The care of HIV-infected children is fraught with many bioethical conflicts and dilemmas that require careful attention if care is to be provided appropriately. Understanding of the interplay of such general principles as autonomy, nonmaleficence, confidentiality, and veracity helps to clarify the nature of specific conflicts. This article addresses both general principles and their specific applications to pediatric patients with HIV infection. It addresses these matters from the points of view both of patients and parents. It shows why conflict is practically inevitable, and it points the way toward prevention and resolution of conflict. Practical guidelines are provided in relation to the critical problem of disclosure of diagnosis to the patient.
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References
1.
1. Oleske J, Minnefor A, Cooper R, et al. Immune deficiency syndrome in children. JAA'I. 1983;249:2345-2349.
2.
2. Kilbourne BW, Bulhler JW, Rogers MR. AIDS as a cause of death in children, adolescents, and young adults. AmJPublic Health. 1990;80:499-500.
3.
3. Hutto SC. Pediatric HIV infection and AIDS: medical issues. In: Olson RA, Mullins LL, Gillman JB, Chaney JM, eds. The Sourcebook of Pediatric Psychology. Needham Heights, MA: Allyn and Bacon; 1994:218-224.
4.
4. Swales TP. Pediatric HIV infection and AIDS: psychological issues. In: Olson RA, Mullins LL, Gillman JB, ChaneyJM, eds. The Sourcebook of Pediatric Psychology. Needham Heights, MA: Allyn and Bacon; 1994:225-236.
5.
5. Ross JW, Glaser JW, Rasinski-Gregory D, et al. Health Care Ethics Committees: The Next Generation. Chicago: American Hospital Publishing, Inc.; 1993.
6.
6. Weithorn LA, McCabe MA. Emerging ethical and legal issues in pediatric psychology. In: Routh DK, ed. Handbook of Pediatric Psychology. New York: Gilford Press; 1988:567-606.
7.
7. American Academy of Pediatrics Task Force on Pediatric AIDS, Adolescents and Human Immunodeficiency Virus Infection: the role of the pediatrician in prevention and intervention. Pediatrics. 1993;92:626-630.
8.
8. AIDS Institute, New York State Health Department. A Guide to HIV Counseling and Testing. Albany, NY: New York State Health Department; 1994.
9.
9. Martin JM, Sacks HS. Do HIV-infected children in foster care have access to clinical trials of new treatments?AIDS and Public Policy. 1990;5:3-8.
10.
10. Olson RA, Huszti HC, Mason PJ, Seibert JM. Pediatric AIDS/HIV infection: an emerging challenge to pediatric psychology. J Pediatr Psychol1989;14:1-21.
11.
11. Howe EG. Societal and clinical approaches to preventing pediatric AIDS: some ethical considerations. AIDS and Public Policy. 1990;5:9-16.
12.
12. Cassidy RC. Tell all the truth? Shepherds, liberators, or educators? In: Cassidy RC, Fleischman AR, eds. Pediatric Ethics-from Principles to Practice. Amsterdam, The Netherlands: Harwood Academic Publishers; 1996:67-82.
13.
13. Wittenberg J, Lazenby A. AIDS in infancy: diagnostic, therapeutic, and ethical problems. Can J Psychiatry. 1989;34:576-580.
14.
14. Majer LS. HIV-infected students in school: who really “needs to know?”J Sch Health. 1992;62:243-245.
15.
15. American Academy of Pediatrics Task Force on Pediatric AIDS. Education of children with human immunodeficiency virus infection. Pediatrics. 1991; 88:645-647.
16.
16. Moreno JD. Treating the adolescent patient: an ethical analysis. J Adolesc Health Care. 1989;10:454-459.
17.
17. English A. AIDS testing and epidemiology for youth: recommendations of the work group. J Adolesc Health Care. 1989;10:52S-57S.
18.
18. Burns J, Truog R. The limits of the physician's duty to treat. In: Cassidy RC, Fleischman AR, eds. Pediatric Ethics from Principles to Practice. Amsterdam, The Netherlands: Harwood Academic Publishers; 1996.
19.
19. Sigman GS, Kraut J, LaPuma J. Disclosure of a diagnosis to children and adolescents when parents object. AmJ Dis Child. 1993;147:764-768.
20.
20. Lipson M. What do you say to a child with AIDS?Hastings Center Report. 1993;23:6-12.
21.
21. Lipson M. Disclosure of diagnosis to children with human immunodeficiency virus or acquired immunodeficiency syndrome. J Dev Behav Pediatr. 1994;15:S61-S65.
