Unconsented HIV Testing in Cases of Occupational Exposure: Ethics, Law, and Policy

Authors

  • Ethan Cowan MD, MS,

    1. From the Department of Emergency Medicine, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Jacobi Medical Center (EC), Bronx, NY; and the Department of Epidemiology & Population Health, Dr. Shoshanah Trachtenberg Frackman Faculty Scholar in Biomedical Ethics, Albert Einstein College of Medicine, Jack and Pearl Resnick Campus (RM), Bronx, NY.
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  • Ruth Macklin PhD

    1. From the Department of Emergency Medicine, Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Jacobi Medical Center (EC), Bronx, NY; and the Department of Epidemiology & Population Health, Dr. Shoshanah Trachtenberg Frackman Faculty Scholar in Biomedical Ethics, Albert Einstein College of Medicine, Jack and Pearl Resnick Campus (RM), Bronx, NY.
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  • EC is supported by a career development award from the National Institute of Allergy and Infectious Diseases (5K23AI078755-04). No authors have any financial arrangements that may represent conflict of interest.

  • Supervising Editor: James G. Adams, MD.

Address for correspondence and reprints: Ethan Cowan, MD, MS; e-mail: ethan.cowan@nbhn.net. Reprints will not be available.

Abstract

ACADEMIC EMERGENCY MEDICINE 2012; 19:1181–1187 © 2012 by the Society for Academic Emergency Medicine

Abstract

Postexposure prophylaxis (PEP) has substantially reduced the risk of acquiring human immunodeficiency virus (HIV) after an occupational exposure; nevertheless, exposure to HIV remains a concern for emergency department providers. According to published guidelines, PEP should be taken only when source patients are HIV-positive or have risk factors for HIV. Initiating PEP when source patients are uninfected puts exposed persons at risk from taking toxic drugs with no compensating benefit. Forgoing PEP if the source is infected results in increased risk of acquiring HIV. What should be done if source patients refuse HIV testing? Is it justifiable to test the blood of these patients over their autonomous objection? The authors review current law and policy and perform an ethical analysis to determine if laws permitting unconsented testing in cases of occupational exposure can be ethically justified.

Abstract

Resumen

La profilaxis post exposición (PPE) ha reducido de forma substancial el riesgo de adquirir el virus de la inmunodeficiencia humana (VIH) tras una exposición ocupacional; no obstante, la exposición al VIH continúa siendo una preocupación para el personal de los servicios de urgencias. Según las guías clínicas publicadas, la PPE debería realizarse sólo cuando los pacientes fuente son VIH positivos o tienen factores de riesgo para el VIH. El inicio de la PPE cuando los pacientes fuente no están infectados sitúa a las personas expuestas en riesgo de tomar fármacos tóxicos sin que el beneficio compense. Renunciar a la PPE si la fuente está infectada resulta en un riesgo aumentado de adquirir el VIH. ¿Qué debería hacerse si los pacientes fuente se niegan al test del VIH? ¿Está justificada la analítica de sangre de estos pacientes por encima de su objeción autónoma? Los autores revisan la política y la ley actual y realizan un análisis ético para determinar si las leyes que permiten la prueba sin consentimiento en casos de exposición ocupacional pueden estar éticamente justificadas.

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