I wish to address, in this post, the issue of Ashley's level of cognition and how it relates to g.a. This is with reference to this previous post where Sara Goering remarks about discussions she had with parents where they "shared stories of how their children had matured in multiple ways...despite the official medical prognosis that they would remain at the cognitive level of a 6-month-old."
I go into some detail about cognition and its relevance to the valuation of human life here. At this juncture, I am more interested in talking about the certainty with which doctors make their prognoses about the cognitive level of children with severe, multiple physical challenges.
In the AJOB rejoinder "Growth Attenuation: Good Intentions, Bad Decision by Adrienne Asch and Anna Stubblefield, (AJOB 10(1):46-48, 2010), you can read the following:
Diekema and Fost's calculations underestimate the risk that Ashley may be more self-aware than they presume. When a child does not have access to a means of verbal communication and when her mobilty is severely impaired such that she may not be able to point clearly or manipulate objects, it is impossible to accurately determine her cognitive abilities. (p.47)
Precisely. More damning is the fact that both Fost and Diekema feel that g.a. would be inappropriate for children with "normal" cognitive function.
Diekema and Fost do not recommend growth attenuation for non-ambulatory children with typical cognitive development because, for these children the benefits would be outweighed by psychosocial disadvantages. (p.47)
OK...so Fost and Diekema would not do g.a. on a child with "normal" (or one could assume fairly "high") cognitive abilities but they insist that they are absolutely correct in theirs and others' assessment of Ashley's abilities:
We concede that certainty can never be achieved in medicine, but the issue about which they are concerned is not in dispute among any of the professionals who have evaluated Ashley. (Ashley Revisited: A Response to the Peer Commentaries, AJOB, 10(1): W4-W6, 2010, p.W4)
This said in spite of the fact that there's a fairly long history of underestimating the cognitive abilities of disabled people in general (which Asch and Stubblefield point out on p.47).
The arrogance of this position is mind-boggling. It is logically untenable. If an individual cannot willfully move themselves, it is impossible for them to communicate their cognitive abilities. Furthermore, the concept of cognition as static and never open to change or growth is equally nonsensical (consider the most recent developments in neuroplasticity). Brain scans are unreliable methods of assessing cognition as well. This I know from personal experience. Consider the fact that, based on my daughter's MRI results taken in the first hours after her stroke, the technician's report was to "harvest her organs". Consider the fact that a number of neurosurgeons and a neurologist...those wonderful experts...asserted that my daughter was brain dead. Consider the fact that, just under 10 years later (and obviously still alive), with CT scans that show her frontal lobe is fundamentally dead, my daughter is able to talk, write, read and respond fully to her environment. What of those expert opinions?
Of course, the fact of the matter is that, cognition or no cognition, g.a. is wrong, and Asch and Stubblefield say as much. Given the fact that the two good doctors oppose g.a. for normally cognitive children, however, and given the fact that individuals more qualified than they are have made serious errors in their assessments of cognition in the distant and recent past, g.a. shouldn't be carried out especially on children like Ashley. The margin of error is too great.