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) coinfe ction to an adolescent boy without symptoms with hemophilia despite the obj ections of his parents. An actual case history is presented and the dilemma faced by the medical team is discussed. Numerous family conferences, all e xcluding the patient, held during the last 5 years discussed the medical tr am's obligation for full disclosure, the emerging autonomy of the patient, and the potential for medical disaster (e.g., HIV transmission) if full dis closure were not permitted. Despite this, the family did not agree to allow disclosure. The patient and parents assured us of his sexual inactivity. L egal opinion was sought from the university counsel. The dilemmas are multi ple. Is there a convincing argument to insist on disclosure of these facts to this patient, particularly when there is ambiguity regarding the appropr iateness 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 m inor?! Is it our ethical responsibility to disclose a probably fatal diagno sis?