A Press Release Is No Prescription : What is to be done when a doctor or dentist has AIDS?

AIDS not only ends in certain death, it also continues to force doctors and dentists through one ethical minefield after another.

The American Medical Assn. and its dental counterpart touched off one such mine the other day in an apparent attempt to calm the most natural fear imaginable among Americans conversant with the case of David Acer, a Florida dentist who died of AIDS. What they did was ill-considered, illogical and may well have alarmed more people than it could possibly soothe.

The federal Centers for Disease Control has concluded after a long investigation that three of Acer’s patients were infected while they were in his dental chair with the human immunodeficiency virus, which causes AIDS. The remotest chance of a recurrence elsewhere is enough to invoke a sense of dread.

Even though Acer’s is the only such case on record after 10 years of the AIDS pandemic, the two Washington-based associations apparently felt that America’s medical and dental patients--and that includes most of us--should not suffer in silence.

Their solution was to call on doctors and dentists infected with HIV to voluntarily refrain from surgical practice or to announce their condition to their patients. Even with the best of intentions, it is probably an unworkable public relations gimmick.

The most serious count against it is that the advice runs directly contrary to one of the basic tenets of the fight to curb AIDS--that forcing people who are infected with HIV to undergo mandatory testing or to disclose their condition just drives them underground, out of reach of medical help.

Another is that although the CDC has persuasive, but circumstantial, evidence that the patients became infected in Acer’s office, they must guess at just how it happened. Thus the medical associations can only guess that their idea would have spared Acer’s patients.

Finally, and perhaps most persuasively, the proposal won’t work. Doctors or dentists who announced that they were infected would, in effect, be announcing their retirement.

What will work? That is yet another ethical minefield, now being approached by the CDC as it examines arguments for and against regulating health-care workers who are known to be infected with HIV.

Any solution must end the dread for patients of not knowing, but without throwing the nation’s health care system into further turmoil. That will take more thought and debate than went into last week’s Washington press release.