October 23, 1987


JAMA. 1987;258(16):2298-2300. doi:10.1001/jama.1987.03400160152049

Two topics will be treated in this review—acquired immunodeficiency syndrome (AIDS) and surrogate motherhood. Each is chosen because it poses a wide variety of fundamental ethical dilemmas and illustrates the formidable obstacles that stand in the way of ethical consensus in our morally pluralistic society.

Without a vaccine or effective cure, primary prevention is mandatory if the world is to avoid a pandemic of human immunodeficiency virus (HIV) infections.1,2 But the methods of prevention—change in sexual behavior, screening, and isolation—give rise to serious, unresolved ethical conflicts.

Behavioral change has been approached in two ways. One way emphasizes moral education aimed at achieving sexual abstinence or sexual monogamy; the other emphasizes explicit sex education, widespread use of condoms and their distribution in schools and colleges, and abortion for seropositive mothers. For many, the first method is unrealistic; for others, the second method sanctions and even encourages morally repugnant sexual practices.