Ethical and legal concerns and prerequisites

Informed consent

Informed consent is necessary when testing for HIV is required, for example if a person chooses to

• donate blood, organs, tissue (including sperm and ova) or breast milk
• obtain insurance or
• apply for a visa to travel to a foreign country.

• the patient must be deemed competent
• the patient must understand the purposes, risks, harms and benefits of being tested, as well as those of not being tested
• the person's consent must be voluntary.

Consent for testing infants, children and youth
Policy and definitions regarding testing of emancipated or mature minors, both of whom have capacity to consent, vary among the provinces and territories. Where such definitions are directed by law, they should prevail. Otherwise, the working definitions accompanying this report may be helpful.

Generally, for children and minors without the legal capacity to consent, voluntary informed consent from parents or legal guardian is required.

Refusal to be tested

Reasons that may motivate a person's refusal to be tested for HIV include

• false or inaccurate information
• insufficient psychological or emotional preparation
• lack of social support
• fear of breach of confidentiality
• fear of testing procedures
• fear of losing employment, housing, insurance or other economic support
• fear of losing friends, partners or child custody
• past or current history of physical or sexual abuse, or both
• personal or cultural values or beliefs.

Confidentiality

Any disclosure of confidential information -- no matter how inconsequential it may seem, whether it occurs in public settings, over the telephone, on an answering machine, by mail or fax -- requires the patient's consent except when disclosure is required by law.

During a clinical audit by third parties, physicians should ensure that patient confidentiality is respected by the auditing agency.

The patient should be informed of how information about his or her serologic test results is recorded and stored and how confidentiality is maintained by staff.

Pediatric confidentiality
No one except the child's parents, other guardians and the physician has a need to know the child's status regarding HIV infection.

The family has no obligation to inform school authorities. If the family chooses to inform school authorities, the child's right to privacy must be assured.

The physician or medical officer of health, or both, may be required to serve as an advocate for the child and family.

  Continue