Medical arrogance

Several years ago, the government recommended universal HIV testing of expectant mothers in order to reduce the chances of transmitting the virus to their children. So far, only Waikato DHB has implemented the scheme, but it has already thrown up a significant problem: a large number of doctors aren't asking the patients first:

Waikato's programme, which began in June 2005, achieved 99.7 per cent uptake of the HIV test in the first 12 months by making it one of six routine antenatal tests and giving women the opportunity to opt out.

Two of more than 9000 expectant mothers tested were found to have HIV. Both their babies were born free of the virus.

However, Mrs Campbell said she was disturbed that 12 per cent of doctors who responded to a survey admitted they did not discuss the test with their patients beforehand.

While the scheme is opt-out, patients must be given the opportunity to do so. By not discussing the test, these doctors are denying their patients that chance, making a mockery of the requirement for informed consent. This isn't just a gross violation of medical ethics; it also violates the BORA ban on involuntary medical treatment, exposing the government to legal challenge and claims for damages.

As for the doctors, their justification is typical: they know best, anyone who thinks otherwise is just "politically correct", and people should just shut up and let them get on with it. That's the sort of thinking that led to the "unfortunate experiment", and its sad to see that it is still alive and well in our medical profession.

As for the policy implications, I think they're pretty clear: opt-out relies on doctors to behave ethically, explain what is being done and why, and give people the chance to refuse. If they can't be trusted to do that (and pretty clearly, a unacceptable proportion of them cannot), then we must return to explicit opt-in. That will likely be less effective, but that's the cost of medical arrogance.