Saturday, November 20, 2010

The Best for Last

The most exceptional piece of writing and argument against g.a. comes from this article, "Discrimination against Children with Cognitive Impairments?" by

Friday, November 19, 2010

Infamous quotes by Norman Fost

The Hastings report includes an article by Norman Fost, a behind the scenes man strongly influencing the Ashley debates...PRO g.a.. He is supremely arrogant, believing that doctors and hospitals should be above any sort of "third party influence" when making medical decisions.

I think the best thing to do when it comes to Fost, is to let him speak for himself. You will see what sort of a man he is and then you can make up your own mind. I am including quotes from both the article in the Hastings report "Offense to third Parties?"
The Hasting Center Report > November-December 2010 (volume 40, number 6) and from another document by Christopher Mims, "The Ashley Case, Three Bioethicists Weigh In". This was done via email on January 5, 2007.

Here are a few golden nuggets from the email exchange:

Joel Frader, agreeing with Brosco and Feudtner, says that the measures used to limit her growth "miss the point," which is the lack of social support which might allow the family to care for her at home even if she grew to normal adult size; e.g., by providing mechanical devices to assist in lifting her. I must day I think this misses the point, which is to try to maximize Ashley's interests, or more precisely, to maximize the ratio of benefit to burden. (emphasis mine)

(The life of a child is boiled down to a benefit to burden ratio)

I also agree with the father's observation that having her size be more appropriate to her developmental level will make her less of a "freak" (my word, not his). I have long thought that part of the discomfort we feel in looking at profoundly retarded adults is the aesthetic disconnect between their developmental status and their bodies. There is nothing repulsive about a 2 month old infant, despite its limited cognitive, motor, and social skills. But when the 2 month baby is put into a 20 year old body, the disconnect is jarring.

(need I say more?)

It reminds of the scandal some years ago when it was discovered that some Cadillacs had Chevrolet engines. The owners hadn't noticed the problem until it was brought it to their attention. If children like Ashley could magically retain the appearance of an infant, they would not only be easier to care for in the physical sense, but the emotional reaction to them would probably be more favorable. This, of course, may be more of a problem for strangers than the parents, who seem wonderfully attached to her, with little difficulty seeing her as a beautiful, radiant, contributing member of their family.

(Again, the quote is appalling, but notice how surprised he seems about the parents being "wonderfully attached" to their daughter, etc.)

It's helpful to note the father's primary reason for removing her uterus: she doesn't need it. Since it's only purpose is procreation, which will clearly not be in her interest, it presents her with risks and burdens and no benefits.

(Under this rationale, Ashley neither needs her teeth, her legs nor her arms.)

The detailed account of the medical basis for the decisions in Ashley's case, as well as the careful ethical reasoning that they relied on, are well documented in the article by Gunther and Diekema, and the father's extraordinary detailed account of how and why they came to their conclusions. Whatever disagreements critics may have, it is not possible to say this decision was made casually or quickly, without careful consideration of the relevant facts and arguments.

(There were no disability advocates on this committee.)

From the Hasting's article:

That said, I believe too much deference has been given to the claims of third parties that their interests or preferences should be taken into account when individual families, in consultation with their physicians, are contemplating growth attenuation for children similar to Ashley.

(Here, Dr. Fost is talking about disability advocates and the LAW, which prohibits the sterilization of the disabled, without their consent.)

With the help of a federally authorized advocacy group with remarkable powers to subpoena hospital records, those who were offended by Ashley’s treatment succeeded in pressuring the hospital to prohibit its physicians from offering similar treatment to future patients without court approval.

(Again, this is the law...and the "advocacy group" WPAS, Washington Protection and Advocacy System, now Disability Rights Washington, pointed out the legal matters involved in Ashley's strerilization. I believe it is Fost that is offended here.)

This remarkable intrusion into private medical decisions lacks any plausible claim of harm to third parties other than emotional distress on becoming aware that one’s moral or political views are not shared by everyone. By this criterion, parents seeking cochlear implants for a deaf child, surgical correction of club feet or scoliosis, or a do-not-resuscitate order for a terminally ill child should be reminded that their decisions may be offensive to others and should be given literature on the reasons for the disagreement. Worse, many of those who opposed Ashley’s treatment argue that other treatments that involve changing the body should be prohibited without prior court approval.

(Do I need to say anything here, really?)

The report states that (disability advocates') “concerns and perspectives . . . should be considered during the decision-making process” by providing parents with “information summarizing arguments for and against this controversial intervention, or offering them copies of relevant publications.”

(Fost is opposed to this...he believes that it is possible to make an informed decision with a hospital ethics committee, a doctor and parents...none of whom have any understanding of disability. Remember, the medical community once "informed" parents that institutionalization, lobotomies, and enforced sterilization on their disabled children were the only, viable ways of dealing with them.)

Thursday, November 18, 2010

Will technology help us avoid more Ashley X's?

I read an interesting post over at the Bloom site. "Technology: Hype or Hope". I, for one, think technology brings a great deal of hope! Here's one little excerpt...

What do you think about the hype around technology?

Karen Castelane: When I think about hype I think of the positives. It grabs the attention of the general public, stops them in their tracks and makes them take note. It motivates scientists to work in this field, and donors to donate, and gives hope to parents and therapists. It shows that this population has value and endorses the notion that communication is a right for all. When I think of negatives, hype can backfire when we don’t have quick results and the technology doesn’t live up to expectations. (emphasis mine)

What a great point, Ms. Castelane!

When I read about all the wonderful technology that is out there, I wonder about all the children who are "locked in"...minds that function, bodies that don't...and how some of these technologies may help to "unlock" them. Then I think about how this will affect proponents of the Ashley "treatment".

Those who promote g.a. also promote outdated concepts of "static brains" that will never change. They talk about children who have "the mentality" of babies and that it is not possible for any progression to be made. They are peddling falsehoods like the snake-oil salesmen of old...and parents are buying into it and are irreversibly altering their children's bodies based on these lies.

Brains CAN change and grow and develop. In the severely disabled, they may not do so "typically", but they do change. Parents with severely disabled adults will almost always attest to this fact. It remains difficult to impossible, however, to really know just how much these people understand, when they cannot do even the slightest movement consistently with their bodies.

Now, we have technology (changing and improving at lightning speed) that may be able to unlock the potential for communication in our severely disabled population. Yes, it won't work for every one, every time, but will it work more often than not?

What will doctors tell parents about g.a. then? Will they continue to spew the old party line that their children will never change and that, in the end, they won't know what is being done to them, so it's okay? Or will they have to change their tunes, given that a child could be assessed for communication ability with new technology? Proponents of g.a. want parents to start the protocols as early as possible...counselling for it by the child's third birthday. Does that allow enough time for a child's brain to develop sufficiently to be outfitted with the new technologies? How will parents feel, then, to have so drastically affected their children's physical selves if, in years hence, they discover their children are able to communicate?

I can only hope that new technology, made readily available to the severely disabled an their parents, will make g.a. a dinosaur concept promoted only by dinosaurs in medicine.

Wednesday, November 17, 2010

Another Hasting article addressed

I will be commenting now on another article of the Hastings Centre report. This one is entitled "Against Fixing a Child--A Parent's View" by Sue Swenson (The Hasting Center Report > November-December 2010 (volume 40, number 6).

Obviously, this piece is more in tune with my views as it is opposed to the Ashley "treatment".

It is difficult to care for a son who is legally blind, quadriplegic, nonverbal, autistic, profoundly intellectually disabled, prone to seizures and sleep disturbances, six feet tall, and 190 pounds.

Indeed. Swenson sets the tone right away: she knows what this is all about, caring for a severely disabled child. This deflects typical criticism from those in support of g.a. that those of us who stand against it "don't know what it's like."

Though I had to read this piece a number of times to really get its focus, I think, in the end, Swenson succeeds in making her point most clear: community supports that assist in families in caring for high needs children allow for these individuals to live full, satisfying lives, as they are. Community supports allow for our children's human rights to be honoured by valuing them as people...people who are part of the community.

Family support—services whose aim is to help families nurture and enjoy their disabled child at home—helped us learn to let go and gave us information about raising a severely disabled child: how to position him so he could participate in a broad range of activities, how to transfer him without lifting, how to support his mobility and find useful equipment, how to include him in everything, how to figure out what he wanted, how to think about his rights.

Swenson is also quick to establish her view when it comes to the role of parents in decision making for their children:

Growth attenuation should be out of bounds unless it treats an underlying disorder. The human rights of the child as a person with disability should limit parental rights

Do I know what my child wants or will want?
Is there a supported decision-making process that gives me more to go on than my own interpretations? Who is protecting my child’s rights? Decisions that are made behind a parental privacy shield can be too easy for our own good.

I could not agree more. Gaining this perspective can be a difficult one for parents, however, when it is intended that g.a. be offered as an "option" to them when their children are as young as three years old. I might add that, it is not only the "parental privacy shield" that is of concern, but the "medical shield", that is, the very strong influence medical practionners have on parents who often feel overwhelmed with their childrens' issues, and have not yet had the chance to explore perspectives from outside the doctors biases.

Though I am happy to read anything from anyone that opposes g.a., there were a few areas where I felt the issues being presented were significantly unclear. In the following paragraph, Swenson describes her 28 year old son's living situation:

Home- and community-based supports are services offered to adults in places other than a family home, as the person’s needs and the family’s situation (and age) dictate. Last month, Charlie moved to a house (not a group home) with two roommates and staff. His community support workers are great. They support him; they do not control him. They are well trained, well supervised, and well managed. They are dedicated, friendly, and respectful.

Let me say that Swenson's son is lucky indeed! Would that such supports existed everywhere. One almost gets the impression that she takes this for granted. If this were indeed the case for most parents, I think the entire g.a. debate would be moot. It is possible, however, that she is simply emphasizing this point with personal experience: services like these make it possible for children with severe disabilities to live fully and happily without being subjected to drastic and unncessary physical alterations. SERVICES are THE answer to the "problems" perceived by those who would support g.a.

Another point that I had to mull over from Swenson's article is one of the questions she directs parents to ask themselves before making decisions that will affect their child's future.

What would I do if my child did not have disabilities?
Parents (and physicians) of children with disabilities do not always understand disability policy and culture. Interventions such as growth attenuation that are allowed only when a person has profound intellectual disabilities are especially difficult to justify.

Whereas I certainly understand and agree with the answer to the question, I didn't quite actually get the question itself at first. I mean, the fact is, you are in a dilemma precisely because your child is disabled. Life takes on an entirely new direction than the "standard". I suspect, though, that she is once again, pointing out a perspective about human rights: would you do this to a "normal" child? Why would you do it to a disabled child? What is it about disability that leads us to believe that we are allowed to compromise a child's physical integrity, thus violating their human rights? An excellent point.

Swenson's last q and a...

Am I driven by my own pride or ego? We are often put on the defensive about our sons’ and daughters’ dependence on public support. But support of vulnerable people is almost always recognized as a legitimate activity of government. It is easier to overcome the shame of public dependence when you try to be public-spirited. Disabled people, too, can live simply so that others may simply live.

I have to admit that there have been times when I felt uncomfortable with the fact that the world seemed to have to bend over backward to accommodate my child's very expensive needs. Swenson has a legitimate point to make here. I'm not entirely satisfied with the answer...and I really don't understand the last line at all. Perhaps someone could clarify it for me.

In any case, I am happy that Swenson stepped up to stand against the so-called Ashley "treatment", in support of the human rights of the severely disabled.

Friday, November 12, 2010

There are several Ashley "treatment" articles in the Hastings Centre's most recent report. Many are free to view with a simple registration. Go for it if you are interested. Each piece is short and fairly easy to read. You can come to your own conclusions. I will be commenting on each piece in the following posts.

First: "In Support of the Ashley Treatment--A Parent's View" by Sandy Walker.
The Hasting Center Report > November-December 2010 (volume 40, number 6)

This article is weak in a number of areas. I am surprised that it passed muster from the Hastings Centre.

Basically, Walker's piece takes position that, because her daughter is growing, the family can no longer do the things they once did.

We are no longer able to take her out to many of her favorite places and activities, and our ability to travel with her—by car or air—has also been limited. Until she was around four feet tall, she used to be able to ride on her father’s shoulders. This allowed her passage to many places where it was difficult to carry her or to take the chair: the beach, through the snow for that wild sled ride down the hill, and even up the stairs of our friends’ inaccessible homes. At her present size, this is no longer possible.

Walker adds that, with the development of knee flexion contractures,

She can no longer assist with transfers, stand or dance with Barney in front of the television, jump on the trampoline, zoom down the slide, or be supported in the swing at the local park. Getting her in and out of the pool is also no longer possible for me.

There is also a reference to spasticity:

Diaper changes and positional changes at night also cannot be managed by a lift, and they, too, have become increasingly difficult with her increased size and spasticity.

Before I address the first point, let me point out here that the mention of contractures and increased spasticity in this article provide considerable distraction from the issue at hand. There is no evidence, scientific or even anecdotal, that growth attenuation can prevent or even minimize the presence of contractures or mitigate spasticity in the disabled population. Yet this is directly implied in the piece.
It is important that these sorts of diversionary tactics don't get tossed into the mix when discussing g.a. G.A. does one thing and one thing only: it attenuates growth. All other perceived benefits are speculative. Long term studies from a significant population of growth attenuated children will need be carried out before any claims beyond the effect on physical size can be made.

Another thing that is unclear here, is Jessica's level of ability. Apparently, prior to the leg contractures, the child could "stand or dance in front of the television" and "jump on a trampoline." This implies the child had use of her legs...enough to dance and jump! One gets the impression that,
in a fit of 20/20 hindsight, Walker would have attenuated her child's growth, yet her child was not a candidate for growth attenuation in the first place. The powers that be, in their wisdom, felt that only those children who are non-ambulatory would be "eligible".

Our analysis suggests that growth attenuation is an innovative and sufficiently safe therapy that offers the possibility of an improved quality of life for nonambulatory children with profound cognitive disability and their families. (emphasis mine) ("Growth-Attenuation Therapy: Principles for Practice", Pediatrics magazine, June 2009)

What you are seeing here is the slippery slope in the making. It begins with non-ambulatory children, then progresses to children who might become non-ambulatory based on past experiences with other children or based on the "typical progression" of a child's condition?

In returning to the main point...that the child's size is affecting her ability to do things she once did...Walker is quick to make the following assessment:

These are problems that no amount of resources could solve. And in reality, not only are these “resources” not readily available, but many of them do not work for a child like Jessica. Those who call for “more resources” to solve these problems do not fully understand my daughter’s needs or my desire not only to keep Jessica comfortable and healthy, but also to save her from boredom and seclusion.

It is true that resources for the disabled are not readily available everywhere, but to dismiss the idea out of hand is ludicrous. In our city of under 400,000, there is more than one accessible pool, more than one Snoezelen room, accessible buses, plus paratransit,
a children's centre that caters specifically to the disabled population, accessible playgrounds, good school programs, a children's museum that is fully accessible and a host of other places to take a child with significant challenges. In the small town of 26,000 in which I lived previously, there were still quite a few services....some buses were accessible, but there was always para-transit, there were many accessible playgrounds, there was one Snoezelen room, one accessible pool, and another in a small town 20 minutes away, schools, by law, all had programs to suit disabled children. So, when Walker categorically states that "no amount of services" will "save her (daughter) from boredom and seclusion", she is, quite simply, wrong. Her child's size may force change to the activities that she once did, but it is not a wholesale prescription for "boredom and seclusion". Friends whose homes are inaccessible may be friends enough to make their homes accessible or friends enough to meet elsewhere with the family. There may be no more zooms down slides, but zooms down ramps. There may be dancing in the wheelchair. There may be no more supported rides on swings, but, the creation of a swing that holds the chair...something most service clubs are only too happy to build. Change comes to all families. To expect to keep everything the same via growth attenuation is unrealistic, to say the least. It doesn't give the child any chance for growth and alternative stimulation either. Really, does even a disabled child want to do the same thing for the rest of her life?

Walker also refers to "parents' aging bodies" being an issue with caring for Jessica. As she gets bigger, it gets more difficult to lift and move her. I do not doubt this. Proponents of g.a., then, like to see themselves as true visionaries, being proactive in planning for the future of their children at home, which is where they are expected to be cared for, forever, that time-span being particularly ill-defined. Unfortunately, such short-sighted naivete serves no one in the long run. It has obviously never occurred to Walker that her own life situation may change significantly in the blink of an eye, precluding her from taking care of her child at any size. She or her husband may themselves become disabled or incapacitated in some way. There may be divorce, financial ruin, death. Even more basically, an 80 year-old parent is no more likely to be able to lift a small child than a larger child. In truth then, proponents of g.a. have their heads in the sand about disabled children's futures. To freeze the child into a small size does not freeze the inexorable marching of time and the unknown that unfolds in it's wake. The future must be addressed: who will care for my child should I no longer be able to?

This begs the question of services once again: home care, respite, nursing, appropriate housing outside of the home. These are things all parents should avail themselves of or work hard to create in their communities. You do it for your child's future best interests. You do it for yourself, as a caregiver, to give you the space you need to carry on with the daily tasks of living with a child that requires full-on care. Growth attenuation does in no way guarantee a particular sort of future for any child.

Toward the conclusion of the article, Walker mentions "the disability community", and
how she felt "disenfranchised by the very organizations and individuals that were put into place to protect Jessica and our family."

I also found that many of those speaking out against growth attenuation did not understand the enormous physical implications and limitations of children as involved as Jessica.

I will be the first to agree with Walker that disability activists have done a poor job of reaching out to and trying to understand the issues that face families caring for severely, multiply challenged children. There are a number of reasons for this, this being beyond the scope of discussion here. Suffice it to say that, as a parent with a child who is severely disabled physically, cognitively and is medically fragile, I know that those advocates in the disability community have rarely been in tune with mine and my child's reality when it comes to our day to day lives.

However, a significant distinction must be made here. They don't get our day to day, but they do understand the long term societal implications of a "treatment" like that put forward by Ashley's parents and her doctors. Here, the shoe is on the other foot; most doctors and many parents new to the disability game are unaware of the long and terrible history of the treatment of the disabled in society.
Things that were once thought to be "good for the disabled" like automatic institutionalization and forced sterilization, are only now, in retrospect, understood to be the horrors that they were. Much was done to those with disabled bodies and minds in the name of doing what was best for them...much of it nothing more than abominations. Disability advocates, when it comes to growth attenuation, are able to see the forest for the trees in ways many parents, over-busy with caring for our children and in lock-step with the medical community, cannot. Their shouts of dismay about this "treatment" are dead on. In not listening to them now, will we have to wait another 50 years, and sacrifice too many of our severely disabled children, before we look back and see what an assault to their human rights that is growth attenuation?

Walker concludes her piece with the following:

I believe the opposition to the Ashley Treatment has taken our society a step backward in what has been a positive attempt in recent years by the medical community to allow parents to make some of the difficult decisions regarding their children’s care. Personalized medical care should allow individual families to make informed decisions within the medical and moral boundaries that are found in the hospitals they frequent. (emphasis mine)

Walker's error here is that she never steps outside of the medical community's perspective to view the large scale societal implications of growth attenuation. Understandably, given this bias, it looks fine. Once again, this is where she must turn to disability advocates to broaden her perspectives. If she wishes to build bridges, she needs to turn to those whom she felt abandoned her and be willing to teach and be taught. She must move away from a purely medical model of disability which aims to alter the disability rather than the society that encompasses it. Our children do not so much need to change as society needs to accommodate them...big or small, severely or not so severely challenged, young or old. Similarly, we parents who are choosing to do this important work as caregivers need all the support we can get and plans in place to assure ours and our children's happy and safe futures.

Thursday, November 11, 2010

Ashley Treatment in the Hastings Center Report

William Peace

In the November/December issue of the Hastings Center Report growth attenuation and the so called Ashley Treatment is discussed. A subscription is required to read the feature article entitled "Navigating Growth Attenuation in Children with Profound Disabilities". However, the responses, excluding a commentary by Alice Dreger, can be accessed for free. I strongly urge readers to visit the Hastings Center website and read the most recent report. I have always been intrigued by the Hastings Center. It is a bioethics think tank that produces first rate scholarship. I do not always agree with what they publish--in fact I have strongly disagreed with some articles they have printed. However, even in disagreement I never questioned the academic integrity of what is produced. In addition, I have found such disagreement fruitful as it forced me to hone my views in response. Thus I am quite happy to see the work produced by the "Seattle Growth Attenuation and Ethics Working Group" in Seattle appear in the Hastings Center Report. It is my hope that the feature article and the responses will prompt a more nuanced debate about growth attenuation. To date, those for and opposed to growth attenuation have utterly failed to open a reasoned debate. While I am firmly opposed to the Ashley Treatment, I am willing to listen to its advocates. I only wish the same courtesy was extended to me and particularly those in what some people such as Norm Fost derisively refer to as the disability community.

The Hastings Center Report has published the following:

Feature article (subscription required)

Navigating Growth Attenuation in Children with Profound Disabilities: Children's Interests, Family Decision-Making, and Community Concerns
Bejamin S. Wilfond, Paul Steven Miller, Carolyn Korfiatis, Douglas S. Diekema, Denise M. Dudzinski, Sara Goering, and the Seattle Growth Attenuation and Ethics Working Group

Responses (free):

Offense to Third Parties?
Norman Fost

Discrimination against Children with Cognitive Impairments?
Eva Feder Kittay

Against Fixing a Child—A Parent's View
Sue Swenson

In Support of the Ashley Treatment—A Parent's View
Sandy Walker

Another Voice (subscription)

Attenuated Thoughts
Alice Dreger

I will leave it up to the reader to assess the individual contributions above. What I will do however is briefly quote each response and my reaction.

First, the words of Norm Fost:

"We [the working group] heard about disagreement and distress because a caring set of parents, with consultation from competent physicians and the support of an experienced ethics committee, pursued a treatment plan that offended the personal beliefs of some individuals and groups about the treatment of people with disabilities."

Fost is correct, the Ashley Treatment" offended many people with and without disabilities. But he utterly misses the point that Ashley X civil rights were violated. This is not an opinion, this is a statement of fact, a legal fact in the Sate of Washington. What Fost objects to the most is "third party" intrusion. This too is not a tenable position.

Second, the words of Sandy Walker:

When Ashley’s story became public, I was surprised by the reaction of those who identify themselves as “advocates” of persons with disabilities and their families. They spoke of the “perspective of the disability community,” as though Ashley and her family were not a part of it. I felt disenfranchised by the very organizations and individuals that were put into place to protect Jessica and our family. I also found that many of those speaking out against growth attenuation did not understand the enormous physical implications and limitations of children as involved as Jessica.

This is profoundly disturbing comment. We, myself included, in the disability rights community have failed this woman and her family. This cannot be tolerated. While I do not have a child with a disability, I certainly understand the discrimination children and adults with cognitive deficits encounter is far more pronounced than what I experience. This is inherently wrong and we in the disability community much do more to reach these families. They should never feel so disenfranchised.

Third, the words of Sue Swenson:

We would never allow our son to be placed in an institution. Institutional placement of children or adults with profound disabilities—being shut away from the community, rather than engaged with it—is no longer considered an option in civilized places. Fortunately, family support and home- and community-based supports for adults offer modern alternatives. Family support—services whose aim is to help families nurture and enjoy their disabled child at home—helped us learn to let go and gave us information about raising a severely disabled child: how to position him so he could participate in a broad range of activities, how to transfer him without lifting, how to support his mobility and find useful equipment, how to include him in everything, how to figure out what he wanted, how to think about his rights.

I can only state my categorical agreement with the above.

Fourth the, the words of Eva Kittay:

The Seattle Growth Attenuation and Ethics Working Group settled on the compromise that growth attenuation should be limited to severely cognitively disabled and nonambulatory children. I respectfully disagree. I do not believe that growth attenuation is ethically or medically appropriate, even when limited to children with profound developmental and intellectual impairments.
The compromise position rests on the assumption that the constraint will avoid many of its possible abuses. The problem is that the limitation is itself already an abuse. If growth attenuation should not be done on children without these impairments, then it should not be done on any children. To do otherwise amounts to discrimination.

Forceful words eloquently and wonderfully stated. Kittay's response is sobering. A class of people has been set apart and are potentially subject to a "treatment" that would be deemed objectionable if they were ambulatory or did not have a cognitive deficit. What does this say about the way our society views such people?

What to make of all this? I think something productive can come out of what the Hastings Center has done. I suggest the center consider organizing a one day conference on the Ashley Treatment. I would use the prestige of the Hastings Center to force people with entrenched views to come together in a civil fashion. I think people like Douglas Diekema and Norm Fost need to listen to their fiercest critics in the disability rights community who they have ignored or dismissed out of hand. In return disability rights advocates must treat these men with respect regardless of our opposition. The Hastings Center Report is a step in the right direction but much works needs to be done. Alice Dreger grimy noted: "I was invited to join the Seattle Growth Attenuation and Ethics Working Group—collective author of the lead article in this issue of the Report—but I begged off, claiming I had too many other things on my plate. True, but the bigger reason for avoiding the project was my suspicion that I would be torn asunder by the complexity of growth attenuation for persons with disabilities. Reading the essays from the group reveals that instinct to have been dead-on." Rather than be "torn asunder" I think it is in our collective best interest to work together.