Ethical concerns in treating short stature with human growth hormone

Ethics of Human Growth Hormone

Ethics and Human Growth Hormone

Ethics of Human Growth Hormone Treatment

The use of human growth hormone in medical treatment has been successfully implemented in various cases over the past fifty years. This has led to an increase in the usage of this treatment and this in turn has raised a number of moral and ethical issue and problems. There is a general consensus that the growth hormone should be not used in cases where its purpose is purely cosmetic or where the aim of usage is to provide an unfair advantage in sport - although claims in this regard are highly suspect. However, the greatest ethical issue in the use of this treatment is where the prescription of growth hormone is given for those children who do not have a deficiency of the hormone. Related to this is the ethical concern that by promoting human growth hormone treatment where there is no physical deficit, one is in fact 'interfering with nature' as well as possibly promoting societal prejudice and privileging taller over shorter people as being more socially acceptable. On the other hand, there are those who argue that growth hormone treatment is ethically acceptable as it helps to avoid psychological and social problems that may result from societal prejudices towards shorter people.

2. The ethical problems in growth hormone usage

Despite this wide range of applications and therapeutic benefits, the use of growth hormone has been criticized on ethical and moral grounds as a result of what is considered to be the abuse of its proper medical usage in some cases. A central problem that is often noted in terms of the abuse of this treatment is its use in athletics and for bodybuilding. This type of usage is related to unethical practices and is considered to provide an unfair advantage over others. However, despite these assertions there is little if any evidence that growth hormone is actually effective in the athletics and sports environment. (Rennie, 2003)

Another form of usage abuse that raises ethical questions about the way that growth hormones are applied is the use of this hormone in children who are of normal height. Related to this form of abuse linked to ethical issues is the use of growth hormone for cosmetic purpose. The hormone has also been touted by some as effective in reducing the effects of ageing. As one commentator notes, "The quest for a "fountain of youth" is an age old dream, advertisements in print media and on the internet promote the use of human growth hormone or agents touted as increasing human growth hormone levels" (Hintz, 2004).

The above are instances of the practical and ethical abuse of the appropriate and correct usage of the hormone. Unethical usage in this sense is therefore considered as usage that is unnecessary and outside the direct medical parameters of the treatment.

A central issue in the debate on hormone therapy and ethics is the question of whether children should be treated with growth hormones. In an article entitled, Considerations Related to the Use of Recombinant Human Growth Hormone in Children (1997), the authors state that there are certain clinical areas that have raised concern about the ethical aspects of growth hormone treatment in children.

For instance, there is a dispute among pediatricians about the proper diagnostic criteria to determine growth hormone deficiency in children. (Considerations Related to the Use of Recombinant Human Growth Hormone in Children, 1997) This raises a question about when growth hormone treatment is applicable and in which cases it is not. "Pediatricians must address directly whether GH therapy is acceptable for any children who do not fulfill the "classic" description of GH deficiency, and, if so, for which ones" (Considerations Related to the Use of Recombinant Human Growth Hormone in Children, 1997).

There is also a certain amount of concern about the effects of this form of treatment. This refers to the "...present lack of an established risk-benefit ratio for GH therapy" (Considerations Related to the Use of Recombinant Human Growth Hormone in Children, 1997). In other words, there is no definitive consensus about the benefits of this treatment among children. For instance,

It is also unclear whether GH therapy reduces the psychosocial problems that very short children may experience..." (Considerations Related to the Use of Recombinant Human Growth Hormone in Children, 1997). There is even evidence that that in some cases growth hormone therapy actually increases certain problems. This has been found particularly in children, where therapy may actually increase the perception that they have something" wrong " with them. (Considerations Related to the Use of Recombinant Human Growth Hormone in Children, 1997).

The last-mentioned problem refers more directly to a central area of ethical concern. One of the most problematic issues in the rationale for using of growth hormone therapy is the underlying assumption implied by the use of such therapy that short people are somehow " less able " or less valued then taller people. This can be seen as a form of discrimination against shorter people. It therefore follows that the use of growth hormone theory is perceived as in fact a way of promoting this social assumption. This leads to the view that the very use of hormone therapy in some cases is implicitly discriminatory and unethical.

The above debate refers to the rather complex debate about what is considered normal or abnormal in society and to what extent these categories are prejudicial and therefore unethical in terms equality and fairness. This raises questions such as, " if short stature is indeed an appropriate target for medical intervention, at what point is a child "short enough?" Moreover, in this context it is arguably society that needs "treatment," not the people who are now at a disadvantage." (Considerations Related to the Use of Recombinant Human Growth Hormone in Children, 1997)

The above considerations can also be found in other studies that raise the fundamental thorny ethical question of whether the medical profession has the right to alter the course of nature. As Konner (1999) states.

So at the dawn of the age of gene technology, we already faced a decision: Do short children (and their ever-anxious parents) have a "right" to be made taller by hormones even when they have no apparent deficiency or illness when they are short, but "normal"? and, for that matter, is it ethical for physicians to treat them? (Konner, 1999, p. 55)

However in spite of these arguments many doctors in the 1980s began prescribing hormone treatments for children whose short stature was unrelated to any medical problem. By 1996"... such "off-label" use accounted for 40% of human-growth-hormone prescriptions. (Sandel, 2004)

There are many critics who feel that instead of using growth hormone to rectify innate prejudices in the society it is rather the society that should be educated and changed. On the other hand, there are also many in the medical arena who are of the opinion that this view is too radical and essentially unhelpful. Many doctors consider that a strict ethical view of growth hormone treatment would be unreasonable and unfair to the individuals who must bear the burdens of discrimination... It is not easy to dismiss the profound and understandable distress some children experience because they are short. Such children undeniably are disadvantaged by their condition" (Considerations Related to the Use of Recombinant Human Growth Hormone in Children, 1997)

This important ethical debate is also discussed in various other studies. For example, in a study entitled Moral assessment of growth hormone therapy for children with idiopathic short stature (1997) by Verweij and Kortmann, the authors state that one of the greatest ethical dilemmas facing medicine is the prescription of growth hormone treatment for those children who do not have a deficiency of the growth hormone. They ask the question; "Is it morally appropriate to enhance the growth, by means of medical treatment, of a child wish idiopathic short stature? The medical, moral, and philosophical questions in this area are many" (p. 305). This article in fact favors the view that growth hormone treatment is ethically validated when it serves to prevent of psychological and social problems due to short stature.

3. Conclusion

In conclusion and in summary, the effectiveness of growth hormone theory has been seen in the many applications that have emerged for the hormone in the last few decades. These include increasing growth in individuals who lack this particular hormone or who have suffered a depletion of the hormone due to illness. However, there are many other instances in which the hormone is used that lead to various ethical and moral issues.

On the one hand, studies note that the exact outcome and effects of this type of hormone treatment are not adequately known and that this fact in itself becomes and an ethical dilemma. However, the most complex ethical area is the use of this hormone treatment in cases where ether is no innate or medical necessity for its usage.

In these cases, the question is raised as to whether the use of this treatment is not in fact exacerbating and tacitly supporting social prejudice that privileges taller people in society. Many studies however conclude that it is medically ethical to make use of this hormone treatment in cases where lack of stature can lead to psychological and social problems for the individual.