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The Pediatric Forum
April 2007

Growth Attenuation by Commission and Omission May Be Ethically Justifiable in Children With Profound Disabilities

Arch Pediatr Adolesc Med. 2007;161(4):418. doi:10.1001/archpedi.161.4.418-a

Gunther and Diekema1 present a unique case report of a child with profound disabilities whose parents requested an active intervention to arrest growth to facilitate caregiving at home. More common is a child with profound disabilities whose annual growth rate is subnormal. In an otherwise healthy child, a workup would include growth hormone (GH) function studies, whereas with this child, the parents and physicians may choose not to test for GH function. In fact, I would argue that it is ethical for the physician to not even suggest a GH workup in this setting. It is not in the child's interest to undergo daily injections to attain larger stature both because of the child's inability to understand the need for the injections and the low likelihood of benefiting from the increased growth. If GH deficiency testing is offered by a physician, one could argue that the parents should refuse the intervention because of the lack of benefit to this child and because the smaller size may facilitate the parents' ability to care for their child.

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