Jan 21, 2007

Saletan and the Ashley treatment

William Saletan, taking on the "Ashley treatment," explores the wider cultural context. Ultimately, he minimizes the parents' rationale for the radical surgeries doctors have performed on their daughter, instead offering a slippery slope:
But if those are good arguments for shrinking people, or at least for removing some of their tissue, why stop with Ashley? We're facing an epidemic of patients who are physically and cognitively incapacitated, hard to lift, extremely cancer-prone, extremely uncomfortable, and incapable of childbearing. They're called old people.
Would Saletan disapprove of treatment to reduce the ill effects, say, of gigantism and acromegaly? Does treating gigantism lead to a slippery slope, since the risks--"significant morbidity and mortality"--are well-known?

In fact, wouldn't we have slipped down the slope already, since we've been treating gigantism for much longer than we've known about Ashley?


TheTachyix said...

The problem that I have with this solution (one that I preemptively note gets overridden by myself) is it seems that both science/medicine and her parents are giving up on her as a possible fully-formed individual.

She fell asleep for no reason. Is it possible that Ashley could wake up? Ideally yes...realistically no.

So, while her parents are right in their medical decision making process, the fact they are abandoning the daughter that could-be for the daughter that-is, strikes a chord at the gut level. A negative chord.

As for Saletan's article...his putting aside of the oddness of the circumstances in favor of making social claims seems...too purposeful.

Jim Anderson said...

Since her brain has already gone through puberty without a miraculous awakening, there is only the most infinitesimal chance that she will ever attain any higher state of cognizance. Post-puberty, that sort of radical neurological reorganization just doesn't happen.

William said...

"Does treating gigantism lead to a slippery slope"?

Good question. Here's an empirical answer:


"Children at risk for tall stature due to acromegaly thus became the first recipients of estrogen and testosterone therapy for prevention of excess growth during the 1940s. Clinical trials revealed that estrogen preparations, in contrast to testosterone preparations, were particularly successful for preventing tall stature in children with acromegaly. As a consequence, physicians naturally considered whether the same treatment could be applied in other settings. Girls with constitutional tall stature represented a potential group of patients for whom hormone therapy might prevent further growth, an outcome that some considered desirable. In 1946, a brief abstract was published about the clinical experience of estrogen treatment in tall girls who were ‘becoming alarmed and unhappy about the extremes to which their exuberant, albeit normal growth was carrying them.’ A decade later, Goldzieher published the first formal clinical study of the use of estrogen therapy for the treatment of constitutional tall stature in girls. Goldzieher cast his research in terms of the application of new scientific advances; he claimed that estrogen treatment of girls destined to be tall as adults was a logical next step following the estrogen treatment of children with acromegaly and hence represented ‘no novelty.’”

Jim Anderson said...


Your link is busted, but the cited text, if accurate, is revealing. It shows the inherent fallacy in slippery slope arguments: since anything can precipitate them, anything is therefore morally suspect.

Also, what I said above about puberty is inaccurate. Ashley is 9 years old, and though I read somewhere that her bones had started to develop as they would in puberty, she has not undergone (and, thanks to the surgery, will never undergo) full puberty.