State laws should be revised to allow HIV testing of patients who are unable to consent to the procedure, the University of Pennsylvania School of Medicine's Scott D. Halpern, MD, PhD, said in a recently published article.
Other than heritable genetic disorders, HIV is the only medical condition for which explicit consent is required prior to testing. However, a variety of conditions may leave a patient unable to consent. Knowing the HIV status of such a patient may lead to earlier use of life-saving therapies and reduce the burdens associated with unnecessary procedures.
"Sometimes, when doctors are frustrated by their inability to obtain information that is vital to treat their patients, they order other tests to assess a patient's immune function," according to Halpern. "But in critically ill patients, these tests provide less reliable information than do true HIV tests. Furthermore, testing for immune function without consent runs counter to the spirit of legal restrictions on HIV testing; and it is wrong to put doctors in the awkward position of having to circumvent restrictions in order to properly care for their patients."
Halpern cited four reasons why the requirement should be lifted:
*The testing may improve care for critically ill patients.
*If competent and aware of their circumstances, most patients would likely consent. Therefore, allowing the testing shows respect for their autonomy even if they cannot articulate consent.
*The need to consider HIV as an exceptional illness requiring exceptional policies has diminished.
*Social epidemiology does not justify exceptional HIV policies because other illnesses share HIV's propensity to affect underserved populations.
Halpern discussed several alternatives for caring for patients who cannot consent to testing. However, surrogate consent is potentially antagonizing, raising the specter of HIV infection among those who may not have known the patient was at risk. Obtaining a court order is another route, but the delay in treatment may lessen its usefulness.
Halpern's article, "HIV Testing Without Consent in Critically Ill Patients," was published in the Journal of the American Medical Association (2005;294(6):734-737).
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