Intended for healthcare professionals


Ashley X: a difficult moral choice

BMJ 2007; 334 doi: (Published 11 January 2007) Cite this as: BMJ 2007;334:72
  1. Rebecca Coombes, journalist, London

    Did the doctors and parents responsible for a severely disabled girl have the right to keep her small?

    What's the story?

    Until New Year's Day, Ashley X was simply the anonymous child at the heart of a family case history published in an American medical journal.

    The 9 year old girl has static encephalopathy and is an infant state, cannot sit up, roll over, hold an object, walk, or talk. In a radical move, she has been receiving growth attenuation treatment for the past three years designed to keep her the size of a 6 year old, through high dose oestrogen.

    The goal was to improve Ashley's quality of life and make it easier for her parents to care for her at home. More controversially, the girl also had a hysterectomy to eliminate the menstrual cycle and associated cramps, and breast bud removal to avoid the development of large breasts.

    How did the story break?

    Ashley's case history was published in October's Archives of Pediatrics and Adolescent Medicine (Arch Pediatr Adolesc Med 2006;160:1013-7). It did more than just stir up ethical debate in the medical community—it sparked global publicity. “Eugenics,” “mutilation,” “Frankenstein-esque” were some of the criticisms it set off.

    It motivated Ashley's parents, a professional couple from Seattle, to go public, naming their daughter and posting family photographs on a blog on 1 January.

    The blog (http://ashleytreatment, took a million hits in the first 48 hours, topped the health section of Google News for several days, and …

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