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From correspondents in New York
November 02, 2006 10:33am
Article from: AAP
IN a controversial treatment, doctors in the US have given a severely disabled child drugs to keep her small and 'manageable' for her parents.
In a report published in a medical journal this month, the doctors described a six-year-old girl with profound, irreversible developmental disability who was given high doses of estrogen to permanently halt her growth so that her parents could continue to care for her at home.
The controversial growth-attenuation treatment, which included hysterectomy, was requested by the child's parents and initiated after careful consultation and review by an ethics committee.
In their report in the Archives of Pediatrics and Adolescent Medicine, doctors Daniel F. Gunther and Douglas S. Diekema, both at the University of Washington in Seattle, explained the reasoning behind what they hoped would generate healthy debate.
Dr Gunther is at the Division of Pediatric Endocrinology, and Dr Diekema is at the Centre for Pediatric Bioethics.
Caring for children with profound developmental disabilities could be difficult and demanding, they said.
For children with severe combined neurologic and cognitive impairment who are unable to move without assistance, all the necessities of life – dressing, bathing, transporting – must be provided by caregivers, usually parents, and these tasks become increasing difficult, if not impossible, as the child increases in size.
"Achieving permanent growth attenuation while the child is still young and of manageable size would remove one of the major obstacles to family care and might extend the time that parents with the ability, resources, and inclination to care for their child at home might be able to do so," the doctors wrote.
The parents of the six-year-old, both of whom were university-educated professionals, indicated a strong desire to continue caring for their daughter.
Despite having the neurologic development no greater than that of an infant, the six-year-old responded to her parents and two healthy siblings – vocalising and smiling in response to care and affection – and "clearly is an integral, and much loved, member of the family," the authors said.
After extensive evaluation, the combined opinion of a team of specialists was that the child would have no significant neurologic or cognitive improvements.
The onset of puberty and continued growth caused concern in the parents about how they would care for their daughter long-term, which they clearly wanted to do.
They were concerned about having to turn over care to "strangers" and also about the complications that would arise when the child started menstruating.
The child was now a little more than a year into growth-attenuating therapy and approaching the end of her growth, Dr Gunther and Dr Diekema reported.
"As of yet, there have been no treatment complications."
The authors felt that growth-arresting therapy could be "both ethical and feasible and should be an option available to parents."
The authors of a commentary applauded the pair for publishing this case report, although they believed that attempts to attenuate growth were "ill-advised."
Nonetheless, Dr Jeffrey P. Brosco from the University of Miami and Dr Chris Feudtner from the University of Pennsylvania, Philadelphia, said that by beginning the debate, the paper helped to "advance our ethical dialogue as we struggle to define our core values in words, laws, and deeds.
"Only with further research and public discussion will we learn whether attempts to attenuate growth run with or against our fundamental values in caring for children with profound developmental disabilities," he said.