fandarast
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A clearly competent, pregnant, 25-year-old woman tells her obstetrician that over the past year she has repeatedly abused intravenous drugs and has had at least 10 sexual partners. The doctor explains to the patient that, because she may have been exposed to HIV through sexual contact or infected needles, the fetus she is carrying also is at high risk for infection. The doctor then suggests that the woman be tested for HIV so that, if the test is positive, she can be treated with an antiviral agent that can significantly reduce the danger of HIV transmission to the unborn child. The woman states that her boyfriend has said he will leave her if she is infected with the virus and she refuses to be tested for HIV. What's the most appropriate action for the doctor to take?
Edited by fandarast on 09/23/07 - 05:00 PM
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| gr8doc
Forum Senior
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Don't test her for HIV.
Follow the competent adult woman's wishes.
If one of the options is that either you or the woman can explain the nature of the disease & little more details about it to the either or both partners, I would go for it. BTW, What are the options here ?
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| dermatology
Forum Elite
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well i guess if patient says no for test , don't do it ..... even if condition causes harm to fetus ...
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| Doc750
transfer:step 3 prison
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What I really would do: club her over the head when her back is turned, draw the blood, and test her. 
What you do on the test: "ask her to talk about her relationship/life some more and see if there is a way to clear up her life and alow her to get tested" ... and if that option is not available .. then no, you don't test her.
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Experience is a hard teacher because she gives the test first, and the lesson afterwards.
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| Ivonne
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Fandarast thank you, It is a beautiful question.
1.-A pregnant patient at risk for HIV infection can not be tested for the virus or treated against her will even if the fetus could be adversely affected by such refusal.
Action: Note in the chart that she has refused to be tested and continue caring for her.
2.-Doctors are not required to maintain confidentiality when an HIV patient habitually puts another person at risk by engaging in unprotected sex. but in this case I don't know the HIV status of the patient or if they are having unprotected sex  .
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If you beleive you can do it then you WILL DO IT!! (by Mymeghhi)
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| Doc750
transfer:step 3 prison
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exactly if you knew for sure she had an std, then your required to report it to public health so that her partners can be made aware and get tested. But here, you don't know her status, so there is nothing to report. And there is no law requiring her to report it.
There have been some recent cases where a person knows they're HIV + and continue to have unprotected sex without disclosing it to their partner. But here she never got tested so she's in the clear. (legally)
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Experience is a hard teacher because she gives the test first, and the lesson afterwards.
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| fandarast
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Thanks Ivonne for your complement
And you're absolutely right about the most appropriate action the doctor can take here (which is the point of the question): just note in the patient's chart that she has refused to be tested and continue to providing appropriate prenetal care, since she, as any other competent patients, has the right to refuse medical tests or treatment even if the fetus will die or be seriously injured as a result.
And guys, thanks for elaborating on the issue of breaching confidentiality when it comes to informing the sexual partner at risk, even though it wasn't the point of this question. Good review for me.
What about when the child of this woman is born?
P.S. I share your rage doc 750
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| Ivonne
Forum Guru
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Hey fandarast, what book are you reading for Psyquiatry&Ethics. Thanks in advance.
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If you beleive you can do it then you WILL DO IT!! (by Mymeghhi)
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| fandarast
Forum Junior
Topics: 15
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Hey Ivonne!
Kaplan notes + Behavioral Science Medicine by Barbara Fadem (2004 ed)
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| starcraftbw
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she said "NO" so don't do it
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| starcraftbw
Forum Senior
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What's about her baby (very good question)????
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| Doc750
transfer:step 3 prison
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once "it" is born, then it's a baby and has rights .. before that, only concern is what mother wants
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Experience is a hard teacher because she gives the test first, and the lesson afterwards.
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| fandarast
Forum Junior
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for starcraftbw:
Can you test the baby for HIV after the birth and treat him/her if necessary without the mama's consent?
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| fandarast
Forum Junior
Topics: 15
Posts: 53
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for starcraftbw:
Can you test the baby for HIV after the birth and treat him/her if necessary without the mama's consent?
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