To the Editor: In the November-December 2010 issue, the Seattle Growth Attenuation and Ethics Working Group ("Navigating Growth Attenuation in Children with Profound Disabilities") analyzed the arguments for and against growth attenuation in children with permanent, profound intellectual disabilities and identified conditions under which its use may be ethically acceptable.
The group focused on growth attenuation rather than on the broader "Ashley Treatment," which also included a hysterectomy and breast bud removal.
The treatment included growth attenuation
via estrogen therapy, hysterectomy, and bilateral breast bud removal.
In some cases when binding capacity exceeds 2 mg/L, growth attenuation
has been described.
As is common with protein therapeutics, antibodies to the protein complex were detected in most patients, but were not associated with growth attenuation
or adverse effects.
To the Editor: As the lawyer representing the hospital involved in the Ashley case, I write to offer my profound thanks to the Seattle Growth Attenuation and Ethics Working Group for their thorough, thoughtful, balanced, and considerate analysis in "Navigating Growth Attenuation in Children with Profound Disabilities" (Nov-Dec 2010).
We recognized that as a hospital that stood to benefit financially from approval of growth attenuation treatment, we had an irreducible conflict of interest that made it improper for the hospital to seek court approval for the care.
I was invited to join the Seattle Growth Attenuation and Ethics Working Group--collective author of the lead article in this issue of the Report--but I begged off, claiming I had too many other things on my plate.
As a person who has long advocated on behalf of people actively made disabled by charitable pediatric attempts to make them more normal, I breathed a sigh of relief when reading the group's recommendation that growth attenuation be registered and studied in a way that could provide meaningful outcomes data for those considering the treatment.
1) The article also offered an ethical justification for growth attenuation, as this kind of intervention is known: it would let her parents lift and move her more easily, which the parents believed would allow her to participate in more social and recreational activities and would help them with routine activities like dressing and changing her diapers.
In January 2007, the girl's parents posted a justification of growth attenuation on their blog and suggested that the "Ashley Treatment," as they called it--which also included surgical removal of her uterus and breast buds--should be considered by other families.
stimulates worries within the context of these social policies and attitudes.