Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We present an ethical dilemma in patient care; you vote on your decision in the case. Next week, we'll reveal how you all made the call. And stay tuned -- bioethicist Jacob M. Appel, MD, JD, will weigh in next week with an ethical framework to help you learn and prepare.
The following case is from Appel's new book, .
Clifford and Carla have a 6-year-old daughter, Charity, who suffers from profound intellectual disabilities. She cannot speak, walk, or hold her head upright and has the cognitive skills of a 4-month-old baby.
Clifford and Carla are loving parents -- they have four other children -- and they are determined to care for their disabled daughter at home and to integrate her into their family. Yet they are concerned that as she grows, she will prove too difficult to manage.
Specifically, they are worried that they will no longer be able to carry her around the house or transport her easily on family events, such as picnics and outings to the aquarium. They are also concerned that when she reaches puberty, she might become an easy target for sexual abuse.
To protect their daughter, Carla and Clifford seek hormonal therapy that will close the growth plates in her bones, ensuring that she will permanently have the body of a 6-year-old child. They also wish to put her on a hormonal regimen that will prevent puberty.
Leave comments using the tool below to explain your decision and discuss the dilemma further! And please send in ethical dilemmas you've faced to for possible inclusion in a future Ethics Consult edition.
It should be obvious, but we'll say it anyway -- this is not to be construed in any way as legal or medical advice.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board for Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College. Appel is the author of the book, .