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Commentary on Ethics of HIV testing in general practice without informed consent: a case series
  1. D K Sokol
  1. Correspondence to:
 Daniel K Sokol
 Medical Ethics Unit, Department of Primary Health Care and General Practice, Imperial College London, Reynolds Building, St Dunstan’s Road, London W6 8RP, UK; daniel.sokol{at}

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Case 1 reminds us that patients have duties too, while case 2 presents an instance of justified withholding of information

How refreshing to read these two cases! No conjoined twins, fantastical chimeras, or other incredible scenarios at the fringes of medical reality. Each case highlights the practical and theoretical difficulties that doctors face in their everyday practice.

Case 1: In case 1, the patient, who had declined an HIV test, changed his mind and requested an HIV test on the request form without informing the doctor. The pathologist performed the tests and returned the results to the unsuspecting doctor, who duly investigated the matter. The doctor’s anxiety at the situation, as well as the worries of the entire practice and pathology laboratory, must have been deeply unpleasant. Thus the patient, no doubt unintentionally, caused much distress by requesting the HIV test. He was, at the very least, guilty of a lack of foresight and consideration. As a minimum, he should have informed the doctor of his last minute alteration. This would have enabled the doctor to discuss the implications of the test, to organise appropriate counselling, and, most importantly, to receive the results in full knowledge of the situation.

As Dr Fraser points out, the experience of case 1 reinforces the importance of taking good medical notes. Even if the patient’s refusal had been documented in the notes, however, this would not have prevented him from requesting the HIV test, and indeed other tests, on the blood form. Pharmacists may still occasionally be faced with situations when they are unsure whether the doctor prescribed 10 capsules of a drug, or 110 capsules, as the patient may have added a “1” in front of the doctor’s original prescription. Similarly, how …

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