As of right now, in order for any medical professional to perform an HIV test, a consent form must be signed, either by the patient, or a proxy for the patient. There is a single exception: when a medical professional is exposed to bodily fluids that could transmit HIV (such as blood), tests can be performed without the consent of the patient, as the safety of the professional takes precedence over the privacy of the patient.
The interesting thing about this law is that this consent isn't required for other tests, such as Hepatitis B and C. While a patient can certainly refuse to allow these tests to be run by refusing to give a sample, most people generally don't know when these tests are going to be run, because a physician orders them without telling the patient what is being ordered. There have been more than a few times when I've gone into a room, and patients have asked me what tests are being run. When I explain it to them, some even ask me why the tests are being run. Of course, I don't know, because I don't know their history and why they're in the hospital. I just know what blood tests the physician ordered.
So, why is it that HIV is treated so special? I mean, Hepatitis C doesn't have any sort of prevention or treatment; you're stuck with it once you have it, and liver failure generally isn't all that pretty. Cancer can be a death sentence, depending on the type and severity of the cancer, and yet blood tests can be run without any consent that can test for these. HIV is now a treatable disease, and people live for decades before succumbing to the diseases of AIDS.
Granted, I wouldn't like the idea of going in for what I think is a simple blood test and coming out to my physician telling me I have HIV. But what about individuals who can't give consent? Recently, we had an HIV test ordered for someone in the ICU. When I went to draw the blood, I spoke with the nurse (as most people in the ICU have really bad veins, and they're very difficult to get adequate amounts of blood from, so most tend to be line draws, which only nurses can do). She told me (rather rudely, actually) that she hadn't given consent, and they couldn't find any family to give consent for her. So, the test had to be canceled eventually. Depending on the reason she was in the ICU, that piece of information could have helped her in the long run, should she have survived her stay.
So, my question for you is simple: should HIV require consent, as it currently does, or should it be like all other blood tests (implied consent by submitting to the blood draw)?
I think it should be implied consent, especially in cases where there may have been transmission of bodily fluids that can transmit HIV (and isn't it already implied [or consent is required to continue] for things like blood donation?).
It's a treatable disease and can be best handled before the immune system is so shot that the person is back in the ER with half a dozen diseases from opportunistic strains that have gotten into the bloodstream.
Not to mention the fact that doctors should assume that an adult is sexually active, and for the safety of anyone involved with the person, the patient should be tested.
The only rationale I could see for requiring consent is that it's an expensive test and insurance doesn't want to cover it or something.
I am treated as evil by people who claim that they are being oppressed because they are not allowed to force me to practice what they do. ~D. Dale Gulledge
....that it is inherently unethical to perform ANY medical procedure on a patient without his or her consent. And to fend off the obvious question, I define "normal circumstances" as any situation in which the patient is conscious, competent and capable of providing (or denying) that consent.
TTFN,
Blackout
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A question of love.
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But MOST medical tests have implied consent, where by submitting to the testing procedure, you're allowing the test to be run. So, if I draw blood on you, you're consenting to the tests that that blood was ordered for, whether those tests be for medical reasons or not. You can refuse to have the tests run by refusing to have your blood drawn. That's completely within your rights as a patient. HIV is the only blood test (with the possible exception of paternity testing) that requires written consent. Even other blood borne pathogen testing, such as Hepatitis C (which is, in some ways, more serious than HIV, because it can't be slowed or prevented in any way).
So, should HIV be different? That's the question I am asking.
~C
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...but whenever my doctor wants to run a test, he tells me first. Even though he knows that I am a diabetic and I know that he knows (obviously), he always says, "I want to draw some blood to check your A1C." Of course, people aren't regularly dropped from their insurance, fired from their jobs, kicked out of their homes and ostracized by their families when they are diagnosed with diabetes, but that IS a very real concern when dealing with a person's HIV status (which is of course the source of much of the onus on gaining prior consent for HIV testing). I don't let my doctor test me for HIV, though I DO get tested regularly through a local clinic that does anonymous testing. That way, if I am ever diagnosed HIV+, I am in control of what happens next.
To quote the American Medical Association, "Standards of medical ethics place great emphasis upon respect for patients’ self-determination." (LINK) How can a patient make reasonable, informed decisions about his or her own heathcare if they don't even know what you're doing to them?
There are a lot of problems with the implied consent model. The following quote from the AMA is specifically speaking about blood donations, but think it is applicable, here...
It seems to me that the key to answering your question would be to ask you why would you want to perform an HIV test (or ANY test for that matter) on a patient without telling them?
TTFN,
Blackout
---
A question of love.
---
Check out Progressive PRIDE, a Gay-Straight Alliance for the Progressive U community.
Actually, my NP/PA (I haven't had a doctor since I left my pediatrician, with the exception of optometrists, who haven't had to run any blood tests on me) never told me exactly what tests they were running. They'd reference what they were testing for (general health, most of the time... I almost always went in for a blood draw on a physical, though once she told me she was testing my thyroid because it might've been the cause of the problems I was having at the time). If I wanted to know, I had to ask the people drawing my blood. Of course, I was treated in a military hospital, and they tend to function a little differently than their civilian counterparts.
Now that I'm on the other side of things, and actually drawing the blood, I get asked at least once a day what tests are being run. Then, right after I tell them the tests, 9 times out of 10 they will ask me what the test is and why it's being run. Things like CMPs and CBCs are easy... they're things that test the general health of a person. But I don't know why a doctor would order a renal function screen (the guy figured it was because they wanted to do an MRI with contrast and wanted to make sure the last contrast didn't mess with his kidneys). People who come in regularly for blood draws... the diabetics like yourself, the coumadin patients, the schizophrenic patients... they all know what's being tested and why. But the people who aren't in the hospital that often usually don't have a clue why they are asked to give blood 2-3 times a day.
That's the reality. Should it be that way? Of course not. Then again, most patients aren't that proactive in their healthcare in the first place... something that has to change if we want the healthcare system as a whole to change.
~C
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I guess what I should be saying is that consent should always be given first, but on this topic I'm iffy.
You see, I look at it this way: These are serious diseases. Wouldn't it be important for these people to know what they have, especially if it is transmittable to another person? So even if they never were asked about the test, I think that's an important thing to know.
So I guess that's where I'm stuck. Usually I'm on the side of consent, but unless someone wishes to remain completely unaware of a disease they may have, this is something that should be tested for.