Should Doctors Disclose They Have HIV?

C H I C A G O, Oct. 17 -- A leading health expert says the governmentshould no longer compel HIV-infected doctors to tell patients abouttheir disease, reopening a debate that raged a decade ago afterKimberly Bergalis most likely got AIDS from her Florida dentist.

Lawrence Gostin of Georgetown University Law Center said thecurrent rules “pose significant human rights burdens” and are notsupported by recent data showing the risk of doctor-patienttransmission is extremely low.

The guidelines are being evaluated under a routine review by theCenters for Disease Control and Prevention. Gostin’s proposal waspublished in today’s Journal of the American MedicalAssociation.

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

Right to Know?

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

“This is the same argument that was vented 10 years ago,”complained George Bergalis, Kimberly’s father. “The same attitudesin place today are the same ones that caused us to lose ourdaughter. We told them, our daughter told them 10 years ago, and noone listened.”

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

“For very traditional mainstream legal and ethical reasons, itseems 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-bornediseases because the transmission of hepatitis B from doctor topatient could occur. Hepatitis B is a viral infection of theliver. It kills about 1 million people worldwide annually.