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

[Onionbhajisandwich]

Hi all,

Please tell me if I’m wrong here but do the NHS require consent to test for HIV or Hepatitis?? I would have thought they did.

I attended A and E last month (sent by my GP) as I had suspected pneumonia. I received a text today stating this:

“You recently attended the Emergency Department. We are part of an NHS programme testing for HIV, Hepatitis B and C but your test wasn't processed due to technical issues. Please attend one of the walk-in blood test centres, Mon - Fri 8am- 4.30pm. We requested the repeat test electronically, so please give your NHS number on arrival. We will only contact you if the test is positive and you need care”

I’m a bit surprised that they can screen you without consent - as far as I knew the blood tests that they did we for infection markers and a full blood count, along with one that checks for clotting.

I won’t be attending to get the tests done as it’s within work time but aibu to think this isn’t ok??

Also to look at the post about medical staff making decisions without consent from next of kin. That is patently not the case or we wouldn't have had the circus with that boy who was clinically dead, but his mother had on life support for months with court cases.
It's quite complex @ARealitycheck
Doctors can make decisions in the best interests of patients who lack capacity but it is best practice to involve next of kin/other people who have a legitimate interest. Ultimately though, doctors make medical decisions. We had this with a relative who lacked capacity, with lots of "best interests meetings" involving the family, carers and various health professionals but it was the doctors who signed a special consent form for treatment, not us as next of kin. We came to agreement, which I imagine is the usual outcome in most cases, but if there is impasse then I think medical staff would generally seek a court order. It's rare though, which is why such cases hit the headlines. Legally doctors cannot be forced to provide futile treatment but of course there are sometimes differences of opinions even between specialists so legal intervention is sometimes needed, to protect all involved. But most of the time families and HCPs can come to a resolution without needing to involve lawyers.
Medical staff should be well trained in matters relating to consent and have a good understanding of the Mental Capacity Act, Deprivation of Liberty Safeguards and so on, but in my experience it is very variable.

Again… because your patients lack capacity!

hence the reply to the person who was talking about patients who lack capacity. (and with insight that that's not what the thread was originally about, but attempting to clarify some of the nonsense that's being posted with a misguided tone of expertise)

To be clear I tell patients when I am ordering an HIV test, but I couche it in terms of it being routine screening as it can be asymptomatic but have devastating consequences if untreated.

@MrsAvocet Thank you for the reply. It is worrying to me that some posters believe that Dr's have this sort of complete right to carry out certain things without outside consent from relatives or if an impasse is reached, somebody who is impartial deciding on it, ie the courts.

But what is being discussed is when that HIV test is done without consent being sought, using a get out clause that 'oh we have posters saying you must object if you don't want one'. That is not and should never be acceptable.

It was disorienting when my baby was in NICU how little input I had into her care. I was barely even informed about, let alone asked for consent, as to what was taking place. In fact I was pretty much entirely irrelevant to the situation. The only thing I recall being asked for my consent about was what brand of formula they should give her 😂,

Well it is true that, unless they have Lasting Power of Attorney for Health and Welfare a relative cannot actually consent on behalf of someone who lacks capacity, and "next of kin" doesn't really have any legal basis. But, apart from in emergency circumstances, staff should make an effort to determine what the likely wishes of a patient who lacks capacity would be and that often involves speaking to family. Relatives shouldn't be made to feel that they are responsible for making major medical decisions but we should have a voice.
I honestly don't think I have met any doctors or other healthcare staff who don't genuinely believe they are acting in their patient's best interests but I have met quite a few who are poor communicators and who don't seem to have read the GMC guidance on decision making and consent or the Mental Capacity Act recently! But we digress...

That's a miscommunication on their part. We never ask permission to withdraw treatment, that is a medical decision and on us only (we would never want a family to feel responsible for their loved ones passing). We don't ask permission to do traches, we are more trying to determine the patients wishes via your thoughts on the matter (occasionally people would have predetermined wishes "never to be on a breathing machine" for eg. But again it's a medical decision, we are seeking your opinions but it's not asking permission. Noone but a power of attorney can consent on behalf of another outside of paeds

That is medically incorrect we never remove breathing tubes to check for responses. It's having a tube in that causes someone to gag when sedation is lightened that causes the response. You can remove a tubebwithousomeone having adequate tidal volumes, low enough oxygen requirements, ventilator support, good cough, and obeying commands

No treatment on icu do we ask permission to do. We seek the relatives opinions on what the patient may want. Never permission

Well I can only speak from experience, and my family most definately were asked for permission to remove the breathing tubes and create a tracheotomy. This was a few years go granted, but if that is something else that has changed in recent years, then I find that worrying in terms of how the NHS is treating the concept of consent.

As others have said unless there is a LPOA decisions are taken in best interests- it has been this way dor at least 10 years.

It is 15 years since I had a baby but they tested pregnant mothers for HIV as routine at that point. It is as much about keeping a track on how many have it, as much as it is about ensuring it isn't passed on to babies. Presumably it helps inform public health spending as well as clinical needs of different groups within the population.

Do I think that is best pratice ? No
Can I see how that could happen in a busy A&E ? absolutely.
Just for interest what is about BBV that requires specific consent ?
I would say something like " I am taling blood to check your liver, kidney and thyriod function" but other people may just say " routine bloods" which isn't wrong.

Similarly I tend to say " I am checking for hepatitis, hiv, syphylis, gonorrhoea, TB and chalmydia because thse infections can be asymptomatic and are easy to treat but I could just say I doing an infection screen. Again that wouldn't be wrong.

Yeah has been the case since 2009 when I started uni. Been working on icu since 2015

I find that worrying in terms of how the NHS is treating the concept of consent

It really is a problem in the NHS- both in terms of culture and policy.

I think the problem here os one of perception. A doctor says I think it would be a good idea to extubate/ fashion a tracheotomy or get a DNAR in place. The family 9 times out of 10 or maybe even 99 times out of a hundred say " yes that sounds sensible/ you are the expert " or something along those lines. The family erroneously belive their cinsent has been sought and given. The reality is the clinician was informing not asking.

Yes I understand.
I was replying to the concern about the culture and policy in the nhs around informed consent. I think it’s a disgrace.

Again I can only speak from experience and it was around 30 years ago when I think back. But my father was asked to give permission for a tracheotomy to be carried out, they pointed out the risks of inability to speak afterwards, along with the possible benefits.

If situations like the lady before and her baby in pitu are common. I'd suggest there does seem to be a mentality among medics that only they no best and we shouldn't question or delay. That is a serious concern for us patients, especially when the subject in this thread is lack of clarity when running a test for HIV without reasonably finding out if a patient gives consent.

You get those tests if you give blood too. But I do think it should be an option in your case.

I hope to goodness I never meet you, I cannot fathom how people still wish to hold on to these stereotypes and stigmas from the past. Surely you have been educated enough since those adverts and the 80s to learn that people with HIV and Hepatitis are the same as everybody else and want compassion not someone stepping back.

I am in my 40s and would most certainly not take a step back. As you say, people living with blood viruses already have had to deal with that stigma already and I most certainly would not be adding to their discomfort.
Do you not learn from history? All sorts of things have changed since the 80s - new advice on using car seats/ not smoking/ using sun cream / new treatments etc etc. I’m sure you don’t hang on to everything you did in the 80s do you?

So do you really want to still live with outdated views on blood viruses? And fuel the stigma that clearly still lives on?

https://nat.org.uk/news/new-polling-shows-hiv-stigma-still-widespread/

It isn't just me. It is large swathes of the population. The stigma towards those with HIV & aids still exists and never went away. As I said in my post, I know there is no logical reason for my or others thinking there is a risk to ourselves.

But when this level of concern still remains, I'd suggest the population is not ready for HIV testing without consent being reasonably sought.

That PP never said she wanted to live with that stigma- she said that it’s still real and people feel it. The stigma absolutely shouldn’t be there - treatments have completely transformed the disease since the 80s , but society has absolutely not caught up. There was an awful mumsnet post only a couple of months ago - I can’t remember the exact details but it was something about going on a date with someone HIV positive who didn’t disclose their status in advance- or something like that- and it was basically one long pile on of people saying that the person should disclose in advance and they would never consider dating someone with HIV. Never mind the new data on zero risk of transmission if on proper treatment/ undetectable viral load etc, people didn’t care or want to hear it. I was one of the few people pointing out the abhorrence in what people were saying and got piled on. the stigma , phobia, unpleasantness directed against people living with HIV was brazen and unashamedly out there, - the majority standpoint in fact. To pretend this isn’t the case is bullshit.

Illogical stigma is no reason not to test for communicable disease.
The very reason HIV is still being transmitted is because people are not testing.
You're a grown up, you acknowledge it is illogical, so go off an work on your attitude. Educate yourself instead of perpetuating misconceptions.

I’m not pretending it isn’t there. It’s awful.

But the poster clearly said they would step back.

I think it’s appalling the stigma is still there and stand by that and that I wouldn’t want to meet them. I won’t apologise for the low opinion I have of people who still think like that.