Ethical dilemmas can occur with the vulnerable population, such as unborn babies, infants and uneducated mothers. The main topic is pregnant women and Human immunodeficiency virus (HIV). When pregnant women decline HIV testing or treatment, public health, legal, and ethical dilemmas can result. Federal courts consistently stand by a woman's right to refuse medical testing and treatment, even though it may benefit her fetus or newborn infant.
About 35% of newborns born to HIV infected women contract the virus from their mothers if efforts to prevent mother-to-child transmission are not in place (Schuklenk, & Kleinsmidt, 2007). Ninety-three percent of pediatric AIDS cases are the result of perinatal HIV transmission, a disease that is almost entirely preventable with early intervention, which reduces the risk of perinatal HIV infection from 25% to <2% (Tuck, Poku, & Berkle, 2014). When pregnant women refuse HIV testing and/or treatment, public health, legal, and ethical dilemmas can result.
The Pediatric Associations of America does recommend that the newborns get tested. This specific article is about a young lady that was adopted and tested positive to HIV, her adopted parents gave her medication and stopped after two years. Since then the lady had not received medication and did not feel she needed it. After conceiving and carrying a baby for 41 weeks she told the hospital that her HIV status was unknown and refused a HIV test.
Rapid HIV testing of her newborn infant was recommended but declined by the patient and her partner. A review of public available records then identified the patient's positive childhood HIV test, Physicians and the hospitals legal team informed her that, if she continued to decline testing, they would seek a court order mandating her newborn infant's testing and treatment. (Tuck, Poku, & Berkle, 2014). The mother and her partner were convinced by the hospital to undergo testing for herself and her infant.
The mother and the infant both tested positive for HIV. The parents originally refused treatment for the infant but eventually agreed once convinced by hospital staff to start treatment on the baby. Once the mother and baby was discharged, the parents agreed to a plan for continued HIV treatment with the understanding that, if they failed to treat or follow up, social services would be contacted (Tuck, Poku, & Berkle, 2014). When the mother and infant failed to show up for a scheduled appointment with pediatric infectious diseases, the infant was taken into state custody, and a legal dispute ensued. The Mower County District Court in the State of Minnesota subsequently held that the infant had active symptoms of HIV infection that were improving with anti-retroviral therapy (Tuck, Poku, & Berkle, 2014).
The baby was released to the parents under state supervision and as long as the parents continued to give the anti-viral medication. The researchers protect the pregnant ladies by letting them know their rights on testing and treatment for themselves and their infant.
In most developed countries, HIV testing of pregnant women is voluntary and requires informed consent and elaborate counseling procedures (Schuklenk, & Kleinsmidt, 2007). Centers for Disease Control and Prevention (CDC) revised recommendations for HIV testing and endorsed routine HIV testing of all pregnant women in the United States, unless the woman declines, which is called an "opt-out" approach (Tuck, Poku, & Berkle, 2014). Although doctors often follow the CDC's recommendations, the CDC has no legal bearing on the testing and treatment of women; to date, the Supreme Court has not weighed in on the issue. This leaves states to develop their own regulations.
The authors concluded that additional education of practicing obstetricians/gynecologists on ACOG and CDC recommendations and the variations in state regulations was important to ongoing public health attempts to decrease perinatal HIV transmission (Tuck, Poku, & Berkle, 2014). The researcher was protecting the unborn child and trying to make sure that the families and the physicians were educated about the CDC recommendations on testing and treatments.