Parents are presumed to have the best interests of their children at heart. In many cases, however, the values and interests of the child are not the same as those of the parents. This becomes a critical issue when evaluating consent to treatment. This problem becomes more common as children enter adolescence. Physicians who care for adolescent boys often see families in which the boy feels compelled to compete in sports to retain his father’s affection. As long as this does not interfere with the child’s growth and development, it is not a problem for the physician. However, parental enthusiasm becomes detrimental to the child if decisions about the care of injuries are made on the basis of ability to play rather than what is best for the long-term health of the child.

Physicians are increasingly pressured by parents to use medical treatments to alter characteristics of normal healthy children. One of the most controversial therapies is the use of human growth hormone to stimulate growth in children without intrinsic growth hormone deficiency. In most cases, the child is short for his or her age. Questions are being raised, however, about using growth hormone to help already tall children gain the extra height and size that is a critical edge in professional sports. Unlike the analogous problem of vanity surgery, the patient is not able to give an informed, legally binding consent to the treatment. This raises profound ethical questions about the role of the physician and the definition of health. [Lantos J, Siegler M, Cuttler L. Ethical issues in growth hormone therapy. JAMA. 1989;261:1020–1024.]