking out for the best interest of their child...especially when they have special needs like Ashley has. There are always exceptions, but the majority of parents would bend over backwards to provide the best of care and chances to their child, disabled or not. We do no service to the families or the child when the courts get involved with these very sensitive cases. Someone always looses-and mainly it seems it is the child and his or her family...IMO.