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Discussion

HIV Testing without Consent

Hi all. To give a little background I am a relatively new RN working the 11-7 shift at an inpatient psych unit. One of our jobs in the morning is to obtain any labs that the doctor has ordered. As I was reviewing orders, I saw an order to obtain a blood sample for HIV testing from a patient this morning. At our facility, we have a special consent form that is retained in the patients chart stating that the physician has spoken with them and they consent to being tested for HIV. This morning I asked the patient if the physician had spoken with them about me obtaining a blood sample. The patient stated that no the physician hadn't spoken with him and he hasn't talked to the physician in a couple of days. So I didn't draw the blood sample. During report I spoke with the physician and the physician states "Let's just tell him that it is for something different like a blood sugar or something." Apparently in my state, HIV testing can be obtained without consent for the purposes of diagnosis, treatment, or protection of health and safety according to the National Clinicians Consultation Center. But doesn't this seem like an ethical issue? I always thought that the physician was supposed to explain it to them and we were supposed to get the consent and answer any questions they may have. I guess I am just having trouble wrapping my mind around this and would appreciate any guidance.

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    HIV testing can also be done in my state without consent. However, that is generally limited to samples being obtained after healthcare providers have suffered needle stick injuries. We do not need written consent for routine HIV testing but generally the physician should have at least made the pt aware that they are checking, as some pts do choose to not find out.

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    Regardless of legalities, it seems unethical to test for HIV without the patient's consent unless there is an exposure involved. Having a positive diagnosis on their medical record can have long term repercussions, particularly regarding insurance, and unless someone else's health is on the line patients should have a veto over testing.

    And to lie to the patient about what you are testing for seems even worse.

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    Accd'g to your post, your facility DOES HAVE a special consent for HIV labs, so it would be absolutely necessary for you to follow your facility's P&P. Failure to do so could leave you high & dry by yourself. You could likely be fired, face licensure issues, be sued, etc. Your facility won't stand behind you and the physician ??? I don't think soooooo. And what does your State mandate? Could you be breaking the law?

    And there is the major ethical issue of trying to circumvent the pt for his informed consent.

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    I don't consider HIV testing any different than any other test.

    We don't sign consents for CBC's, or other labs, so unless there is a law in your state that says that you have to? He can order any test he wants.

    However, if a patient specifically asks what the test is for, it is an ethical issue to lie about it. It's because it's the patient's right NOT to subject themselves to a needle stick if they don't wish to...even if a nurse is stuck by a sharp, etc.

    I had a nurse after a surgery that cut herself with a sharp and they came up to take my blood. I am a very easy stick, but after surgery, I was depleted. They stuck me eight times and I told them to stop...the nurse said, "We have to take this"...I said, "You can't take anything that I don't allow you to take...you can do the blood draw later, but I'm in pain and the last thing that I need to be subjected to is more pain." They took a draw two days later and it was no issue and of course, was negative.

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