Ashley Treatment

Ashley X
Born	1997 Seattle area

The Ashley Treatment refers to a controversial set of medical procedures undergone by a Seattle child, "Ashley X". Ashley, born in 1997, has severe developmental disabilities due to static encephalopathy of unknown etiology; she is assumed to be at an infant level mentally and physically. The treatment included growth attenuation via estrogen therapy; hysterectomy, bilateral breast bud removal, and appendectomy.

The principal purpose of the treatment was to improve Ashley's quality of life by limiting her growth in size, eliminating menstrual cramps and bleeding, and preventing discomfort from large breasts. The combination of the surgery and the estrogen therapy attracted much public comment and ethical analysis in early 2007, both supportive and condemning.

Ashley's parents granted their first written interview to CNN Health in March 2008, and their second to The Guardian in March 2012. In addition, The Guardian published two interviews with mothers of a girl and a boy who had completed the treatment. A 2014 TV program and article tell the similar story of a girl in New Zealand. A survey on growth attenuation among pediatric endocrinologists was published in July 2015.

Ashley was born with a severe brain impairment of unknown cause, termed a "static encephalopathy" because it does not improve. Although she sleeps and awakens, and breathes on her own, she is unable to raise her head, sit up, hold an object, walk, or talk, and must be tube-fed. Nonetheless, she is alert and responsive to her environment, particularly enjoying the music of Andrea Bocelli. Her parents have nicknamed Ashley "Pillow Angel", because she always remains where she is placed, which is usually on a pillow.

In 2004 when Ashley was six and a half years old, she began to show signs of puberty and her parents and doctors began to anticipate a variety of issues common in children with severe neurological impairments. As these children grow larger, it takes more strength to move them and provide basic bodily care, raising the risk of pressure sores from immobility. Precocious puberty is common in children with various forms of severe brain damage. The early appearance of secondary sexual characteristics is often distressing to parents and caretakers. Many parents of severely disabled children explore possible ways to avoid having to deal with menstruation and fertility in a diapered child. A variety of treatments have been used over the last several decades to deal with these issues.

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