Welcome to DrPHealth

Please leave comments and stimulate dialogue. For those wanting a bit more privacy or information, email drphealth@gmail.com. Comments will be posted unless they promote specific products or services, or contain inappropriate material or wording. Twitter @drphealth.

Friday, 15 July 2011

When rights conflict

There is a BC member of the legislative assembly making noise about wanting to give emergency services workers (ESW) the ability to require persons from whom they were exposed to blood to have testing for HIV, Hepatitis B and Hepatitis C.

On one side is the desire of the ESW to prevent infection (justice and non-malfiesence or do no harm).  On the other side is the autonomy of the individual who'se blood caused the exposure.  Disclosure of such information can have a devastating impact on an individual, their relationships, their employment and insurance.   Testing is preferably associated with appropriate counselling

The risk of transmitting infection from a person who is known to be positive for one the diseases from a needle that went into their body, and then into someone else, is roughly 30% for Hepatitis B, 3% for Hepatitis C and 0.3% for HIV.   How common on the diseases?  Numbers are almost estimates  but about   0.3% of the Canadian population are carries of hepatitis B, 0.8% carry hepatitis C, and 0.2% have HIV.   Some relatively simple math means that in an everyday scenario, the likelihood that an ESW is infected by a needlestick exposure would mean about 1 in 1000 patients for Hepatitis B (for which an effective vaccine will prevent disease in the ESW in the first place, about 1 in 2500 patients for Hepatitis C, and about 1 in 6000 patients for HIV. 

Admittedly there are some populations for whom the likelihood of infection is higher, but as proposed, the autonomy of thousands in individuals will be compromised for little value. The results of the testing would be available to several individuals and no effort has been made to ensuring their privacy is protected

ESW do however need protection.  Requiring vaccination makes sense.   Using best practices is engrained into their activities.  For HIV exposures, persons can be offered medication to prevent the infection.  for Hepatitis C, there is no current way of preventing infection.  So, to complicate the matter more, we actually can prevent one of the diseases that is most likely to occur, cannot prevent the second most likely disease, and would only provide intervention for the least likely illness. 

Is there a need for compromising the privacy of all those people?  Is there a better way of doing risk assessments, protecting confidentiality through limited access to information, having specialized services that protect the rights of both parties - probably.  There is a balance of need here. Kudos to the member for raising the issue. Shame for assuming that patients can be treated like mere objects.

Which side of the dabate do you stand on?  Is there a middle ground that can adequately protect both?

No comments:

Post a Comment