Does a Bioethicist Have an Ethical Obligation to Respond?
Mandatory Testing Proponent Refuses to Cite References for Passionate Stance
Bioethics is the study of the moral and ethical choices faced in medical research and in the treatment of patients. Dr. Nancy Dubler is the Director of the Division of Bioethics at the Montefiore Medical Center in Bronx, New York. As part of the ABC Prime Time segment on Christine Maggiore that aired December 8, 2005, Dubler made the following statements regarding Maggiores decision to not subject her children to HIV testing:
I would say that the next time a child is born to an HIV-positive woman and that woman refuses to have the child tested and treated if positive, that the state has a moral obligation to proceed immediately
There are only three choices in this kind of situation: Take the child, take the child, take the child.
On December 12, 2005, Maggiore sent the following letter to Dubler asking Dubler to share some of the data that inform her passionately held views on mandatory HIV testing. In a reply the following day, Dubler stated that she was not interested in an ongoing discussion of the topic and would not answer Maggiores questions. Instead, she referred Maggiore to the US Centers for Disease Control web site and accused Maggiore of having a screw loose.
Maggiore says she is not surpised by Dublers harsh reply, These questions tend to put medical experts in an uncomfortable position. They go to straight to the heart of the issue of HIV testing and apparently they have no answers.
Below, for your consideration, is Maggiores message to Dr. Nancy Dubler. If you can provide answers to the specific questions in Maggiores letter, please forward citations using our feedback form. If you wish to email Dr. Dubler directly, send your message to firstname.lastname@example.org.
December 12th 2005
Dear Dr. Dubler,
Thank you for participating in the ABC Prime Time segment that explored some of the issues surrounding the death of my daughter Eliza Jane. I was moved by the compassion you demonstrated for my situation and wanted to thank you for including those kind remarks. I was also intrigued by your position on the necessity of HIV testing and would appreciate learning more about your views on the subject.
Given your conviction that HIV testing should be mandatory for children born to HIV positive testing mothers, you must certainly be convinced of the ability of HIV tests to correctly identify individuals currently infected with the virus. I am not so convinced and would be grateful for your help in understanding the medical and scientific facts that inform your very passionate stance. To this end, would you please share with me the validation study from the published medical literature that in your professional opinion best establishes the specificity and sensitivity of HIV antibody or viral load tests via the direct isolation (purification) of the virus from the fresh uncultured plasma of individuals with positive results on HIV antibody or viral load tests?
I would also be grateful to learn which HIV tests youve found that claim US Food and Drug Administration approval for the specific intended purpose of diagnosing infection with HIV. The manufacturers literature from the test kits Ive reviewed all disclaim use for such purposes. For example, the Roche HIV viral load test kit literature states it is not intended to be used as a screening test for HIV or as a diagnostic to confirm the presence of HIV infection.
To further my understanding of your position, I would also appreciate knowing what study from the medical literature you rely on for evidence of HIV isolation (purification) and identification of the specific viral proteins and DNA.
Since mandatory HIV testing of minor children ultimately leads to mandatory anti-HIV pharmaceutical treatment, could you please tell me what study you believe best demonstrates the long-term clinical health benefits conferred to positive testing children from anti-HIV medications? One that compares clinical health outcomes in positive testing children who take the drugs to a matched cohort who take no anti-HIV medications would be of greatest interest.
Finally, a point for which I would very much appreciate your much studied and experienced perspective is the practice of disregarding or discounting HIV negative test results in infants born to HIV positive mothers. For example, the state of Oregon mandated that Felix Tyson, the infant son of known HIV positive mother Kathleen Tyson, receive AZT treatment for the first six weeks of his life despite the fact that Felix tested HIV negative at birth. If HIV testing provides incontrovertible evidence of HIV infection, why would knowledge of a mothers status affect how test results are interpreted?
With further thanks for your time and in anticipation of your reply.