Ashley X: 10 unanswered questions

The Ashley X case, in which, a six-year old girl was given massive doses of estrogen, a hysterectomy and a bilateral mastectomy in order to “keep her small” at her parents request continues to have a number of unanswered questions. Here are a 10 that need answers:

1. Why was the mastectomy never mentioned in the original article describing the procedures?

2. Why is the breast surgery described by her father as very different from a mastectomy, more like the removal of a birthmark, and described by physicians involved as much less invasive than a mastectomy, when the health care insurer was billed for a bilateral simple (radical) mastectomy?

3. Why do the authors say that there was no experience or literature to guide the decision making, when the ethics of prophylactic pediatric mastectomy have been previously discussed in the ethics literature, which concludes that it cannot be justified?

4. Why does the original article suggest that the surgical procedures undertaken were justified in part by prevention of possible future pain, but not mention that both hysterectomy and mastectomy frequently result in chronic pain syndromes?

5. Why is estrogen, a drug which most frequently produces weight gain (see common side effects, or consider its use to produce short fat calves in meat production) used to control the weight of a child?

6. Why do authors of the original article suggest that risk associated with the estrogen treatment is similar to the risk to adult women taking birth control pills, when the average daily dose given to a six-year-old was about 30 times higher than the adult dose in birth control pills?

7. Why is Ashley’s first name and face shown on the family website, but her parents names and faces are concealed? Why do they require or deserve greater privacy?

8. Will rumors that Ashley’s parents were closely linked to hospital fundraising efforts be dispelled to make it clear that there was no conflict of interest? The description of her father as a software executive and strong links between Microsoft and Hospital fundraising sounds ominous, but there may no connection and it would be helpful to clear the air of any unwarranted conspiracy theories.

9. Why did the hospital rely on the advice of Ashley’s father’s lawyer who advised that they could proceed without court approval instead of seeking an independent opinion?

10. Why does the published article suggest that the purpose of the procedures was to keep the child’s weight down to make lifting, carrying, and transferring easier, but the ethics committee describes the “Issue of Concern” as “aggressive intervention (both surgical and pharmacologic) to limit her linear growth and sexual development?”

Tags: Ashley X, Estrogen, Ethics, Growth attenuation, mastectomy, pillow angel, surgery