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.

Fatal fungal peritonitis in an adolescent on continuous ambulatory peritoneal dialysis: association with deferoxamine.

An unusual case of Rhizopus microsporus (mucormycosis) fungal infection in a teenage boy on continuous ambulatory peritoneal dialysis is presented. Premortem cultures were negative and the patient developed a rapidly disseminated fatal infection. The patient was being treated with deferoxamine (DFO) for iron and aluminum overload. An argument is made for a probable association between DFO and this fatal fungal infection in patients with end-stage renal disease.

The Baby Doe regulations: another view of change.

KIE: Weil, chairman of the Bioethics Committee of the American Academy of Pediatrics, maintains that many changes that are occuring in the medical care of newborns and infants are not mandated by the Child Abuse and Neglect Amendments of 1984 or by the Department of Health and Human Services' April 1985 final rule regarding the Act, but are derived from social forces that have increased public awareness of the interests of the disabled. Other changes will result from state regulations required by the federal action. The author considers the "Baby Doe" rules to be guidelines, not requiring specific acts or decisions and subject to broad interpretation. The intent of the federal and state regulations is to safeguard infants in rare life-and-death situations where parents and physicians undervalue the interests of the child and the hospital ethics committee cannot resolve the issue.^ieng

The effect of polybrominated biphenyl on infants and young children.

The effects of PBB on 33 children born between September 1, 1973, and December 31, 1975, were evaluated in September, 1977. These children, born to families who lived on quarantined farms, were compared to 20 children who were not exposed to PBB. The birthdate interval was selected to obtain children who were exposed in utero or in early infancy or both, the two time periods when damage to developing tissues and organ systems should have been maximal. The results of these studies failed to identify any effects on physical growth, physical examination, or neurologic assessment, although the parents indicated by historical review that the exposed children had had more illnesses, especially respiratory, than had the control children. There were some indications of an inverse relationship between PBB fast level and performance on selected developmental tests.