One of the major changes from then to now has been the widespread use of hospital ethics committees, as occurred in this case. While these consultations obviously can not eliminate the possibility that of a decision that, on reflection, is difficult to defend, they greatly reduce the likelihood that decisions will be based on bad information, or sloppy thinking, as was common in the Baby Doe cases.
The detailed account of the medical basis for the decisions in Ashley's case, as well as the careful ethical reasoning that they relied on, are well documented in the article by Gunther and Diekema, and the father's extraordinary detailed account of how and why they came to their conclusions. Whatever disagreements critics may have, it is not possible to say this decision was made casually or quickly, without careful consideration of the relevant facts and arguments.
This is not to say they considered everything. Joel Frader's question, for example, of why not delay the hysterectomy until there is evidence she is suffering from menstruation, was not explicitly addressed in the available materials. So it is always possible to do it better. But the process they used is dramatically different from the approach that characterized decisions 20-30 years ago. Such a process increases the likelihood that a decision will withstand scrutiny, reduces the likelihood that the participants will later realize they left out some important consideration, and should reassure the public, including advocates for handicapped children, that the child's best interest is the focus of decisions.