Document Detail

Rethinking HIV exceptionalism: the ethics of opt-out HIV testing in sub-Saharan Africa.
MedLine Citation:
PMID:  20865076     Owner:  NLM     Status:  MEDLINE    
Opt-out testing for the human immunodeficiency virus (HIV) incorporates testing as a routine part of health care for all patients unless they refuse. The ethics of this approach to testing in sub-Saharan Africa is a source of controversy. Opt-out HIV testing is expected to improve survival by increasing case detection and thus linking more HIV-infected people to earlier treatment, provided there is effective patient follow-up and programme sustainability. At the population level, these benefits will likely outweigh the potential negative consequences of individuals experiencing HIV-related stigma. These justifications appeal to consequentialist moral theories that the acceptability of an action depends upon its outcomes. On the other hand, liberal moral theories state that the autonomy of individuals should always be protected unless restricting autonomy is necessary to protect the welfare of others. Opt-out consent may restrict autonomy and it is unclear whether it would benefit people other than those being tested. Yet, the doctrine of libertarian paternalism proposes that it is justifiable and desirable to use unobtrusive mechanisms to help individuals make choices to maximize their own welfare. Central to this idea are the premises featured by supporters of opt-out consent that individuals will not always make the best choices for their own welfare but they may be influenced to do so in ways that will not compromise their freedom of choice. Also important is the premise that all policies inevitably exert some such influence: opt-in consent encourages test refusal just as opt-out consent encourages acceptance. Based on these premises, opt-out testing may be an effective and ethically acceptable policy response to Africa's HIV epidemic.
Michael D April
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-06-25
Journal Detail:
Title:  Bulletin of the World Health Organization     Volume:  88     ISSN:  1564-0604     ISO Abbreviation:  Bull. World Health Organ.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-24     Completed Date:  2011-01-06     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  7507052     Medline TA:  Bull World Health Organ     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  703-8     Citation Subset:  IM    
Harvard Medical School, Boston, MA 02115, United States of America.
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MeSH Terms
Africa South of the Sahara
Anti-Retroviral Agents / therapeutic use
HIV Infections / diagnosis*,  drug therapy,  psychology
Primary Health Care / ethics*,  methods*
Reg. No./Substance:
0/Anti-Retroviral Agents

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