To think consent is required to do a HIV or hepatitis blood test??

As the drs on the thread have explained, if there is a clinical reason for doing so we do tell people. The op is referring to the routine screening of all a&e pts which is something different

The consent is, "you're unwell, we are trying to find out why, please can we take your blood?"

its pretty damn hard to take blood without consent, having spend a year working on dementia wards

Yes.

And typically when I have had that done (rarely) they have gone through with me in detail what tests they are sending away for and why.

(I have never had diagnostic tests done on the NHS or even in the UK so maybe they are less bothered about ensuring patients are fully aware of what is being done and why.)

OP hasn't come back to the thread yet, but I assume her issue is around informed consent. If there's a clinical reason to test for something, what's the problem expecting a Dr to explain that to their patient?

From the NHS website about consent “Consent to treatment means a person must give permission before they receive any type of medical treatment, test or examination”
The example of a nurse doing a blood test is given.
Consent is required.

I would like the choice to decline any and all testing because I believe in bodily autonomy and the right to informed consent

I just don't understand why you'd object to this.

How would people feel if the test in question was liver function tests? These are also frequently done on first presentation in A&E for a number of conditions, along with assessment of kidney function, blood counts and inflammatory markers.

What about checking the cholesterol and diabetes status of people with heart disease?

FWIW I do think as HCP we should tell people what tests we are requesting (and I do so long as people are well enough), but I suspect this is more about misplaced perception of prejudice relating to HIV, than a blanket concern that HCP are looking for underlying causes of disease without explicit consent.

When you go in to A&E and they take routine bloods to find eg infection markers for pain etc etc they don't tell you the individual breakdown of things they are looking for / requesting. They just say we will take a few tests, take a couple of vials of blood and on they go. Nobody questions what things they are being tested for but I am sure if you asked, you'd be told.

Why would looking for tuberculosis cultures for example not be scrutinised but looking for HIV would? I agree with stigma as PPs have said.

People put a lot of responsibility on other people when in actual fact, it costs you nothing to simply ask 'could you please let me know the exact things you're testing me for before you take my blood'.

It would take forever for eg when I send an fbc off I get about about 12 different sub components of the blood back. Most I'm not bothered about as I'm not a haematologist but to sit and explain every one would take an age and lots of cell diagrams

Another eg ... vascular patients are high risk for diabetes, if they haven't had a test in the last 12m it should be done as part of their admission, we don't always (often do) say we are specifically testing it. Same with recurrent abscesses, more than one abscess needing iv antibiotics or surgery = diabetes check. There is so much we do routinely that is just part of the job that if people consent to treatment comes as part of that.... would you rather not know you have diabetes and hence no treatment and risk vision loss/toe amputations etc... its not much different

HIV testing / Hepatitis testing is and should be becoming more routine, it is in pregnancy, it actually disadvantages those who don't become pregnant if they are never tested. Would you be upset if they had tested you for high cholesterol or diabetes ?

Genetic testing takes a huge amount of counselling. We have to consent parents for genetic testing at times, and the consent form has to cover things like incidental findings which can have a massive implications.

As others have posted, back in the 90s it was certainly the case that just having had an HIV test was a negative marker for some insurers, leading to either higher premiums or no cover. Not becuase you had a positive result, but becuase the fact you'd even had a test was an indcator you led a more 'dangerous' lifestyle.

Now, thats not the case today, so at one level there is no problem. However, with the current government talking about selling access to anonymised medical data to 'turbocharge growth' I think it's even more important than ever that consent is given for every test / procedure

When it’s a clear yes/no diagnostic result the test should be explained beforehand. All illness checked for in a blood test needs consent for the test.

I did read your post. My point is that posters are great if people can read them, no it everyone is literate, not everyone is able to read English etc.

I also understand that when someone is unconscious you can't get consent. I've had to be part of many debriefs with patients where we have had to discuss investigations and giving medications and blood to save lives.

Back in the day your insurance would have been affected by the mere fact of having a test. And gay people couldn't get mortgages. Thankfully we live in more enlightened times and HIV is now treatable

Yes, I was about to say this. When I took out my first mortgage and the associated life insurance in about 1990 one of the questions was "Have you ever been tested for HIV?". Even if the test had been negative it was highly likely that you'd be turned down as the thinking was that if you'd had the test it was only done because you were at high risk of being positive and therefore even if you weren't infected at that stage then you would be at some point before you'd paid off your mortgage! So in those days it was a test you definitely didn't want without a good reason. I think it's very different now though.
That said, as a matter of principle I do think you should be told if your blood is being taken for anything other than your particular clinical need at that visit. I can see the rationale of "You have X infection which is commoner in HIV positive people so we need to check for that" - that is related to the clinical condition and when I've had bloods taken when I've been ill I certainly haven't given specific consent for every single test. If I have asked what the different bottles are for I've always been told but nobody has ever gone through the pros and cons of every test with me, which I think is fine if it's a standard panel of tests needed to diagnose or treat a given condition. But I think if it isn't, you should be made aware. I don't think it needs to go as far as formal written consent or anything but it should be clear to patients if they're entering a screening programme. Easily accessible written info like posters is ok for most people I suppose but it does assume that everyone can see, read and understand them which isn't necessarily the case.

So... when your clinician tells you that you're having some diagnostic /investigative blood tests ... do you expect to discuss and consent to each and every one individually?

If you read my previous post.... in a&es that routine screen there's posters everywhere, opt out if you want. Hardly our fault people don't read posters, given the a&e wait times I'd have thought they'd have been read out of boredom if nothing else

In anyone we are testing on a ward, we tell them "you've got an infection that's quite outside the normal realms for your age/health issues etc, as part of our investigations for this we look for various infections such as hiv, is that OK with you?" Never had anyone say no

The only time I don't consent is when their intubated on icu, and they just get subjected to every investigation we can to try to make them survive

Yeah it was predominantly stigma and insurance reasons that was opt in before, particularly since historically there wasn't really treatment but now there is

Huntingtons is a huge consent process with psych/genetic counselling etc etc as it has no known treatment and devastating

The tests were for "infection markers"
HIV is one possible infection.

You're only thinking it's different because you think there's some stigma/implication of immorality that you associate with the very possibility of this infection.

You've gone to the doctor to investigate what is wrong with you and your doctor has sent you for investigative blood tests. What is the problem? What do you want them to do, just guess?

Someone older than me might be able to explain this better, but my understanding was that people used to have to actively consent to these tests because once a condition is known then people were refused things like mortgages, life insurance etc.
Obviously treatments policies and attitudes have vastly moved on but I think thats what started tests like HIV being opt-in rather than implied consent.
I guess like you wouldn't test someone now for huntingdons disease without proper consent and counciling first.

why?
would you object to having your kidney function checked?

I get that. When I discuss blood tests and screening, a lot of people aren't that bothered about knowing or understanding what it is but I need informed consent. I totally agree finding out HIV infection early is very beneficial but not everyone will want to be screened for it for various reasons and that is their right. It just doesn't sit right for me that you don't tell people what they are being tested for. Posters are good if people can read them.