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When Parents Reject Interventions to Reduce Postnatal Human Immunodeficiency Virus Transmission
Leslie E. Wolf, JD, MPH;
Bernard Lo, MD;
Karen P. Beckerman, MD;
Alejandro Dorenbaum, MD;
Sarah J. Kilpatrick, MD, PhD;
Peggy S. Weintrub, MD
Arch Pediatr Adolesc Med. 2001;155:927-933.
In a recent Oregon case, the state successfully sued for custody of
an infant to prevent his human immunodeficiency virus (HIV)–infected
mother from breastfeeding him and to require antiretroviral prophylaxis. As
more HIV-infected women give birth, pediatricians may increasingly face dilemmas
when parents reject medical recommendations to forgo breastfeeding and to
administer antiretroviral prophylaxis to the infant. Such disagreements create
ethical dilemmas because pediatricians have an obligation to both protect
the infant and respect parental decision making. Pediatricians need to balance
these obligations in deciding whether to ask the courts to intervene on the
infant's behalf. To that end, we analyze the legal and ethical issues that
arise when an HIV-infected mother refuses interventions to reduce neonatal
transmission of HIV to her infant, provide an approach for addressing these
disagreements, and present illustrative scenarios in which pediatricians should,
may, and should not seek a court order to intervene.
From the Program in Medical Ethics, the Center for AIDS Prevention
Studies, the Division of General Internal Medicine (Ms Wolf and Dr Lo), Department
of Obstetrics, Gynecology and Reproductive Sciences (Dr Beckerman), and Department
of Pediatrics (Drs Dorenbaum and Weintrub), University of California, San
Francisco; and Division of Maternal Fetal Medicine, Department of Obstetrics
and Gynecology, University of Illinois at Chicago (Dr Kilpatrick).
Corresponding author and reprints: Leslie E. Wolf, JD, MPH, Program
in Medical Ethics, University of California, San Francisco, 521 Parnassus
Ave, Suite C-126, San Francisco, CA 94143-0903 (e-mail: lwolf{at}medicine.ucsf.edu).
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