It's helpful to note the father's primary reason for removing her uterus: she doesn't need it. Since it's only purpose is procreation, which will clearly not be in her interest, it presents her with risks and burdens and no benefits. The most likely of these is menstruation, which should not be trivialized. Ashley may be just competent enough to experience the difficulties that menstruation often bring to severely retarded women, include being terrified on a recurring basis. There is also the small risk of pregnancy, which has occurred in such individuals, particularly if she needs to be institutionalized later in life. The risks of thrombosis (from progesterone), and cancer (from estrogen) may be low, but cumulatively these risks should be weighed against the low risk and transient discomfort of surgery. Different people may reach a different weighing than the parents did, but I do not think their conclusion can be described as unreasonable. Notice also her ovaries were not removed, because of concerns about aggravating her already high risk for osteoporosis.
One other point about the hysterectomy. Some of the critics on the weblog have raised the familiar cry of eugenic sterilization. This criticism is singularly misplaced. The appropriate concerns about eugenic sterilization, in the US and elsewhere, were based on coercive governmental programs, for the purpose of preventing procreation by individuals who were believed (often falsely) to be at risk for producing retarded offspring who would be a burden to society. None of these issues are involved in Ashley's case. She is extremely unlikely to procreate, unless she is raped, and has no interest in procreation. The motive has nothing to do with societal burden. And the state is not involved. This was a private decision, made by her parents in consultation with expert, caring physicians, and clearly motivated to make her life easier.
There is another organ she probably doesn't need, with some risk for discomfort; namely, her appendix. This too, was removed, as is commonly done in patients undergoing laparotomy for another reason.
Norm
Joel Frader, 2:42 PM EST
In reply to Norm:Generally, I agree. However, it would also have been reasonable to see if menstruation represented either psychological or hygienic difficulties for Ashley. If either or both developed, one could respond medically to minimize the frequency and amount of bleeding or decide on hysterectomy after puberty. I raised the issue not because of specific concern in Ashley's case but to alert readers about less-than-careful thinking that has occurred in other cases.
Joel
Norman Fost, 3:59 PM EST
I'd like to raise another point in response to some comments on the weblog suggesting that this is an example of parents and doctors going off the deep end and treating a handicapped child in a way that is not her interests. Part of this criticism reflects a belief that the parents have asked for these interventions for their own convenience, to minimize their burdens.There was a time when parents and doctors commonly conspired to deprive handicapped children of standard medical care, often with the explicit goal of hastening death. The "Baby Doe" controversy in the 1970's and 1980's was largely about a well documented pattern, over many years, of withholding standard medical treatment from infants with excellent prospects for long happy lives. The paradigm cases involved children with Down Syndrome and easily fixable defects, such as duodenal atresia.
That problem has largely been resolved in the US. It is, for example, unheard of for an infant to have standard treatment withheld simply because the child has Down Syndrome, or spina bifida, another common birth defect which resulted in inappropriate discrimination on the basis of handicap. The way in which it was resolved produced an over-correction in many people's minds: i.e., excessive use of technology to rescue infants with little or no prospect for long or meaningful existence. Disagreements now are more commonly about very gray cases, babies with uncertain futures and insufficient facts to predict likely longterm outcomes.
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