Editor's Choice | This Week in BMJ | Press releases

BMJ No 7102 Volume 315 Letters Saturday 26 July 1997 Informed consent Study in which patients had HIV tests could have been designed differently Editor, We share Rajendra Kale's view that failing to seek patients' consent to HIV testing is always wrong.(1) In a bronchoscopy study of patients with HIV infection in Harare the patient's consent was sought in every case. It was only rarely declined, and even when this occurred the data were still acceptable for publication.(2) Satish Bhagwanjee and colleagues' study could have been designed differently. HIV testing could have been done anonymously, with matching of the results of the tests and patient data done by a third party not involved in the patients' care. Alternatively, serum samples from all the patients admitted to the intensive care unit could have been stored and survivors asked for their permission for testing. Serum samples from non-survivors could have been tested and given a number that would render them unidentifiable to anyone outside the study. Testing without consent and then informing the patients can be an unfortunate combination. The fact that only three out of 402 patients wished to know the result of their HIV test suggests some unconscious resistance to being tested, and of course by then they were not in a position to refuse testing. Were all patients asked whether they objected to being included without prior testing, and if so how was this question posed? We believe that the ethics committee that considered this proposal did the investigators a disservice by not pointing out alternative ways of doing this study while protecting patients' rights. Adam Malin Specialist registrar in chest medicine Whittington Hospital NHS Trust, London N19 5NF Diana Lockwood Senior lecturer London School of Hygiene and Tropical Medicine, London WC1E 7HT References 1 Bhagwanjee S, Muckart D, Jeena P, Moodley P. Does HIV status influence the outcome of patients admitted to a surgical intensive care unit? A prospective double blind study. [With commentaries by R Kale, S Bhagwanjee et al, and Y K Seedat.] BMJ 1997;314:1077-1084. (12 April.) 2 Malin AS, Gwanzura LEC, Klein S, Robertson VJ, Musvaire P, Mason PR. Pneumocystis carinii pneumonia in Zimbabwe. Lancet 1995;346:1258-61. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline