Ethical Analysis of the Ashley Treatment

A six year old girl in Seattle has recently undergone a radical medical procedure at the request of her parents. The girl who suffers from a severe brain impairment called static encephalopathy, cannot communicate and is not ambulatory. Her parents had doctors remove her uterus, breast tissue, and appendix and give her estrogen to stunt her growth to eliminate the possibility of uterine and breast cancer and reduce the risk of bedsores and pneumonia. The family claims this is a quality of life issue. The parents claim that their action is morally right (in the eyes of God) because "God would want Ashley's parents to maximize her quality of life."

Because her parents claim that in the eyes of God the action is morally permissible, I have decided to subject the treatment to St. Thomas Aquinas' Doctrine of Double Effect.

First and foremost, without being able to read the parent's true motives, we must assume that the parents honestly do wish to do what is best for their daughter. To that end, they have successfully met the "right intention condition." However, that seems to be the only condition which is met. The nature-of-the-act condition is not met because the act itself involves unnecessary surgery. We cannot consider the nature of the act to be morally good or indifferent as is required (Pojman p. 47) because a surgical removal of tissue that is not endangering a person's health would be tantamount to mutilation. The means-end condition cannot be met either. Here, the bad effect is the sole means of achieving the good effect. In order to meet this requirement, the bad effects of the treatment would have to be unintended consequences. Lastly, the proportionality condition is not met because the good effects are all merely potential good effects. The surgery is very real but the results will only prevent cancer and sexual abuses which may not have occurred even without the surgery. According to St. Thomas' Doctrine of Double Effect, this action is morally impermissible. In order to be morally permissible, the "Ashley Treatment" would have to meet all of the conditions.

As the parents claim the action is permissible and, in fact, would be permitted by God, the methods of St. Thomas provide the best analysis of the morality of this treatment. Unfortunately, at best the action would be morally impermissible but done with the right-intention. Unfortunately, as the common saying goes "The path to Hell is paved with good intentions."

Louis Pojman, Ethics Discovering Right and Wrong 5th Ed.

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