On Defusing an AIDS Time Bomb

If a killer were loose in your neighborhood, you would expect him to be hunted down. If someone were walking the streets, fatally injuring people, you would expect him to be stopped.

But if that someone had AIDS and was transmitting the disease to other people on purpose, it turns out there is virtually nothing that can be done to stop it.

This week, a Washington-area psychiatrist wrote a chilling article in the Washington Post. Her name is Dr. Lise Van Susteren.

She wrote: “. . . a deeply disturbed bisexual AIDS victim is, I fear, deliberately trying to infect other people with his disease. He knows it could kill them. Sometimes it bothers him; at other times he seems indifferent.

“He once told me, ‘At first when I found out I had AIDS, I decided not to have sex with anyone, and then I just got angry and said: ‘Let’s conquer the world.’ ”

The doctor has been treating the man for more than a year and knows who he is. That is not the problem.

“The case has been a nightmare,” the doctor wrote. She said that she was torn “between my gut feeling to call the police and my professional ethics then requiring that I keep my patients’ disclosures secret no matter what.”

The doctor said the real shock, however, was that the system is virtually powerless to do anything. She emphasized her story “must not become an excuse for intolerance” and pointed out that the vast majority of AIDS patients “act responsibly and courageously toward the rest of society.”

But what happens when one doesn’t?

In early 1987, the patient in question told Van Susteren that he had tested positive for the AIDS antibody. In the past, she had treated him for multiple-personality disorders and had encountered two of his personalities--a sexually promiscuous one and an evil one.

The doctor remembered his stories about numerous one-night stands and group sex encounters. Naturally, she asked the patient if he was still having sex.

Yes, he said. And, no, he was not using condoms or taking other protective steps.

“Did he know that the AIDS virus would likely kill everyone who had it? Yes, sort of, he realized it. Did he realize that having sex with people was almost like handing them a death sentence? He guessed so.”

The doctor, to her immense credit, decided she could not let the man go back on the streets. But how could she stop him? Could she call the police and rat on her own patient? And what could the police really do?

Fortunately, the man agreed to be admitted to a hospital for the weekend. But he wouldn’t be kept there long. So what should the doctor do? She called several lawyers and got conflicting advice. Van Susteren knew of the Tarasoff case in California in 1976 in which a therapist was held responsible when he didn’t warn a woman of his patient’s intent to kill her (which the patient then did).

Van Susteren decided to call the police. Then she changed her mind. And called the hospital instead and told them the whole story. Several days later, the hospital called to say they were releasing the man. “Incredulous, I reminded the caller of the patient’s homicidal intent,” the doctor said.

The hospital said there was nothing it could do. The man was released and came back to see Van Susteren. He told her he was living with a bisexual man who was promiscuous with women. The doctor was convinced her patient was telling the truth.

Again, the doctor went to lawyers, other psychiatrists, and finally to a judge to have the man involuntarily committed. The judge signed the commitment papers, but the police could not find the man and when the order expired in 48 hours, the judge would not issue it again.

It was a “murder” case, the judge said, and he could do nothing without the name of a victim.

The case went on and on. The patient went into hospitals and got out of hospitals. Law enforcement was sometimes interested and then lost interest.

The patient has now been on the streets for more than a year. The doctor says she has no reason to doubt that he is seeking out people to infect with AIDS.

“How has a man with murder in his heart, who is sick and is asking for help, been allowed to wander the streets?” the doctor asked. “No one has wanted to take a stand on this controversial issue. How many people will suffer the consequences?”

I don’t know how many people will suffer, but I’d be glad to take a stand. First, confidentiality has limits. A lawyer must keep confidential conversations with his client. But if a client tells his lawyer: “I’m going to kill the President tomorrow,” the lawyer has a duty to warn the proper authorities.

If a patient tells a psychiatrist that he is infecting people with a deadly virus, the psychiatrist should have the same duty to warn.

That’s the first step. The authorities should then have the right to quarantine the patient. That’s the second step. Don’t misunderstand me. People with AIDS and people who test positive for the AIDS virus should not be quarantined. The only people who should are those few who refuse to stop putting others at risk, people like Van Susteren’s patient.

It’s not a perfect solution. But I don’t see much choice.

Murder is murder whether you do it with a gun or with a disease.