Kudos, and a Correction

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). The humility and openness of the authors is in sharp contrast to the dogmatic rancor that characterized much of the debate—I will not call it a discussion—at the time.

There is one factual error in the article to note: Seattle Children's Hospital did not "agree to obtain a court order prior to any future medical interventions to attenuate growth in children with developmental disabilities" (emphasis added). Instead, we agreed that we would not provide such interventions unless we had "received a valid order from a court of competent jurisdiction, not subject to appeal, authorizing such intervention in a given specific case" (from the Agreement between Children's Hospital and Regional Medical Center and Washington Protection and Advocacy System [Disability Rights Washington], at paragraph 2, emphasis added).

There's a difference. 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. That responsibility rests with the parents or legal guardians of the child whose growth may be limited, not the hospital. Our role is to require such an order before proceeding, and to make sure that it is final, valid, binding, and not subject to appeal.

To the best of my knowledge, no parent has sought such an order. No one knows what a court will do when considering a petition to permit growth attenuation: will the court deny that it has jurisdiction? Defer to the parents as the guardians of the child? Deny the petition as an abuse of human rights and dignity? The article paints the considerations in such a case vividly and well. Who knows how a court will respond?