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Friday, September 3, 1999 Published at 14:30 GMT 15:30 UK


HIV test ruling: The reaction

The High Court ruled the child must have an HIV test

A High Court ruling that a four-month-old girl must be given an HIV test against her parents' wishes could have far reaching implications for patient choice.

The BMA's Vivienne Nathanson: "This is a significant ruling"
The case was brought to court by Camden Council, whose director of social services Simon White said after the judgement: "We have a legal duty to investigate a child's circumstances and decide whether we need to take action to safeguard or promote a child's welfare.

"We brought this case to the High Court because we felt that the issues needed detailed consideration by a judge who was independent and could examine the facts of the case dispassionately."

[ image: Dr Vivienne Nathanson backed the court decision]
Dr Vivienne Nathanson backed the court decision
Dr Vivienne Nathanson, head of ethics and science at the British Medical Association, said is was very rare that parents and doctors could not reach a consensus on the best interests of a child, and that it was sad that the courts had to become involved in this case.

She said: "We support the court's view that it would be beneficial for the child's HIV status to be known because of the advances in our knowledge of HIV and in the treatments available.

"If the baby tests negative for HIV, the mother has a strong incentive to stop breastfeeding to reduce the risk of maternal/child transmission. It is always a matter of regret if parents' genuinely held beliefs about the care of their children are overruled.

"A decision to do so is not taken lightly but the weight of scientific evidence backing the court's action is very strong."

However, Dr Richard Nicholson, editor of the Bulletin of Medical Ethics, said the judgement set a dangerous precedent by overruling the parents.

He said: "It suggests that the paternalism of some doctors is now becoming dictatorial."

Difficult case

Mike Stone, general manager of the Patient's Association, said the case was particularly difficult.

He said: "We are in favour of informed consent and patient choice, but every case has got to be taken on its individual merits.

"This judgement is something that we will have to look at and assess the ramifications for patients in general because they could be far reaching.

Mr Stone said the judgement appeared to take power away from patients and echoed a similar decision made earlier this year when a schoolgirl was compelled to undergo heart surgery despite initially expressing a wish to be allowed to die.

The National Aids Trust said it was "extremely regrettable" that court intervention was thought necessary in this case.

Derek Bodell, trust director, said voluntary testing based on informed consent was the best approach and had led to the UK having one of the lowest HIV infection rates in Western Europe

But he added: "Enshrined in our statutes is the policy of acting in the best interests of the child. We believe that children have the right to receive the best HIV care available."

'Not interested in informed consent'

Aids and HIV charity the George House Trust said the courts were not interested in informed consent.

In a statement, the charity said: "Nobody should be forcibly tested for HIV.

"Focusing only on potential benefits of treatment for the child, overlooks the impact on the mother and the household. This is not in the interest of child or parent.

"Demanding routine testing and taking people to court to ensure testing - risks driving HIV underground, making it less likely that people will access services."

The charity also said that using the courts was tantamount to launching a witch-hunt against people who were HIV positive.

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