'Ashley treatment' doc's suicide not related to case

'History of depression' blamed for Gunther's death

The Seattle pediatric endocrinologist who spearheaded the growth attenuation treatment on a disabled 9-year-old girl known as "Ashley" died in an apparent suicide in late September. The family of Daniel Gunther, MD, who was 49, said they believe his death was not related to the controversy over the so-called "Ashley treatment," but rather was the result of a long struggle with depression.

Gunther was an endocrinologist at Children's Hospital and Regional Medical Center in Seattle when, in 2004, the parents of a then 6-year-old girl came seeking his help. Their daughter, who was and continues to be cared for by her parents at home, was diagnosed with static encephalopathy. Marked global developmental deficits caused her development to never progress beyond infancy. She cannot sit up, walk, or talk; she is fed via gastrostomy tube, and the specialists treating her say there will be no significant improvement in her cognitive and neurologic state.

When she started showing signs of puberty at age 6 (breast buds, pubic hair), her parents became concerned about the effects of growth and maturation on their ability to care for her and keep her comfortable. Lifting an immobile 7-year-old is difficult; maneuvering an immobile adult at home would prove very difficult. Fully developed breasts would interfere with Ashley's ability to comfortably wear the harness that allows her to sit up, and menses would make hygiene additionally difficult for her caregivers and uncomfortable for Ashley, her parents said.

Gunther concurred, and together they approached Children's about performing three separate but concurrent treatments — a hysterectomy, hormonal growth attenuation, and surgical removal of her breast buds.

The course of treatment was approved by the hospital's 40-member ethics committee, and took place in 2004. The therapy came to wider public knowledge in 2006, when Gunther and his colleague, Doug Diekema, MD, MPH, of the Treuman Katz Center for Pediatric Bioethics at Children's Hospital, published their report on the procedures.

In mid-2007, Children's Hospital acknowledged that it broke Washington state law by permitting the hysterectomy portion of the treatment without a court order.

The parents of the child known as Ashley posted the following comment on their blog (www.ashleytreatment.spaces.live.com) following Gunther's death:

"We are deeply shocked and saddened to learn of the sudden death of Dr. Daniel Gunther. His tragic death is a tremendous loss to everyone, especially to other vulnerable kids like Ashley and their families, to whom he represented hope."

For more information on the treatment of the child known as Ashley, see Medical Ethics Advisor March 2007 ("Hysterectomy and growth attenuation: Therapy for disabled girl sparks debate," pp. 25-28) and July 2007 ("Hospital: Growth attenuation in disabled child illegal, not unethical," pp. 73-75).