Disclosing HIV status: ethical issues explored

Events throughout the country are cited that point to the public's growing fears of infection with human immunodeficiency virus (HIV, associated with AIDS) by health care workers. Since initial reports that one patient of an HIV-infected Florida dentist was infected by him, concern has mounted; a law in this is under consideration that would require disclosure by HIV-infected health care workers of their status to a medical board. The ethical aspects and possible implications of such rulings are considered. Admitting that one is infected with HIV would lead to compassion, care, and help in a perfect society, whereas disclosure in our society brings ostracization. Irrational fears of the dangers of transmission from health care worker to patient abound, and public trust in the safety of donated blood, transplanted organs, and hospital safety procedures has been eroded. People's fears are intensified by the certainty that HIV infection leads to death. The American Medical Association (AMA) and the American Dental Association (ADA) have explicitly stated their views that physicians and dentists are ethically obligated to treat people infected with HIV. In early 1991, both the AMA and ADA recommended that HIV-infected health professionals stop performing invasive procedures or inform their patients that they are infected. Opponents to this recommendation cite the disastrous consequences of disclosure for the professional's career and financial security, and the difficulty of deciding which procedures are hazardous. According to one recent report, three-fourths of the dentists surveyed believed that patients should be told if their dentist was HIV-infected. Several recommendations are presented, including: (1) development of safer instruments and procedures; (2) development of reimbursement procedures to finance health care for HIV-infected people; (3) mandatory reporting of HIV-positive health care workers to a panel of experts; and (4) the requirement that HIV-infected patients inform their doctor or dentist of their status. (Consumer Summary produced by Reliance Medical Information, Inc.)