A Serious Moral Question

[VinnieK]

Where would you draw the line. Is it OK to subject her to an hysterectomy but not a face lift to stop people on the streets staring when she goes out. Both are elective, ie choice procedures, she cannot chose.

 

The analogy a crude one, verging on being outright crass. The treatment she's undergone is one that should allow her physical standards of living to remain the same throughout her life (as opposed to lessening later on), and, as Chinahand mentions stands a chance of preventing future illnesses. The cosmetic option, on the other hand, has only the potential to enhance one part of her life (that being certain aspects of her public life) which is psychological and one which some would say can be in part be achieved anyway by being a part of a loving family unit.

 

In other words, the former procedure is a matter of bringing real physical benefit and possibly avoiding illness at a later date, whereas the latter would carry lesser benefits that can potentially be achieved by other means. Chalk and cheese.

 

So you are a woman, you live in a society that recognises that a married woman belongs to her husband and can take no decisions of her own. He does not want children,, but he does want unprotected sex, he books you in for an hysterectomy. Is that OK or not.

This is surely little more than a bizarre attempt to sideline the debate. The two scenarios are not even vaguely comparable given that the procedure in question is entirely for the benefit of the husband, and even those benefits focus upon personal preference rather than true questions of health and care.

 

I can understand that you find the parent's motives questionable, and I understand that you are concerned about the implications of such a procedure for like minded cases, but this argument does neither issue any justice. Instead of trying to argue your case regarding the parent's motives (which only has peripheral value since it says nothing about whether or not the procedure would be reasonable, or at least have a greater justification, in a similar instance where parents could be proven to have the purest of motives), you draw conclusions from an unsubstantiated assumption that the parents are motivated by convenience and a notion of their child as property - in this respect at least your entire argument can be reduced to an callous ad hominem attack on the parents which, as an advocate, I should hope that you realise really should be beneath you.

 

If Ashley had a life threatening illness that required intervention its very different, as it was growing up was going to make it difecult for those around her to care for her as they wished. Where do we draw the line if that is acceptable. Growing up is not a medical condition to treat, its part of life, for us all, including Ashley.

 

Growing up is a physical process, in this case one that threatens the health and standard of living of the patient. It is not unusual to medically halt or modify other such processes in the human body if they carry the risk of causing a patient future difficulties or medical problems, so why is this different? That it's not only makes sense if you regard growing as some kind of sacrosant property of humanity that is more important than the individual's health and well being, which I reject out right.

 

I am afraid the more I analyse it the more I think its the slipppery slope.

 

This concern has been raised a number of times now, but how valuable is it to the debate in question? Is it really legitimate to stop potentially beneficial procedures on the basis that they might in some way lead to future developments that are less desirable? I would say no it is not.

 

Take for instance the issue of sterilization. In many instances this is a medically valid procedure that is necessary, but just because the procedure is open to misuse via the enforced sterilization of those a government considers as undesirable does not then mean we should never have even considered allowing it in the first place.

 

Of course Ashley's procedure could be misused, just like most medical procedures, in the hands of callous and deranged individuals or governments, and it is the responsibility of governments to ensure through a reasoned discussion of when and where such a procedure is justified that it doesn't, but there is no place in such a discussion for notions of "what it might lead to" as if humanity is a mindless slave to its own technology that can't help but take things to irrational extremes.

 

As another example, consider abortion: should abortion have been legally forbidden on the basis that one day Dr Bizarro might take over the world and make abortions a mandatory feature of population control? or because parents or husbands might one day force their daughters to undergo abortions? Of course not. Even from the anti-abortion perspective such arguments are non-sensical, just as the slippery slope argument is in this case. It's possible to argue that the procedure is wrong or right based on its own merits, but, for the reasons above, not that it is wrong because it will lead to worse procedures that are wholly unacceptable in any circumstance.

[John Wright]

I am not attacking the parents. I am trying to demonstrate, obviously poorly, the difference between essentail and elective surgery in these cases and the patriarchal way soem decisions are made and have been made. I object to the patriarchialism of "I as father, doctor, etc know best and have the right to take because I own or am in control"

 

When it is a matter of choice and you cannot choose, should any one be able to make that choice for you or is it always an unjustified assault?

[VinnieK]

I am not attacking the parents.

I disagree. You've already stated that:

Noned of what was done to Ashley was really for her benefit, it was for the conevenience of her carers, keep her light and she camn look angelic on the pilow, remain our baby forever

before throwing in a straw man by adding that this sounds mawkish and wrong.

Furthermore, nearly every analogy you've drawn has involved one person undergoing an operation that benefits only someone who's close to them (largely passing over the issue of how the procedure benefits Ashley, other than making the plastic surgery comparison), which only reinforces the unsubstantiated claim in the quote.

I am trying to demonstrate, obviously poorly, the difference between essentail and elective surgery in these cases and the patriarchal way soem decisions are made and have been made. I object to the patriarchialism of "I as father, doctor, etc know best and have the right to take because I own or am in control"

Surely this is another straw man: to my knowledge no one's suggesting that the procedure was essential, or even merely that it's beneficial. The counter argument to your stance is that the procedure has, in addition to its benefits, the potential to evade future problems which although not life threatening are nevertheless serious ones and as such should be considered.

 

You talk of patriarchialism (which I'd suggest is the wrong term, and a potentially disingenuous one to use, given the numbers of female doctors), but isn't it the case that doctors have the right to recommend or suggest a procedure based on their knowledge (which surely we must acknowledge as superior to our own, otherwise we undermine the entire medical practice), and that, when a child is incapable of making a decision or indicating their preference, parents have the power to make decisions provided they are judged to be in the best interests of the child and the decision made will not knowingly cause physical harm?

 

If we disagree on this then we are done, there is little left to argue since we've already reached a deadlock of principles (although such a position could undermine your own assesment, which I actually agree with, of how right you were in you application for sterilization of the young mentally handicapped girl you mention, but that's another discussion entirely).

 

I would add, however, that this authority can be seen to stem from a natural duty. If such a decision were not made, and the child in question went on to suffer through no fault of her own, wouldn't this be a case of negligence, the results of which being the same for the individual in question no matter how high the principles used to justify it.

When it is a matter of choice and you cannot choose, should any one be able to make that choice for you or is it always an unjustified assault?

Isn't this simplistic to the extreme? Asking us to choose between "any one" having the power to decide for us and such decisions "always" being a case of unjustified assault is a highly suspect piece of rhetoric in relation to what's actually being discussed.

[John Wright]

Vinnie, I am not as far from you as you seem to think. I have posed most of my post with questions rather than answers. I don't have the answers. But the question about who is allowed to authorise an assault on another and in what circumstances is at the very cente of the debate if the operative procedure is not in an emergency to resolve an immediate life threatening condition.

 

If it weren't it would be OK for Mengele as a doctor in loco parentis (having killed the parents)to authorise medical experiments on handicapped children, it would be able to be extrapolated to it being OK for you to decide to hit someone when the emergency of self defence is not present.

 

The general rule is the sacrosancy of the human body and of life. It is only in extremes that we have ever allowed diversions. (boxing apart)

 

Lady doctors can be just as patriarchal as men. Its an attitude of the profeesion we are moving away from slowly. The emphasis today is on knowing consent, not just a scribbled signature, whilst half under the anasthetic, on basis Dr knows best. Ashley can never give knowing consent, the operative procedures under anasthesia are themselves dangerous to her weakened condition.

 

My heart bleeds for her and her family. But, and its a big but, I think, on my rational analysis and with some knowledge and experience of the law that its on the wrong side of the line I want to see drawn. I accept the line is arbitrary, there has to be one. For you it is obviousley on the right side of the line. You are entitled to that belief and I will fight for yourvright to express it.

 

I still have my doubts about the intervention on the young girl here. There was no eveidence she would have had handicapped babies, just not be able to care for them, why not ensure she takes the pill or has injections, why invade. Actually its fairly commonplace now. But I have a nagging doubt it isn't Dr's, parents and social workers saying how much more difficult their lives would become rather than for any specific medical benefits. Yes the social and care benefits are huge, but should medical decisions be taken on the basis of non medaical benefits.

 

I admire the parents in the case of Ashley, but perhaps their view that they are doing and must do everything for Ashley, whilst admirable, clouds their judgement in the arena of cutting edge ethics.

 

There is certainly no medical benefit for Ashley in what they have done. It is a social benefit and a family benefit. Same as a lot of cosmetic surgery, which might also save parents from distress and embarrassment. It is not pejorative to point this out, it is all part of the equation and also helps in the deabte to see if we can agree a line in the sand or not. They are two points in a continuum, they are not even at the extreme ends, those are do nothing and eugenics.

 

You seem to accept the procedure was not essential, in that case it becomes very difficult to justify, in present medical ethics law, the intervention. except on the basis of Dr's saying they know best. That is against the drift of more and more explicit information being given to the patient for informed consent and remeember informed consent means having your decision to refuse the proffered treatment respected as well.

 

In law, generally neither Drs nor parents nor next of kin have the right to authorise invasive procedures except in emergencies. This was not an emergency.

 

By doing nothing as a Dr when there was no requirement because there was no diseaes process or medical emergency to treat would certainly not be negligent.

 

I repeat, what you dismiss as simplistic and suspect rhetoric, is the actual question we as a society have to answer. It is why in areas such as human fertilsation and embryology we have taken the decision making away from the Drs and patients involved and set up an authority to make rules and set standards. maybe we need that here and in things like euthansia, an independent body to review the decisions of the drs and familys who may be too involved to get it right.

 

The husband wife debate is comparable, directly, The woman is saved frtom the risks of conception and delivery, will never have child bearing hips and will always reamain slim and beautiful and be loved by her husband. A bird in a gilded cage or an angel on the pillow. It really is not all that different. Yes it is extreme but it is an illustration of the dangers of Dr or daddy or the government knows best and should be allowed to do what it wants.

[VinnieK]

the question about who is allowed to authorise an assault on another and in what circumstances is at the very cente of the debate if the operative procedure is not in an emergency to resolve an immediate life threatening condition.

 

If it weren't it would be OK for Mengele as a doctor in loco parentis (having killed the parents)to authorise medical experiments on handicapped children, it would be able to be extrapolated to it being OK for you to decide to hit someone when the emergency of self defence is not present.

 

But the issue isn't quite so simple as to be about who has the authority to decide when non-essential procedures can be carried out on an individual, otherwise yes you could extend the analogy to Mengele. Such a perspective neglects the benefit that Ashley receives individually from the procedure, which was presumably the primary subject of the discussions held by those who approved the procedure. Mengele was a madman who performed horrific experiments on children that benefitted no one (and had negligeable medical value), a situation that can hardly be said to follow from one where difficult decisions are made and elective procedures are performed primarily for the benefit of the patient. Of course this needs to be regulated, with ethics committees rigorously scrutinizing the issue on a case by case basis

 

You raise the following point

 

There was no eveidence she would have had handicapped babies, just not be able to care for them, why not ensure she takes the pill or has injections, why invade.

referring to the removal of Ashley's uterus. The reasons behind its removal were more than concerns over pregnancy or child birth, being medical concerns over eliminating uterine cancer, infections and various disorders, and the menstrual cycle - the symptoms of all of which Ashley would be unable to communicate to her parents. In this circumstance the pill and injections are not the answer. Contraceptive injections can actually increase the severity of the affects of the menstrual cycle, whilst the pill carries an enhanced risk of heart attack and, perhaps more pertinantly in someone who's incapacitated, deep vein thrombosis.

 

Since she has the mind of a baby and is incapacitated, the only possible time Ashley's uterus would serve a practical purpose is if she was made pregnant through sexual abuse. As such its removal, if anything, is the safer, more practical solution to the problem than other contraceptive methods.

 

The husband wife debate is comparable, directly, The woman is saved frtom the risks of conception and delivery, will never have child bearing hips and will always reamain slim and beautiful and be loved by her husband. A bird in a gilded cage or an angel on the pillow. It really is not all that different. Yes it is extreme but it is an illustration of the dangers of Dr or daddy or the government knows best and should be allowed to do what it wants.

 

But, and here's the crucial difference and why the comparison fails, the woman in your scenario is clearly able to communicate her own wishes. Ashley cannot (and indeed lacks the mental faculties to even comprehend the current situation) and it's almost certain that without the procedure Ashley's life would deteriorate in quality, as well as put her at a greater risk of developing medical conditions that are only further complicated by her inability to communicate.

 

One aspect of your posts that is interesting is that you focus entirely on the authority of doctors and the parents (which I believe clouds the discussion and distorts it into one of patriarchalism of parents and the professional classes), neglecting the fact that this procedure went through full review by a medical ethics committee (which tend to include lawyers, non medical experts in the field of ethics, and lay people), and that it is this group that ultimately has the highest authority (outside of the government and courts) in this matter.

[John Wright]

just two things, I was referring to the child in whose case I participated, not Ashleys case when I expressed the doubts about steriliastion over the pill

 

The medical profession does time and time agin ignore women and decare them incapable of taking a rational decision and thenin spite of their utterances the medical profession applies to the courts which endorse invasive treatment against the womans will.