Evaluating Potential Adoptive Children
The publicity about crack babies and babies infected with HIV has made potential adoptive parents very concerned with the health of the baby in question. Less well publicized is the high level of tuberculosis in adoptive children from Third World countries. Physicians examining babies for adoption are subject to malpractice lawsuits if they fail to diagnose conditions, within the standard of care for pediatrics, that would be grounds for not adopting the baby. In some states, physicians may be sued for fraud if they withhold information about the baby that would influence the adoption decision. Since such information may involve the mother’s behavior, the physician must have a written authorization from the mother or a court order before transmitting such information to the adoption agency or prospective parents. There may be a conflict with the physician–patient relationship for family practitioners and others who are treating both the mother and the baby. Evaluating the infant for adoption may put the physician in conflict with the mother if the physician’s determination is at odds with the mother’s wishes.
In addressing the specific problem of HIV testing for children to be placed in foster care or adoptive homes, the American Academy of Pediatrics’ Task Force on Pediatric AIDS [American Academy of Pediatrics Task Force on Pediatric AIDS. Perinatal human immunodeficiency virus (HIV) testing. Pediatrics. 1992;89:791–794] found the following:
In response to the legitimate need for preplacement HIV testing of the infant or child in areas of high prevalence of HIV infection in childbearing women, procedures should be established by foster care and adoption agencies in collaboration with medical care facilities, to accomplish the following.
1. Develop the expertise to provide prospective foster care or adoptive families with comprehensive and up-to-date information regarding all aspects of pediatric HIV infection.
2. Establish a process that would accomplish, with the appropriate consent of the infant’s legal guardian, the preplacement HIV testing of infants or children, initiated either (a) at the request of the prospective adopting or foster care parents through the physician who is responsible for that child’s care, or (b) through the request of the infant’s physician in response to his or her judgment that the mother is at high risk for HIV infection and that the infant’s health supervision and/or placement may be affected by knowing the infant’s antibody status.
3. Provide comprehensive and up-to-date interpretation of the meaning of test results, taking into account the age and health status of the child and the reliability of the test.
4. Establish a record-keeping system to contain information regarding the child’s test results with access to such information strictly limited to those who need to know, but specifically including the informed adoptive or foster care family and the physician responsible for the infant’s medical care.
5. Establish a procedure whereby all infants who have positive results on HIV antibody tests are retested on a regular basis to distinguish between passively transmitted antibody and true HIV infection in the infant.