Ethics for the Pediatrician: The Persuasion of Enhancements in Pediatrics

Abstract

1. Ferdinand D. Yates Jr, MD, MA* 1. *Clinical Associate Professor of Pediatrics, State University of New York at Buffalo, NY. Is there anything wrong with wanting to be more alert in a school class or to do better on an entrance examination? What about having better concentration on the balance beam or greater muscle mass for a wrestling match? What about the parent who wants his average-size basketball-playing son to be 3 inches taller? Most pediatrics patients want to do well and to succeed, and their parents are generally supportive of such desire. Should we, as physicians, be complicit with their goals, and if so, to what extent do we participate? This treatise highlights some of the foundational ethical principles regarding the use of enhancements in the pediatric population, specifically the use of growth hormone (GH) as a height enhancer, as well as some of the unrealized technologies that are on the horizon. Reflective consideration of the use of enhancements must guide not only current therapeutic options, but also future possibilities. One of the core considerations in the use of the term “enhancement” is the actual purpose of the enhancement. Is the enhancement to be therapeutic or nontherapeutic? Is the enhancement designed to replace what no longer functions well or is it designed to exceed the initial limitations? Is the enhancement to make a person well or perhaps even better than well? Among the many examples of medications that enhance are: GH in short children, erythropoietin for the increased production of red blood cells, propranolol for lowering blood pressure and inducing bradycardia, steroids in asthma, and modafinil for narcolepsy. Each of these medications, and others, has legitimate medical applications, but an ethically problematic situation arises as medications are used off-label for unapproved …