title: When parents reject interventions to reduce postnatal human immunodeficiency virus transmission.
abstract: 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 forego 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.
authors.affiliation: Program in Medical Ethics, University of California-San Francisco, 521 Parnassus Ave, Suite C-126, San Francisco, CA 94143-0903, USA. lwolf@medicine.ucsf.edu
authors.forename: L E
authors.initials: LE
authors.lastname: Wolf
authors.forename: B
authors.initials: B
authors.lastname: Lo
authors.forename: K P
authors.initials: KP
authors.lastname: Beckerman
authors.forename: A
authors.initials: A
authors.lastname: Dorenbaum
authors.forename: S J
authors.initials: SJ
authors.lastname: Kilpatrick
authors.forename: P S
authors.initials: PS
authors.lastname: Weintrub
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage; D001294:Attitude to Health; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004992:Ethics, Medical; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D016365:Liability, Legal; D008297:Male; D010287:Parent-Child Relations; D011247:Pregnancy; D011295:Prenatal Care; D018570:Risk Assessment; D016312:Treatment Refusal / Q000331:legislation & jurisprudence*; D014481:United States; D015215:Zidovudine / Q000008:administration & dosage
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine