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Related Experiment Videos

HIV exceptionalism, CD4+ cell testing, and conscientious subversion.

L A Jansen1

  • 1The John J Conley Department of Ethics, Saint Vincent's Medical Center, Manhattan, 153 West 11th Street (NR 815), New York, NY 10011, USA. Ljhomes@aol.com

Journal of Medical Ethics
|June 1, 2005
PubMed
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Many states now require reporting of low CD4 cell counts, an indicator of HIV, to health departments. This practice raises ethical questions about patient consent for CD4 testing versus direct HIV testing.

Area of Science:

  • Medical Ethics
  • Public Health Law
  • Infectious Disease Surveillance

Background:

  • Recent US state legislation mandates reporting of low CD4 cell counts to Departments of Health.
  • This reporting is linked to HIV Reporting and Partner Notification Laws, influenced by CDC guidelines.
  • Low CD4 cell counts are increasingly recognized as an indicator of HIV infection.

Purpose of the Study:

  • To examine the ethical and legal implications of using CD4 cell counts as a surrogate for HIV testing.
  • To analyze the practice of "conscientious subversion" by clinicians.
  • To evaluate consent requirements for CD4 cell testing in light of its role as an HIV indicator.

Main Methods:

  • Review of state legislation regarding CD4 cell count reporting and HIV testing consent.
Keywords:
Health Care and Public Health

Related Experiment Videos

  • Analysis of ethical principles related to patient autonomy and public health.
  • Examination of legal standards for "presumed consent" versus explicit consent for medical tests.

    • Main Results:

    • Most states rely on pre-existing presumed consent standards for CD4 cell testing.
    • This allows clinicians to order CD4 tests as a surrogate for HIV testing, even if patients refuse direct HIV testing.
    • The practice raises concerns about "conscientious subversion" of patient consent.

    Conclusions:

    • The use of CD4 cell counts as a surrogate for HIV testing presents significant ethical and legal challenges.
    • There is a need to clarify and potentially revise consent requirements for CD4 cell testing.
    • Balancing public health goals with individual patient rights is crucial in HIV surveillance and testing policies.