title: Managing ethically questionable parental requests: growth suppression and manipulation of puberty.
abstract: Doctors sometimes struggle with ethically challenging requests for treatment from children's parents. For instance, we have recently had two requests by parents of children, a girl and a boy, each with a severe developmental disability, for hormonal therapy to suppress growth and puberty: the girl's parents requested, in addition, hysterectomy and mastectomy. We propose a reliable approach to assessing the ethical and legal aspects of these and other requests for 'non-therapeutic' treatment of a minor who lacks the capacity to give informed consent. We argue that a doctor should first assess whether the request is one that he or she can, in conscience, accede to, and then, if it is, seek the authorisation of a court. We outline considerations relevant to the doctor's assessment of both the ethical issues and to the need for court authorisation.
authors.affiliation: Clinical Ethics Advisory Committee, Children's Hospital at Westmead, Westmead, University of Sydney, Australia. davidi@chw.edu.au
authors.forename: David
authors.initials: D
authors.lastname: Isaacs
authors.forename: Bernadette
authors.initials: B
authors.lastname: Tobin
authors.forename: Julie
authors.initials: J
authors.lastname: Hamblin
authors.forename: Emma
authors.initials: E
authors.lastname: Slaytor
authors.forename: Kim C
authors.initials: KC
authors.lastname: Donaghue
authors.forename: Craig
authors.initials: C
authors.lastname: Munns
authors.forename: Henry A
authors.initials: HA
authors.lastname: Kilham
mesh_terms: D001315:Australia; D002648:Child; D002669:Child Welfare / Q000941:ethics* / Q000331:legislation & jurisprudence*; D019988:Children with Disabilities / Q000331:legislation & jurisprudence*; D005260:Female; D006128:Growth; D006728:Hormones / Q000008:administration & dosage*; D006801:Humans; D008607:Intellectual Disability; D008297:Male; D033282:Parental Consent / Q000941:ethics / Q000331:legislation & jurisprudence; D010372:Pediatrics / Q000941:ethics / Q000331:legislation & jurisprudence; D011627:Puberty
chemical_list: D006728:Hormones