Current Uses and Practices for Growth Attenuation Therapy: A Literature Review

Hailey VanRonzelen – OMS-IV, MA Bioethics Candidate, Bioethics, Kansas City University College of Osteopathic Medicine; Ryan Pferdehirt, HEC-C – Vice President of Ethics Services, Center for Practical Bioethics. Assistant Professor of Bioethics, Bioethics, Kansas City University

Abstract: Growth attenuation therapy (GAT), one aspect of the “Ashley Treatment,” entered into the public knowledge after its use on a severely disabled girl in Seattle in 2006. The patient, known as “Ashley”, underwent a mastectomy, hysterectomy, and high-dose estrogen in order to maintain her small size and ensure long term care in her parents home. Upon announcement of this therapy, bioethicists from all over the globe weighed in with opinions and concerns. It has been nearly 20 years since the discussion began and other patients started to receive treatment. But what is the common best practices or current moral standing of the treatment? The goal of this paper is to bring knowledge on the current uses of Growth Attenuation Therapy. This was accomplished by a comprehensive review of the literature to discover current beliefs on GAT and how often it was being practiced. Overall, similar opinions on the treatment are still being used today. However, pediatric endocrinologists and the American Pediatrics Association both support the use in severely disabled children. There is no concrete evidence on the number of hormonal, or hormonal and surgical, growth attenuation patients are present in the world at this time. We recommend having a holistic approach with each patient and family who is eligible and asking for GAT and only using ethical consults when major concerns arise.

Keywords: Growth Attenuation Therapy, Ashley Treatment, Pediatric Endocrinology