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There is currently no public policy that provides guidance concerning whether and when physicians infected with hepatitis B virus (HBV), hepatitis C virus (HCV), and/or human immunodeficiency virus (HIV) can safely perform invasive procedures. A committee of experts in the fields of medicine, law, and biomedical ethics and 1 community member, aided by an advisory board, was established to produce recommendations for policy reform. An extensive literature review was conducted for these 3 infectious diseases, medicine, surgery, epidemiology, law, and bioethics to gather all relevant data. Special recommendations are made regarding the management of physicians who are infected with HIV, HBV, and/or HCV. This policy proposal includes a list of exposure-prone procedures and a decision chart that indicates under what conditions infected physicians can practice beyond the need for disclosure of their serological status.

Since 1851, individuals have successfully sued physicians for injuries sustained through infectious disease transmission from the physicians' patients. Liability to third parties must be considered in the management of patients with infectious diseases. Because of this potential liability, physicians with human immunodeficiency virus-infected patients must consider notifying identified third parties of their respective risks of infection.

Although physicians have a moral and professional duty to prevent the spread of human immunodeficiency virus (HIV) by seeing that the infected patient's contacts are informed of the risks, they have no legal guidelines on how to approach the problem. Medical organizations recommend that physicians notify an endangered third party if the infected patient refuses to cease high-risk activity and the authorities do not take action. However, many questions remain about practical application of these recommendations. Some federal recommendations place the burden of notifying the third party on the infected patient, then on the public health authority, and finally on the physician. However, these suggestions are not law. Legal precedent has placed responsibility on the physician for warning persons exposed to an infected patient that a risk exists. However, warning someone who is not clearly at risk can also invite a lawsuit. At present, there is no clear public policy to give guidance either. By considering the infectivity of the virus, injury potential of the infection, and the exposed person's relationship with the patient, the physician can better weigh the risk of breaching patient confidentiality versus ignoring the health dangers to the third party. Thorough counseling of the patient about infectivity, careful documentation of all conversations and efforts, and use of good judgment are the best tools that physicians have at present for handling this legal void.