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R.R.
Frerichs Posting
Ever since Connor and colleagues published their landmark study in the
New England Journal of Medicine that documented the benefits that come
from pre- and perinatal treatment of HIV infected women with AZT (New
England Journal of Medicine 331(18)1173-1180, 1994), the question of
whether to test or not test pregnant women has been widely debated.
While many have resisted mandatory prenatal testing to preserve the
rights of the women to avoid potential harm from discrimination, similar
concerns have not always been expressed for the welfare of their living
offsprings. Some public health officials have tried to avoid the controversy
surrounding forced prenatal screening but have advocated instead, mandatory
screening of all newborn infants. Even though the percentage of lives saved
with such post-birth screening is far less than what comes from testing
pregnant women, there are fewer ethical battles to be waged or angry groups
to contend with.
With pregnant women, some ethicists feel that the balance should favor
the right of the infected mother to avoid potential psychological or physical
harm, over the right of the infant to avoid infection and near-certain
early death. Since women can express their opinions and infants cannot,
this position is widely cited in the international literature. When the
living infant emerges, the balance for many starts to tilt more actively
towards the right of the newborn to avoid infection from contaminated breastmilk,
or to avoid dying early from various secondary infections, with less concern
shown for the right of the mother to avoid detection. In both situations,
the cost, quality and access to HIV antibody testing play an important
role for both wealthy and poor countries, as does the need for HIV normalization.
For those in the sea-group interested in this public health issue I
am submitting a story from the Wednesday, May 1, 1996 New York Times on
legislative actions being considered in the USA, and two recent background
articles from the scientific literature on the efficacy of AZT (1994) and
the approach being taken in Thailand (1995) [the published
material not included here] |
