Good parents or good citizens?

Taking a tiny risk can serve overall community interests.

THE horror of the case in which a Melbourne girl was infected with the HIV virus through an anonymous blood donation, graphically demonstrates the clash between the best interests of the public and the best interests of a particular individual – in this case, a child.

By definition, it is the obligation of public health officials to recommend that the community adopt behavior that is in the best interests of the public overall. Public health officials cannot, and should not, make behavioral recommendations based on risk assessments for particular individuals.

When the Red Cross rejected the attempts of the girl’s father and mother to donate blood for her operation, they did so in line with studies demonstrating that overall, blood recipients are more likely to avoid HIV if transfused with anonymous, rather than ``directed’’, donations.

But while the Red Cross cannot make individual risk assessments for each patient needing blood, parents can make such assessments for their child.

In the Melbourne case, the parents did just that. Satisfied that they had not engaged in any high-risk behavior in the 22-day period in which HIV infection cannot be detected, these parents sought to lower the odds of HIV infection for their daughter – from infinitesimal to none.

Behind all public health risk management strategies around HIV/AIDS, is the promulgation of distrust of one’s sexual partners, lovers and spouses. No matter what the status or longevity of a relationship, people are advised to wear a condom ``every time’’ in order to avoid infection. Sharing needles is also a no-no, no matter how vehemently a fellow user asserts their HIV-negative status.

Such promotions emphasise the impossibility of a person knowing his or her HIV status, or the status of those with whom she has sex or injects drugs, not the purposeful duplicity of those claiming to be virus-free. But while a ``trust no one’’ stance may be appropriate among strangers or acquaintances, when applied to intimate relationships such as those between spouses, it has the hard and unpleasant edge of an X-file.

I have no reason to doubt Red Cross claims that overall, everyone would be better off if they gave and accepted anonymous, rather than directed, donations. When his niece is faced with life-threatening surgery is not the time Uncle Joe – the only compatible donor – is likely to reveal he had sex with other men, is an intravenous drug-user, or is involved in other high-risk behaviors.

But if it was my child who needed blood, I feel confident I could trust myself, my husband or numerous other family members who might be compatible donors to be straight about their suitability to donate. In bypassing an anonymous donation in favor of a directed one, I would be acting in accordance with a personalised risk assessment strategy that – as a parent – I would feel duty-bound to make.

But while I would not be dissuaded from this position by public health assertions that there is no difference between what is in the best interests of my child and of the larger community, I might be influenced by another public interest-type argument. As an ethicist, I would find it difficult to resist appeals to my sense of duty to act – as an individual – as I know others must act if we are all to achieve the best community health outcomes.

As a parent, I seek to install such a sense of community obligation in my own children. Recently, my little one came home with a tiny animal figurine from the child-care farm set. He knew it was unlikely to be missed, and wanted to keep it at home. ``What if every child took a figurine home?‘’ I asked, putting it near the front door to be returned the following day. ``Eventually there’d be no farm animals for anyone to play with.’’

Should the option of giving a directed donation become available in Victoria, undermining the veracity of the personal risk assessment strategy I have made for my child, would not convince me to bypass this option. But appealing to my sense of community obligation might persuade me, and other thinking people engaged in low-risk behaviors, to put those they love at a tiny, tiny risk in order to model behavior that best serves the overall interest of our community.