“‘The Ashley Treatment’ is against physicians’ moral duty to themselves,” says Naomi Tan

In the November issue of the Journal of Medical Ethics, there’s a great paper on the Ashley case by Naomi Tan of Center for Social Ethics and Policy, University of Manchester and I. Brassington. It is titled “Agency, duties and the ‘Ashley Treatment.’”


 Reading its full text, I find it reassuring that the authors, unlike some others who have written papers on the case, have obviously read pertaining documents very rigorously and have steadfast understanding of the facts. After describing the case and pointing out some ethical problems in the justifying rationale by Ashley’s father and the doctors, that are not very different from those already pointed out, the authors proceed to a philosophical discussion.

If we call creatures with autonomy and personhood “agent” for the sake of ease, and think that Ashley is a “non-agent,” would it justify the invasive treatments done to her? The authors give two different arguments to conclude that it wouldn’t. In the first, they write, “although a family might consist of agents, it is not an agent in its own right. And if we are prepared to treat one non-agent – such as a family – as a “direct” object of moral concern, then it is hard to see why we mightn’t have the same attitude to another non-agent – such as Ashley.” But the beauty of the paper is in the next argument of physicians’ moral duty. Here they point out that the doctors’ rationale to justify the Ashley treatment is based on the assumption that moral agents (doctors here) act in a moral way because of the moral status of the recipient of their good act. And quoting from Kant, they claim that we owe our moral duty to ourselves, not to the moral status of the recipient of our act. It is the duty to maintain our humanity, our capacity to act as moral agents. We have to act in a moral way and it is the duty to ourselves because cruelty to non-agent like animals, for example, dulls our compassion and as Kant says “gradually uproots a natural predisposition that is very serviceable to morality in one’s relations with other men.” It is more about virtue than rights. We also have a duty to refrain from acting wantonly for the same reason. That makes causing Ashley to suffer surgically because of the suffering that may or may not be caused doubly immoral in light of the physicians’ moral duties to themselves.

 They write, “Not acting for a reason generates a reason not to act” and conclude “we cannot do to them what we would be unwilling to do to their brothers.” They also say that the problematic and worrisome aspects of the Ashley case “seem to be worthy of further investigation; and the results of this investigation may well resonate beyond questions of what we may do to one disabled girl.”

Not acting for a reason generates a reason not to act…….. This seems to be true not just to “the Ashley treatment” but to many other ethical issues like futile care theory, genetic testing, surrogacy and such. Maybe human-beings have a moral duty to themselves to refrain from doing something just because it is technically doable and refrain from harming their corrective humanity, their ability to sympathize, understand, accommodate, love and care.

This paper also reminds me of  this great post by Dr. Sobsey.

4 thoughts on ““‘The Ashley Treatment’ is against physicians’ moral duty to themselves,” says Naomi Tan

  1. I haven’t read the full text, but based on your description of the paper and the abstract, here’s the problem I see: it begs the question. It would be immoral to violate a duty to oneself, as it would be to violate duties to others … provided those duties exist. But whether there’s a duty to act in certain ways w.r.t. Ashley and more generally the Ashley treatment is precisely what is in dispute between those (like Singer and the doctors involved) who see no substantive moral problem in the treatment, and those (like you, Sobsey, and me) who think it is deeply morally problematic. Bottom line: while an appeal to the Kantian idea of duties to oneself might provide another way of creeping up on what is wrong here, it likely has got the yarbles to do the work that other notions–like duties to others, avoidance of harm, respect for others, etc.–do in arguments over the case.

  2. One thing I thought reading the article is that at least Ashley’s father seriously believes he is acting in a very moral way in introducing these interventions to help severely disabled children and their families and that might bring us back to the very beginning of the argument here with a question of how we should know whether a certain act is moral or not. I agree with you in this. But as for the doctors, they do not seem to have been so sure as the father at the time they approved his request in 2004 and my opinion is that they acted against their professional duties as well as their moral duties. And they have been trying very hard to cover it up with their dubious justification because they know it. If Ashley’s intellectual disability is just an alibi or a magic they use to make something immoral to do to children with physical disabilities look moral in her case as I pointed out in the post below, Tan’s argument sounds quite valid to me.


  3. Yes, I think you’re right about the doctors, hospital, etc., especially given the evasiveness, admitted illegalities, inconsistent shifts in justification, etc., that you have documented so well in the past.

    But then that seems to me only to reinforce skepticism about the need to, or benefit to, shifting to a “duties to oneself” perspective on the case, as Tan does, or appeal to virtue theory, rather than another normative framework. If the doctors violated their duties to others via their soft-peddling on the rules and regulations in place that should constrain their actions and decision, I don’t see what an appeal to Kantian duties to others or Aristotelian-inspired virtues helps with. Maybe if / when I read the whole article I’ll have other thoughts.

  4. I’ve been thinking about your comments in my own way. Sorry I know this is not the way you point. But maybe we are in a very nasty dilemma here. If the doctors went out of the way to ignore some rules to allow this to happen and tried to hide or cover it up, that alone would prove that they share our opinion about the treatments and render all this debate on ethical appropriateness of these interventions meaningless and totally unnecessary. But due to what I suspect could be initial failures of watchdogs, public or civil, and including the media, to do their job right (some more people who went against their professional duties as well as their moral duties in this case?), we have been dragged into this debate and forced to go along with the farce of the doctors’ justification. And as the debate goes on over ethical appropriateness of the treatments, we have been forced to deal with a case that might have actually been just “an exception” as “a precedent”, which in turn, makes it an actual precedent. The wider and longer this debate goes on, the more used to the idea of the Ashley treatment medical professionals and general public become.

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