• Ethics

The authors’ deference for Claim A (‘there is a very strong presumption that it is morally wrong to override a competent adult's refusal of an HIV test’) is unsustainable. It is at odds with their view of Claim B (‘there is a very strong presumption that it is morally wrong to override a competent adult's desire not to know their HIV result’), and relies on an assumption that HIV testing is a rather special case—not to be addressed using general principles.

Their defence of Claim A falls into two parts. There is a brief, qualified appeal to the English law, which they say (relying on cases about enforced Caesarean section in the face of maternal refusal) tends to endorse ‘Strong RTR’ (the view that ‘it is always morally wrong to override a competent adult's refusal of medical intervention unless doing so might prevent serious harm to others’: original emphasis). They acknowledge, though, that there are circumstances in which the law endorses treatment in the face of a competent refusal.

They then use three arguments to defend Claim A: ‘Consequences’, ‘O'Neill’ and ‘Privacy’. Each of these three is expounded specifically in the context of HIV testing, and each identifies some harm or wrong (the distinction does not matter for these purposes) associated with testing for HIV where the patient has not given consent. These arguments are introduced by the assertion: ‘Defending Claim A on autonomy grounds is problematic.’

The core assertion of the paper is that their suspicion of Claim B does not diminish the strength of their defence of Claim A. I have made my own position regarding Claim B clear in the paper cited by the authors. Their formulation of Claim B^H&F (‘there is a very strong presumption that it is morally wrong to override a competent adult's …