Warrick, P. Whose Life is It? Weighing the Ethics of Keeping Unborn Babies Safe from HIV. (1995, February 7). Los Angeles Times, pp. E1, E5.

Last November, a team of French and American scientists announced that maternal transmission of the AIDS virus to newborns was cut by 70% when infected women were given the antiviral drug AZT during pregnancy. The findings, though hailed by AIDS researchers as their "grandest achievement," spark an ethical dilemma: a child’s life versus a mother’s right to confidentiality. At the center of the debate is whether pregnant women should be forced to undergo HIV testing and, if she tests positive, whether she should be forced to comply with the rigorous AZT treatment process.

Susanna (not her real name), an HIV-infected mother, says she feels "lucky." She found out she was pregnant at a county-funded clinic at the same time she found out that she was infected with HIV. "I don’t mean I’m happy about this. Nobody’d be happy. But I have a chance to save my baby, I think, since I know he might get AIDS if I don’t take the AZT."

Deandra has been living with HIV for five years. She had her first child, who is free of infection, before she knew she was HIV-positive. She took AZT during her second pregnancy and that baby also was born with no signs of the disease. "If someone was to have told me while I was pregnant that they’d put me in jail if I didn’t take my medicines, I’d have said ‘Forget this!’ and come back when it was time to have the baby," she says. "Don’t they understand? Mothers will be mothers. If you want them to do right by their children, maybe all you got to do is ask."

Until now, prevailing law and medical ethics have generally allowed competent adults to refuse any medical care for themselves—including AIDS testing and treatment. Supporters of AZT treatment for pregnant women claim the legal obligations to respect a woman’s right to privacy pale in the face of saving the life of her unborn child. "Women (may) keep their privacy intact, but their children will have the privacy of the grave," says Nat Hentoff, a New York columnist and abortion foe, who supports required testing. However, protecting the rights of pregnant women has been historically volatile, and feminists are enraged over the possibility of HIV-infected women having their rights subjugated in favor of their unborn babies. "Out front, this all sounds very good for the children, but you have to understand that women are not little ovens that babies come in. Women are separate individuals with rights and choices," says Ginny Foat, women’s advocate and director of Caring for Babies With AIDS in Los Angeles.

Advocates for the poor worry that mandatory tests also will discriminate against minorities, since African Americans and Latinos account for most HIV cases among pregnant women. For many of them, it is already difficult to get access to basic prenatal care they can afford. "Don’t forget, an HIV test does not occur in a medical vacuum," says Mark Senak of AIDS Project in Los Angeles. "It is a test of your insurability, your access to health care, your relationship with your partner, your family, your church...Whatever you think about mandatory HIV-testing, we must always return to the reality of life for the HIV-infected mother," he says.

The risk of a baby contracting AIDS from its mother is between 15% and 40%, according to the Centers for Disease Control. Babies born to HIV-infected women may become infected before, during, or shortly after birth. About 7,000 HIV-infected women become pregnant each year, according to national health experts. Almost 2,000 of their children are infected before or during birth, or through breast-feeding. Some women choose to terminate their pregnancies or are too sick to carry to term. According to John Schunhoff, Los Angeles County AIDS program director, about 70% of all women offered free HIV testing at county clinics accept. He and other opponents of mandatory testing say that with such positive response to voluntary testing, coerced testing may do more harm than good.

QUESTIONS FOR REFLECTION AND DISCUSSION

1. If you were a pregnant woman, how might you feel about facing legally-binding testing?
2. Where do you stand on the issue of a mother’s right to privacy versus a baby’s life? What do you think about the arguments of the opponents and proponents?
3. Going forward, how do you think the issue should be handled? How can common ground be reached? 

IMPLICATIONS

1. As researchers continue their efforts in the war against AIDS and societal response to the disease continues to be negative, more ethical/moral issues will certainly arise. We need to consider the best means of encouraging testing and control of this rising epidemic.
2. It will be increasingly important for our society to find ways of carrying on difficult dialog on bioethical and controversial cultural issues.