Children with AIDS in the public schools: The ethical issues

Abstract

The question of whether to allow children with AIDS to attend public school generates explosive emotions and has wide-reaching consequences. This paper focuses on the perspective of parents of well children who may be asked to attend school with children who have AIDS. These parents are poised at the heart of the dilemma: they are the ethical “bottom line,” and an argument that fails to satisfy them ought not to satisfy anyone.

The conflicting commitments these parents face are first to the parentchild covenant which requires them to act in their child's best interests, and second, to the principles of beneficence and justice, which require them not to further burden a sick child with ostracism and isolation.

Almost exact parallels exist between this issue and that of proxy consent by parents for children's participation in low-risk, non-therapeutic research. The lengthy and important debate between Paul Ramsey and Richard McCormick on this question is analyzed, concluding that McCormick's position in favor of thoughtful proxy consent is the more compelling. Returning to the question of allowing children with AIDS to attend school, the essay shows why the parallels are persuasive. On the ethical level, the apparent conflict of obligations is almost exactly the same; on the pragmatic level, the essay shows why sharing a classroom with a child who has AIDS is comparable to the “low-risk” category that the National Commission for the Protection of Human Subjects found acceptable in its 1978 guidelines. The essay concludes that parents of healthy childrenmay and ought to accept the presence of children with AIDS in the public school.