Informed consent needed before HIV testing of pregnant mothers: CMA
CMAJ 1997;156:1108
© 1997 Canadian Medical Association
The CMA says physicians should strongly recommend that pregnant mothers be tested for HIV, reaffirming a position outlined in its 1995 Counselling Guidelines for HIV Testing. The issue arose after a motion stating that "all pregnant women should undergo HIV testing" was put forward at the 1996 annual meeting but referred to the Board of Directors; there was some confusion about whether this was a call for mandatory testing. In March the Board of Directors decided that the association's policy will state that HIV testing should "be strongly recommended" for these patients. With rare exceptions, "a patient's informed consent must be obtained prior to testing." (One rare exception involves incapacitated patients whose organs are being harvested for transplantation.)
The question of testing during pregnancy raises major issues for medicine. On one hand, detection of HIV would allow a mother to take medications and perhaps protect the fetus from infection. Detection could also protect the infant after birth by making the mother aware that she should not breast-feed. On the other hand, mandatory testing raises delicate issues about patient rights. The CMA's Counselling Guidelines for HIV Testing make this clear. "If the woman has chosen to be tested," they state, "obtain and record receipt of informed consent."
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