Human growth hormone (HGH) is one among the many hormones your body naturally produces. HGH influences growth in that it helps encourage cell reproduction and regeneration. Athletes really like to pretend that HGH makes them more powerful. It might, but it probably doesn’t. Whether it works or not, athletes should be allowed to utilize it. But banning performance enhancers is a topic already covered, so let’s look at something more interesting.
As part of a thread called “The Bias Against Short Men,” Andrew Sullivan’s The Dish published an email by a reader struggling with a difficult question:
The doctor noticed that my son was comfortably sitting at the bottom of the growth chart and that he would most likely end up a measly 5’5” (a little more than my wife and myself). He went on to say that this could qualify as “idiopathic short stature syndrom.” And that we could potentially get our son on HGH (actually, it’s called rGH I think – see here) if we felt that his projected short height could affect his self-confidence and ultimately, his mental health.
Unlike HGH in athletes, HGH used to treat medical conditions has clinically observable benefits. A child given HGH treatments will have an appreciable difference in height as an adult. The reader feels inclined to give his son the treatments, while the reader’s wife is appalled at the idea. When is it alright to use HGH to help your kid grow to a “normal” height? If you do “treat” a child’s shortness, does that mean it’s a disease?
Crack open any text on bioethics and I can almost guarantee that the “is shortness a disability” example will be somewhere among the pages. Shortness (and deafness, which The Dish is also exploring at the moment) sits right in the blurry space among disability, disease, and normal. How short is “too short?” Why is 5’2″ too short for a man, but not a woman? The answer is pretty much: because we think it is. Human height does fall along a bell curve, but it varies around the world and throughout history. Yet, at some point, being short goes from a relative and descriptive term (e.g. I am shorter than Yao Ming) to a normative one implying a disability.
We might think something is a disability for a few possible reasons. The first is that there is a clear physical issue that prevents events self-care. An example of this might be total-body paralysis. That person is literally unable to care for him or herself.
The second is that a person’s physical attributes allow them to care for themselves, but make it difficult to exist in a society set up for people abled in a different way. A good example of this is that those in wheelchairs are perfectly able to do everything a non-wheelchair bound person can do, it’s just that most things are designed with those who walk in mind. Arthur C. Clark’s Childhood’s End has a race of intelligent aliens that are winged. As a result their buildings have doors wherever they are convenient – as it so happens, ground level is rarely convenient. Stairs are unnecessary. Thus, a person who would be normal among human buildings is utterly disabled and helpless among the world of Clark’s winged aliens. Because most people are enabled in one way, those enabled in another become disabled due to the way things are built and designed.
Finally, and most confusing, are social disabilities. These are disabilities that are a result of the advance of civilization. Think of it this way. Today, we’d consider illiteracy a disability. It prevents a person from learning, pursuing most careers, and significantly lowers quality of life. Imagine trying to use the internet without being able to read or write. For our prehistoric ancestors on the savanna, no one could read, yet we’d hardly describe any of them as disabled. Social or civilizational disabilities are the result of cultural demands not necessarily health related.
Shortness (and deafness) move between those last two definitions if they are considered a disability at all. It’s critical to recognize that changes in social conventions and the way we design products and facilities can actually change what is a disability. Also, technologies that enable a person to do something which he or she was previously unable to do can dissolve the category of disability.
Which brings us back to the question of the Dish reader and his son. The son is short because the reader and his wife are short – genetics 101. Neither the father nor the mother consider themselves disabled, and the son is projected to be taller than his parents. Yet being tall can confer a huge social advantage. Heterosexual women tend to prefer taller men and taller people get bigger paychecks. On the other hand, the other side of the bell curve, too tall, is not much fun either. Taller folks are often crammed into cars and plane seats designed for a general population that needs less space. Additionally, excessive growth often has associated medical issues.
On issues such as this, I tend to defer to personal liberty and the discretion of the parents. The reader is clearly not taking the choice lightly. He sees both his wife’s concern and the doctor’s suggestion to use HGH as legitimate. He is considering letting his son get a bit older, so that his son can at least make something of a choice regarding the HGH injections. The relevant question isn’t “is shortness a disability we should treat with HGH” but, “would making a child who will likely be short a bit taller improve that child’s overall quality of life?” The question is complex and unique to each child, but if investigated earnestly and carefully, I see no reason why increasing a healthy child’s height would be wrong.
Image of frightening vegetable holding ruler to measure height by hoyasmeg via Flickr Creative Commons