Nondisclosure of human immunodeficiency virus and hepatitis C virus coinfection in a patient with hemophilia: medical and ethical considerations.
This article discusses a medical and ethical dilemma: whether to disclose a positive HIV (human immunodeficiency virus)/HCV (hepatitis C virus) coinfection to an adolescent boy without symptoms with hemophilia despite the objections of his parents. An actual case history is presented and the dilemma faced by the medical team is discussed. Numerous family conferences, all excluding the patient, held during the last 5 years discussed the medical team's obligation for full disclosure, the emerging autonomy of the patient, and the potential for medical disaster (e.g., HIV transmission) if full disclosure were not permitted. Despite this, the family did not agree to allow disclosure. The patient and parents assured us of his sexual inactivity. Legal opinion was sought from the university counsel. The dilemmas are multiple. Is there a convincing argument to insist on disclosure of these facts to this patient, particularly when there is ambiguity regarding the appropriateness of HIV and HCV treatment? Does the ethical argument that he is at potential risk for transmitting HIV/HCV outweigh the rights of the family? What are the rights of the rest of the family? What are the rights of the minor? Is it our ethical responsibility to disclose a probably fatal diagnosis?
Kulkarni
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Department of Pediatrics/Human Development, Michigan State University, East Lansing, USA. kulkarn1@msu.edu
Scott-Emuakpor
A B
AB
Brody
H
H
Weil
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WB
Ragni
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MV
Gera
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R
D000293:Adolescent; D004992:Ethics, Medical; D015658:HIV Infections / Q000150:complications / Q000523:psychology*; D006467:Hemophilia A / Q000150:complications / Q000523:psychology*; D006526:Hepatitis C / Q000150:complications / Q000523:psychology*; D006801:Humans; D008297:Male; D010290:Parents; D014342:Truth Disclosure