Should Doctors Disclose They Have HIV?

A leading health expert says the government should no longer compel HIV-infected doctors to tell patients about their disease, reopening a debate that raged a decade ago after Kimberly Bergalis most likely got AIDS from her Florida dentist.

Lawrence Gostin of Georgetown University Law Center said the current rules “pose significant human rights burdens” and are not supported by recent data showing the risk of doctor-patient transmission is extremely low.

The guidelines are being evaluated under a routine review by the Centers for Disease Control and Prevention. Gostin’s proposal was published in today’s Journal of the American Medical Association.

Bergalis’ death nine years ago prompted the CDC to adopt guidelines in 1991 that say HIV-infected health workers should reveal their disease to patients undergoing invasive procedures. Gostin was among the advisers who urged the CDC to adopt those guidelines.

Right to Know?

But since the cases linked to Bergalis’ dentist, only one and possibly two patients, both in France, have been infected by health care workers with AIDS, Gostin said.

“This is the same argument that was vented 10 years ago,” complained George Bergalis, Kimberly’s father. “The same attitudes in place today are the same ones that caused us to lose our daughter. We told them, our daughter told them 10 years ago, and no one listened.”

An accompanying JAMA editorial said Gostin’s proposal runs contrary to evidence suggesting patients would want to know if their doctor was infected with the AIDS virus.

“For very traditional mainstream legal and ethical reasons, it seems to me a patient has a right to know,” wrote Dr. Norman Fost, director of medical ethics at the University of Wisconsin.

Fost also said he favors existing guidelines on blood-borne diseases because the transmission of hepatitis B from doctor to patient could occur. Hepatitis B is a viral infection of the liver. It kills about 1 million people worldwide annually.

Focus on Prevention

Gostin argued that a new national policy should focus on preventive measures, including use of the hepatitis B vaccine, sterilizing equipment and having health care workers wear gloves and other protective gear.

“The problem now is that doctors and nurses who are infected are so frightened that they won’t come forward,” may not even be getting treated, and are more likely to be infectious, Gostin said.

The American Medical Association, the nation’s largest group of doctors, opposes mandatory disclosure by HIV-infected doctors.

But Bergalis said he thinks the rights of the uninfected should be paramount and laws should be enacted to replace the existing guidelines.

“I feel somewhat ashamed of the medical profession, the public health and the political profession because of the fact that they have not taken this seriously enough to do anything over all these years,” he said.

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