P3B105: Navigating Parental Notification and Confidentiality in Perinatal HIV Exposure: A Case Study Analysis

Introduction: The confidentiality of patients is one of the most important ethical principles in healthcare. In pediatrics, this principle is complicated as physicians must act in a child's best interests while respecting their parents' wishes. Here, we present a case that highlights an ethical dilemma when a parent’s medical condition impacts their baby’s health.

Case Description: Baby A was born to a mother who had been incidentally diagnosed with HIV during her pregnancy. As a refugee from Central Africa, the mother was two months pregnant when she arrived in the state of Maine with her husband. Throughout pregnancy, the mother requested that her husband not be informed of their baby’s HIV exposure. The healthcare team respected the mother’s confidentiality while she received prenatal treatment. As the pregnancy progressed, the mother’s HIV viral load continued to increase and Baby A was born following an emergent C-section. Due to the baby’s need for additional prophylactic antiretroviral medications, the medical team discussed with the mother about disclosing Baby A's potential HIV infection risk to the father. The mother quickly became visibly agitated, expressing that this did not align with cultural norms in her native country and that her husband would abandon them. She expressed distrust of the medical system, threatening to leave with her baby against medical advice and an emergency ethics panel was called. The panel determined not to inform the father of his child's HIV exposure risk unless explicitly asked about the condition or antiretroviral medications by the father.

Discussion: This case presents several ethical dilemmas balancing a mother's confidentiality, a father's right to know, and respect for cultural beliefs of immigrant patients despite domestic practices. The dilemma at hand is whether it is ethically permissible to tell the father that his infant requires medications due to exposure to HIV. In Maine, single-parent notification laws require only one parent to be informed of a child's medical condition. Through perspectives of justice and beneficence, the father should be informed of the baby's HIV exposure and the importance of timely administration of critical antiretroviral medications. However, in the lens of autonomy and non-maleficence, disclosing the exposure status would challenge the mother's right to autonomy and privacy, while possibly decreasing trust and use of the healthcare system. By balancing autonomy, non-maleficence, and informed care we discuss how best to prioritize a child’s wellbeing with their parent’s beliefs.

Conclusion: The issue of parental notification in cases of perinatal HIV exposure is complex and requires careful consideration of medical, legal, and ethical implications amidst cultural beliefs and stigma surrounding HIV diagnoses. In a country where certain cultural practices and beliefs are not the norm, healthcare professionals must respect and balance the parents' beliefs against beneficence towards the child's wellbeing.