Physicians’ primary ethical obligation is to their individual patients. However, physicians also have a long-recognized responsibility to participate in activities to protect and promote the health of the public. Routine universal screening of adult patients for HIV helps promote the welfare of individual patients, avoid injury to third parties, and protect public health.
Medical and social advances have enhanced the benefits of knowing one’s HIV status and at the same time have minimized the need for specific written informed consent prior to HIV testing. Nonetheless, the ethical tenets of respect for autonomy and informed consent require that physicians continue to seek patients’ informed consent, including informed refusal of HIV testing.
To protect the welfare and interests of individual patients and fulfill their public health obligations in the context of HIV, physicians should:
- Support routine, universal screening of adult patients for HIV with opt-out provisions.
- Make efforts to persuade reluctant patients to be screened, including explaining potential benefits to the patient and to the patient’s close contacts.
- Continue to uphold respect for autonomy by respecting a patient’s informed decision to opt out.
- Test patients without prior consent only in limited cases in which the harms to individual autonomy are offset by significant benefits to known third parties, such as testing to protect occupationally exposed health care professionals or patients.
- Work to ensure that patients who are identified as HIV positive receive appropriate follow-up care and counseling.
- Attempt to persuade patients who are identified as HIV positive to cease endangering others.
- Be aware of and adhere to state and local guidelines regarding public health reporting and disclosure of HIV status when a patient who is identified as HIV positive poses significant risk of infecting an identifiable third party. The doctor may, if permitted, notify the endangered third party without revealing the identity of the source person.
- Safeguard the confidentiality of patient information to the greatest extent possible when required to report HIV status.
AMA Principles of Medical Ethics: I, VI, VII
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