AIDS-Infected Health Workers

Your editorial critical of AMA’s statement that HIV-infected physicians should refrain from certain invasive procedures reflects the same helpless emotionalism--and failure to examine the facts firsthand--that has too often characterized AIDS debates in general. The problem of the HIV-infected surgeon is complicated but it is not overwhelming, either as a matter of medical ethics or disease control.

The first thing that is clear is that a physician who has a transmissible and fatal disease should not place his or her patients at risk. That has been the view of the AMA’s Council on Ethical and Judicial Affairs, and most medical ethicists, for a long time. So some restraint on invasive procedures is necessary as a matter of the oldest precept of medical ethics--that the physician shall do no harm.

Secondly, the chief complication of this position cited by The Times involves a policy which AMA does not endorse--mandatory testing of physicians. When the very low probability of a surgeon acquiring AIDS from an infected patient is multiplied by the even lower probability that the same physician would then transmit the infection to another patient, the risk to patients of becoming infected is virtually immeasurable, much lower than the risk that an already infected surgeon would transmit the disease.

Physicians who are at some measurable risk of acquiring AIDS--because they do significant invasive procedures on many HIV-infected patients or for other reasons--do have an obligation to determine their seropositive status in order to protect their loved ones as well as their patients.

Finally, we believe that AMA’s longstanding policy continues to be the best for physicians and patients. It will work because it reflects a fundamental tenet of professional ethics by which the vast majority of physicians abide. Indeed, many infected physicians have voluntarily restricted their practices.

Even if the policy is not universally effective, it is better than any of the alternatives. And patients are certainly better off knowing that the profession has publicly reaffirmed that their interests will always come first.

NANCY DICKEY, MD

Board of Trustees

American Medical Assn.

Chicago