Patients can be made to have HIV test to protect doctor
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《英国医生杂志》
Utrecht
Dutch doctors have welcomed a Supreme Court ruling that a patient can be ordered to give blood for an HIV test in order to limit injury to a doctor during treatment.
After an appeal process lasting more than two years, the court concluded that the need to limit the damage to a doctor outweighed the relatively minor infringement of the patient's rights.
The judgment goes beyond previous similar cases, which involved a rape or biting by someone suspected of being HIV positive. In such cases, a patient not accused of deliberately or irresponsibly spreading an infection was still required to cooperate.
In 2001 a doctor in a dental surgery at the Alkmaar Medical Centre, north of Amsterdam, removed a molar from a remand prisoner. In doing so, he cut his finger on an instrument used in the treatment, resulting in blood contact with his patient.
The patient was considered to have an increased risk of HIV infection because of a history of drug misuse. However, the doctor's request for a blood sample was rejected for fear it could influence the patient's forthcoming trial. The doctor successfully took legal action to order the patient to give blood, with the results being made known only to the doctor and the patient's legal representative. Meanwhile, he had begun prophylactic treatment despite possible "serious and damaging" side effects.
The case was appealed finally to the Supreme Court on the grounds that it violated rights to privacy and physical integrity enshrined in the Dutch constitution. The Supreme Court concluded that the violation of the patient's right was "relatively minor" as the blood test involved no danger to the patient's health and the results could be restricted to only those who needed to know. This was outweighed by the doctor's interest in knowing if he was infected with HIV especially if he was considering beginning treatment with serious side effects.
The court argued the medical treatment agreement could involve "reasonable and fair" limits to rights, including a degree of care towards each other. "The patient can be required, even after the end of the agreement, to act within reasonable limits, to restrict damage caused to the doctor during treatment."
Johan Legemaate, coordinator of legal policy for the Royal Dutch Medical Association (KNMG), said the case had a big psychological impact on doctors, who have felt that discussions about patients' rights were often one sided. "It does not change the overall situation of patients' rights and doctors' duties but it is very important for doctors to feel that, in specific situations, they have rights too," he said.(Tony Sheldon)
Dutch doctors have welcomed a Supreme Court ruling that a patient can be ordered to give blood for an HIV test in order to limit injury to a doctor during treatment.
After an appeal process lasting more than two years, the court concluded that the need to limit the damage to a doctor outweighed the relatively minor infringement of the patient's rights.
The judgment goes beyond previous similar cases, which involved a rape or biting by someone suspected of being HIV positive. In such cases, a patient not accused of deliberately or irresponsibly spreading an infection was still required to cooperate.
In 2001 a doctor in a dental surgery at the Alkmaar Medical Centre, north of Amsterdam, removed a molar from a remand prisoner. In doing so, he cut his finger on an instrument used in the treatment, resulting in blood contact with his patient.
The patient was considered to have an increased risk of HIV infection because of a history of drug misuse. However, the doctor's request for a blood sample was rejected for fear it could influence the patient's forthcoming trial. The doctor successfully took legal action to order the patient to give blood, with the results being made known only to the doctor and the patient's legal representative. Meanwhile, he had begun prophylactic treatment despite possible "serious and damaging" side effects.
The case was appealed finally to the Supreme Court on the grounds that it violated rights to privacy and physical integrity enshrined in the Dutch constitution. The Supreme Court concluded that the violation of the patient's right was "relatively minor" as the blood test involved no danger to the patient's health and the results could be restricted to only those who needed to know. This was outweighed by the doctor's interest in knowing if he was infected with HIV especially if he was considering beginning treatment with serious side effects.
The court argued the medical treatment agreement could involve "reasonable and fair" limits to rights, including a degree of care towards each other. "The patient can be required, even after the end of the agreement, to act within reasonable limits, to restrict damage caused to the doctor during treatment."
Johan Legemaate, coordinator of legal policy for the Royal Dutch Medical Association (KNMG), said the case had a big psychological impact on doctors, who have felt that discussions about patients' rights were often one sided. "It does not change the overall situation of patients' rights and doctors' duties but it is very important for doctors to feel that, in specific situations, they have rights too," he said.(Tony Sheldon)