AIDS is spread by acts, not by casual exposure. As AIDS spreads further, some are urging that those acts, including sexual acts, be treated as crimes. Indeed, two AIDS carriers have already been charged with crimes for risking sexual transmission of AIDS to others. In one case, the United States Army has court-martialed an infected soldier, Pfc. Adrian Morris, Jr., charging that when he had sex with two other soldiers, he committed the crime of “aggravated assault.” Aggravated assault requires use of a “dangerous weapon or other means of force likely to produce death or grievous bodily harm.” What was the “weapon” in his case? The sexually transmittable AIDS virus itself. In the other case, the Los Angeles district attorney has charged an AIDS carrier, Joseph Markowski, with attempted murder for selling his blood and for having sex with another man while infected.

Nine years after the appearance of the world's first “test tube baby,” the public is being deluged with technical and ethical opinions about non-coital reproduction. U.S. legislators, policymakers, and lawyers, energized by the court battle about “Baby M,” are reconsidering the rights of would-be parents and of the children created by the new technologies. But in the course of this turmoil one salient fact has been ignored: social policy and technological advances in respect to reproduction are mediated for the individual woman through her interaction with her doctor.

Doctors have gotten by with remarkably little scrutiny in this regard. The perception of them as benevolent magicians has, indeed, been enhanced. The only criticism has come from religious leaders concerned with the experimental use of fetal or reproductive materials, and from those who see the doctor-scientist “playing God.”

Doctors or hospitals facing the issue of withholding or withdrawing treatment from patients voice a number of concerns, some factually based and some less so. One important concern is the possibility that such behavior will lead to an indictment for murder. How realistic is this fear? This article will review the U.S. cases involving withholding or withdrawing treatment, as they pertain to the issue of criminal liability.

The criminal law, in general, has not been used as a tool to regulate medical practice. While criminal actions against medical professionals are not unknown, few such actions arise dircctly from the practice of medicine. A physician charged with Medicaid fraud, sexually molesting patients, or prescribing drugs for non-therapeutic purposes has not been charged with a crime that involves scrutinizing the standard of care he or she uses in practicing medicine. For example, by definition, there is no medical standard for the non-therapeutic use of prescription drugs.

Throughout history, disease has been associated with bigotry and prejudice. Since biblical times the leper has been shunned and treated as an outcast. In the Middle Ages, the arrival of the plague brought with it violent social upheaval and persecution of the Jews. In the earlier part of this century, prostitutes thought to have venereal disease were quarantined en masse.

Given this sorrowful history, it is not surprising that the AIDS epidemic has brought with it mistreatment of persons associated with AIDS, the term I shall use for people who either have or are thought to have AIDS, AIDS-related complex (ARC), or antibodies to the virus that causes the disease. Indeed, considering that AIDS is a sexually transmitted disease that has in this country primarily afflicted homosexual men and intravenous (IV) drug abusers, it is perhaps surprising that overt acts of prejudice have not been more common.

The role of the Centers for Disease Control (CDC) in the development of recommendations and guidelines on acquired immunodeficiency syndrome (AIDS) evolves from a tradition that originates in the earliest editions of the Morbidity and Mortality Weekly Report (MMWR). In 1961 responsibility for the Public Health Service's MMWR was transferred to CDC from the National Office of Vital Statistics. During the first decade that CDC published it, the MMWR continued the tradition of providing detailed statistics on reportable communicable diseases and unusual occurrences of disease or outbreaks of illness. Only rarely did editorial comments on the data appear. However, as early as 1962 the MMWR became the vehicle the Public Health Service used to publish the recommendations of the surgeon general's Oral Poliomyelitis Vaccine Advisory Committee, the predecessor of the current Immunization Practices Advisory Committee. This practice of publishing immunization and other public health recommendations in the MMWR has continued.

George Annas’ review finds most of what is in the Hastings Center’s Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying “solid.” He takes no issue with the major substantive points. The fundamental premise of the book—that patients’ interests must be protected and their decision-making authority defended—is a view Professor Annas has long championed as well.

Despite this basic agreement, Annas’ criticisms would be significant ones if the Guidelines were what he presents them to be. But they clearly are not. As the Guidelines themselves state: These are ethics guidelines; they are not legal guidelines. They are an attempt to offer practical and reasonably concise suggestions for how to make decisions; they are no substitute for the literature on the pros and cons of different approaches to the termination of treatment. They are meant to provoke a necessary process of debate within a health care institution; they are not the final moral truth.