Nondisclosure of human immunodeficiency virus and hepatitis C virus coinfection in a patient with hemophilia: medical and ethical considerations.

This article discusses a medical and ethical dilemma: whether to disclose a positive HIV (human immunodeficiency virus)/HCV (hepatitis C virus) coinfection to an adolescent boy without symptoms with hemophilia despite the objections of his parents. An actual case history is presented and the dilemma faced by the medical team is discussed. Numerous family conferences, all excluding the patient, held during the last 5 years discussed the medical team's obligation for full disclosure, the emerging autonomy of the patient, and the potential for medical disaster (e.g., HIV transmission) if full disclosure were not permitted. Despite this, the family did not agree to allow disclosure. The patient and parents assured us of his sexual inactivity. Legal opinion was sought from the university counsel. The dilemmas are multiple. Is there a convincing argument to insist on disclosure of these facts to this patient, particularly when there is ambiguity regarding the appropriateness of HIV and HCV treatment? Does the ethical argument that he is at potential risk for transmitting HIV/HCV outweigh the rights of the family? What are the rights of the rest of the family? What are the rights of the minor? Is it our ethical responsibility to disclose a probably fatal diagnosis?

Biological factors which may influence an older child's or adolescent's responses to toxic chemicals.

Currently, there is considerable interest in scientific and regulatory issues relating to protection of children's health. Attention to date has largely been focused on establishing the efficacy and safety of drugs in children and on assessing potential risks of pesticides and similar agents to infants and young children. Older children and adolescents, however, have received little attention as special subgroups at risk from exposure to toxic and carcinogenic chemicals. Adolescence is the second most rapid period of growth and development, after infancy. Several organ systems experience substantial structural and functional changes during puberty. Attention is focused in this review on the more important organ systems that are undergoing maturation and therefore may be the most likely to exhibit aberrant responses to toxicants. Attention is also paid to age-related changes in processes which govern the disposition and metabolism of chemicals in the body.