Complicated Medical Issues: Are Doctors Allowed to Do Everything What’s Medical Possible Without the Willing of the Patient?

Ashley was born with static encephalopathy that means she can’t sit or walk and she will stay on a mental level of a three month old child. Ashley can perceive her environment and music. Her parents have to carry her everywhere they want to go (to the bathroom, to her caddy or to the car). Eating is only possible by a lens barrel. When she was growing up her parents had some fears. What would happen, when Ashley would become too big and heavy to carry her and that it wouldn’t be possible to care for her at home alone. So the parents decided to contact a hospital in Seattle and asked for possibilities to stop/limit her growing and avert her puberty. The treatment includes some different aspects. One aspect was that the uterus was removed to avert menstruation and sexual development. Second was a removal of nascent breast buds to prevent development. And she also underwent an appendectomy. Last aspect was an intense therapy with estrogen to limit her growth. The parents argued that it’s easier to care for her when she stays little. With these actions the usual complications of bedridden patients (furuncle of laying, pneumonia or bladder infections) should be minimized. An also interesting fact is, that the parents wanted to stay anonymous.
So in this case we have not only an ethical dilemma, we also have to look at legal aspects and even economic aspects. The main issue in this case is, are doctors allowed to do everything what’s medical possible without the willing of the patient (even when she’s retarded), especially in the case that there’s no medical necessity to do that.
In the Ashley case there are two choices; to treat her or not to treat her. Apart from the static encephalopathy she was physically healthy. From the ethical...

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...uring the treatment and that only because of the needs of the parents or their worries about the future condition of Ashley. There was no medical reason to do it that way at this point of time.
But there is also an economical factor to think about it. The parents want to care for Ashley at home and want her to stay a small kid. That’s a big advantage for the parents in a financial way. They have to pay once for the treatment (in the case the insurance will not pay for it), but then they don’t need to pay for external care. When she stays at her size the living costs are reduced. And as a result of the removal of all critical parts of the body, the probability of further cost-intensive diseases and treatments is minimized. So from a financial view the question of treating her or not depends on the operating costs compared to the long-term costs of no operation.