Ashley Treatment

"Ashley treatment" is a hormonal treatment used on some severely cognitively disabled young children to keep them small, often to make caring for them easier, and sometimes accompanied by/resulting in sterilization. Peter Singer argues that the treatment ought not be outlawed. He responds to objections that this treatment is unnatural or violates the dignity of the children it treats:

"As for the claim that it was unnatural, well, in one sense all medical treatment is unnatural; it enables us to live longer, and in better health, than we naturally would. Perhaps the most "natural" thing for Ashley's parents to do with their severely disabled daughter would have been to abandon her to the wolves and vultures, as parents have done with such children for most of human existence. Fortunately, we have evolved beyond such 'natural' practices, which are abhorrent to civilised people. The issue of treating Ashley with dignity was never, in my view, a genuine one. Infants are adorable, but not dignified, and the same is true of older and larger human beings who remain at the mental level of an infant. You don't acquire dignity just by being born a member of the species Homo sapiens."

Singer's arguments here are very interesting. He responds to the claim that this treatment is unnatural. His response, that all of medicine is unnatural, assumes that "natural" means anything untouched by man. He maintains that affirming anything that is untouched by man would imply exposing disabled children. Of course, not only disabled infants would die if exposed to the wolves and vultures--every infant would die. But what I really mean to take issue with is his reduction of the idea of nature to that which is untouched my man or by artifice. This is certainly not the understanding of nature held by those who argue against this hormone therapy that keeps disabled children in underdeveloped bodies. Well, at least, it isn't the understanding of nature that they should have. The understanding of nature that allows for some forms of "medical treatment" and not others is an Aristotelian understanding of nature as telos or purpose. Artificially limiting the growth and development of disabled children's bodies thwarts the development of their bodies in accordance with nature's purpose.* A medical treatment like providing antibiotics or, my favorite example, toothpaste, does not thwart human nature, but rather can allow it to move toward its end (which for Aristotle is happiness). Other "medical treatments," like sterilization or elective amputation of healthy limbs, on the other hand, might thwart human happiness. Of course, Peter Singer admits the need for hospital ethics committees later in the piece, which implies that not all medical treatments are ethical, or at least ought not be applied to people in all situations.

Singer's dismissal of dignity in infants is distressing. He maintains that disabled and abled infants alike are not dignified. He expands his position that infants are not dignified to human beings with mental capacities of infants. He writes, "You don't acquire dignity just by being born a member of the species Homo sapiens." First of all, I think that by being born a member of the species Homo sapiens is precisely how you acquire dignity, at least the dignity proper to humans. (I think there's a dignity proper to other things, like animals.) Interestingly, his argument for why infants do not have dignity is that they are not dignified. This implies that dignity must be earned; it is something that must be deserved. There is no dignity owed to you qua human.** Infants certainly do not act in a dignified way! They poop and pee and spit up and burp and scream wherever the urge strikes. But dignity is not something that we earn. In fact, if it were, we'd be in trouble--many adults act contrary to their dignity (just think of Girls Gone Wild, or, as Arrested Development calls it, Girls with Low Self-Esteem). Rather, dignity is something that we have in virtue of being human. Our human dignity has moral claims on others--it requires that they treat us in certain ways and not in others.

It strikes me that Singer's dismissal of human dignity is connected to his dismissal of human nature: if there is not a unique end or purpose to being human that does not belong to animals, then there is no particular ethical treatment owed to humans at all times, quite aside from their rational capabilities or their dignified action.

Singer argues that the decision over the treatment should be made by the children's parents, with the oversight of hospital ethics committees, who should ensure that this treatment is in the best interest of the child:

"There is no reason to believe those children's interests are better understood by disability rights activists without cognitive impairments than they are understood by the children's parents. The best that can be done for profoundly disabled children with caring families is to keep them with their families, and that is more likely to happen if the families are able to lift them and move them, so that they can care for them at home."

This is funny because it's almost a subsidiarity argument. He's obviously right that it's in the best interest of the children to remain with their family where that is possible. This does not, however, absolve ethical reflection and accountability in this matter (as he admits when he calls for the oversight of this treatment by hospital ethics committees). 

I find this hormone treatment deeply troubling (I find even the designation of it as hormone "treatment" troubling). Severely intellectually disabled people clearly need representatives who will act in their interest. It is ideal for families to serve as their representatives as often as possible. However, we also need good laws to ensure the protection of the human dignity of all people, particularly where it is being attacked. The personal stories of those using "Ashley's treatment" are full of passion and emotion. Many of the families cited ease of care as a reason for the treatment, particularly ease of care by aging parents. Several mentioned that the disabled children liked to be held and that this would allow them to continue to be held. It is understandable that disabled persons would be easier to care for if they are smaller. These reasons, however, do not seem to require such extreme measures as preventing children's growth. Which is to say, other methods of addressing these problems exist, including receiving assistance from others outside of the home.

I am heartened by parents who care for their disabled children rather than aborting them. Parents who adopt and care for disabled children are doing something incredibly admirable and generous. However, it is important that serious cognitive disability not serve as an excuse for treatment that is inconsistent with human dignity.


* Admittedly, it becomes harder to talk about nature's end or purpose with regard to the body when, as in the case of some of the disabled persons treated with hormones, their range of independent motion is limited.

** This would have disturbing implications for torture, among other things. You could say that a particular human being was not acting in a dignified way, and so he doesn't deserve the dignity of not being tortured.