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Leslie E. Wolf, JD, MPH; Bernard Lo, MD; Karen P. Beckerman, MD; Alejandro Dorenbaum, MD; Sarah J. Kilpatrick, MD, PhD; Peggy S. Weintrub, MD

Arch Pediatr Adolesc Med. 2001;155:927-933.

In a recent Oregon case, the state successfully sued for custody of an infant to prevent his human immunodeficiency virus (HIV)–infected mother from breastfeeding him and to require antiretroviral prophylaxis. As more HIV-infected women give birth, pediatricians may increasingly face dilemmas when parents reject medical recommendations to forgo breastfeeding and to administer antiretroviral prophylaxis to the infant. Such disagreements create ethical dilemmas because pediatricians have an obligation to both protect the infant and respect parental decision making. Pediatricians need to balance these obligations in deciding whether to ask the courts to intervene on the infant's behalf. To that end, we analyze the legal and ethical issues that arise when an HIV-infected mother refuses interventions to reduce neonatal transmission of HIV to her infant, provide an approach for addressing these disagreements, and present illustrative scenarios in which pediatricians should, may, and should not seek a court order to intervene.

From the Program in Medical Ethics, the Center for AIDS Prevention Studies, the Division of General Internal Medicine (Ms Wolf and Dr Lo), Department of Obstetrics, Gynecology and Reproductive Sciences (Dr Beckerman), and Department of Pediatrics (Drs Dorenbaum and Weintrub), University of California, San Francisco; and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Illinois at Chicago (Dr Kilpatrick).

Corresponding author and reprints: Leslie E. Wolf, JD, MPH, Program in Medical Ethics, University of California, San Francisco, 521 Parnassus Ave, Suite C-126, San Francisco, CA 94143-0903 (e-mail: lwolf{at}medicine.ucsf.edu).

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