The case of Ashley X involved a young girl with profound and permanent developmental disability who underwent growth attenuation using high-dose estrogen, a hysterectomy, and surgical removal of her breast buds. Many individuals and groups have been critical of the decisions made by Ashley's parents, physicians, and the hospital ethics committee that supported the decision. While some of the opposition has been grounded in distorted facts and misunderstandings, others have raised important concerns. The purpose of this paper is to provide (...) a brief review of the case and the issues it raised, then address 25 distinct substantive arguments that have been proposed as reasons that Ashley's treatment might be unethical. We conclude that while some important concerns have been raised, the weight of these concerns is not sufficient to consider the interventions used in Ashley's case to be contrary to her best interests, nor are they sufficient to preclude similar use of these interventions in the future for carefully selected patients who might also benefit from them. (shrink)

This article questions the assumption of parental rights that frames the current legal paradigm for medical decisionmaking for children in the United States. Focusing on cases in which parents exercised their power to size, shape, and sculpt children's bodies through non-therapeutic surgical and medical interventions, I argue that the current paradigm distorts the parent-child relationship and objectifies children by allowing parents to subordinate their children's interests to their own. Such assertions of power violate the moral principle, deeply embedded in American (...) legal tradition, that no person, even a parent, may subordinate the life, liberty, or body of another for her own purposes. I propose an alternative. Pushing the analogy of parent as trustee developed in family law and moral philosophy, I use principles of trust law to define and apply a trust-based construct of the parent-child relationship that limits parental power over children's bodies. Application of the trustee-based construct separates medical decisions that belong to parents, from decisions that belong to children and those that should be made by a neutral third party. (shrink)