Thought this was of interest


Court Order to Enforce AZT Prophylaxis, Bottle Feeding for Infant Can Be
Ethical


WESTPORT, CT (Reuters Health) Aug 16 - Physicians are faced with difficult
decisions when parents refuse to cooperate in reducing the risk of postnatal
mother-to-child HIV transmission. A recent decision by an Oregon court to
order compliance with medical advice in this situation grants pediatricians
new power over such cases — power that should be used with great care,
according to an review in the August issue of Archives of Pediatrics and
Adolescent Medicine.

"The decision regarding whether to intervene is a difficult one because the
judgment of whether the risk of transmission is acceptable or unacceptable
is value laden," physician-attorney Dr. Leslie E. Wolf, of the University of
California at San Diego, and colleagues explain. "Appeals to ethical and
legal principles alone will not help pediatricians resolve this dilemma."

Dr. Wolf and associates review the costs and benefits of using the courts as
a vehicle for forcing parents to administer zidovudine prophylaxis and to
bottlefeed. They offer guidance for making this decision when all other
attempts to persuade parents have failed.

Clinically, they say, it is relatively clear that zidovudine prophylaxis and
foregoing breast-feeding have greater benefits than costs. Both
interventions have been demonstrated to be safe and effective in several
studies. However, there may be psychosocial costs associated with overriding
parental decision-making in order to put these clinical interventions in
place.

"Court proceedings for medical neglect may jeopardize the parent-child
relationship in several ways," Dr. Wolf's group writes. For instance,
parents may be forced to compromise "deeply held personal values and
beliefs" in order to maintain custody of their child. Placing the child in
foster care could jeopardize the child's basic needs." In addition, parents
may be less likely to seek future medical care for their child after being
forced to institute medical interventions.

"Other social harms may result from the family's cultural and social
context," the authors point out. In cultures where breastfeeding is the
norm, or even required by scripture as for Muslim women, a woman may "risk
rejection or abandonment by her spouse or family" if she does not
breastfeed. "Similarly, compliance with prevention measures could lead to
unintended disclosure of the mother's HIV status," leading to violence or
loss of support.

The authors conclude that physicians have an obligation to weigh each of
these costs and benefits, along with the clinical status of the HIV-infected
mother, before seeking a court order to intervene.

Arch Pediatr Adolesc Med 2001;155:927-933. [Abstract]




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