Just to make my position clear. I would have no hesitation in adding an HCG
if I thought it was in the best interests of the patient. The problem is
that in our litigious society one might have to justify that decision in
Court. The decision about what is in the best interests of the patient is
not one that is exclusively that of the health care professional. The
patient has a say as well.
RF
> -----Original Message-----
> From: clinical biochemistry discussion list
> [mailto:[log in to unmask]]On Behalf Of Jeffrey Davies
> Sent: 26 September 2002 14:48
> To: [log in to unmask]
> Subject: Re: Ethics of add-on tests
>
>
> Dear Robert,
> May we consider our actions following the discovery of low
> gonadotrophins if the patient rather than the sample had been
> referred to us for investigation and management? We would have
> enquired about the possibility of pregnancy, which might have
> been denied. We would still have to ensure she was not pregnant
> before proceeding with further investigations or treatment that
> might be harmful in that condition. Should we not provide the
> same reassurance to the doctor who refers the sample to us?
> Surely it is not invasion of privacy when a patient has sought
> our assistance, either directly or indirectly, and we are
> sincerely acting in her best interests or (to confuse matters
> further) those of the unborn child.
> (I daren't ask if the fetus has a right of privacy from antenatal
> screening, nor whether 'protection of health and morals' has any
> bearing on the HIV aspects of this debate!)
> Regards,
> Jeff
>
> >>> Robert Forrest <[log in to unmask]> 09/26/02 09:55am >>>
> Tim, I agree with you but there is possibly a real issue with
> respect to an
> add on pregnancy test. The NHS is probably still an arm of
> Goverment as far
> as the ECHR and Human Rights act is concerned..The let out might
> be that one
> felt it necessary in invade her privacy in the interests of her health...
>
> What if the woman was 15 years old, not 20?
>
> Robert Forrest
>
> ECHR ARTICLE 8. RIGHT TO RESPECT FOR PRIVATE AND FAMILY LIFE
> 1. Everyone has the right to respect for his private and family life, his
> home and his correspondence.
> 2. There shall be no interference by a public authority with the
> exercise of
> this right except such as is in accordance with the law and is
> necessary in
> a democratic society in the interests of national security,
> public safety or
> the economic well-being of the country, for the prevention of disorder or
> crime, for the protection of health or morals, or for the
> protection of the
> rights and freedoms of others.
>
> -----Original Message-----
> From: clinical biochemistry discussion list
> [mailto:[log in to unmask]]On Behalf Of Reynolds Tim (RJF)
> Burtonh-tr
> Sent: 26 September 2002 09:33
> To: [log in to unmask]
> Subject: Re: Ethics of add-on tests
>
>
> In the case of add on tests, the samples are technically sent for a
> pathological opinion from the department. Add on tests in this case are
> entirely ethical. Indeed there would be an argument that NOT adding on the
> test would be negligent because it could result in missed diagnosis.
> Clearly there are tests that you cannot add on such as HIV because there
> are other legal issues that have been constructed around it but
> in the case
> of investigation of amenorrhoea where the most likely diagnosis
> in a female
> in the fertile years is pregnancy, then HCG should be tested.
>
> TIM
>
>
> ******************************************************************
> **********
> *********
> Prof. Tim Reynolds,
> Clinical Chemistry Department,
> Queens Hospital,
> Belvedere Rd.,
> Burton-on-Trent,
> STAFFORDSHIRE,
> DE13 0RB,
> UK.
> tel: 01283 511511 ext. 4035
> fax: 01283 593064
> email: [log in to unmask]
> alternative email for the all too frequent occasions when the NHS email
> connection doesn't work:
> [log in to unmask]
>
>
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> -----Original Message-----
> From: g.challand [mailto:[log in to unmask]]
> Sent: 25 September 2002 10:06
> To: [log in to unmask]
> Subject: Ethics of add-on tests
>
>
> In the most recent 'case for comment' distributed through
> UK NEQAS,
> HCG was added by laboratory staff to a request for FSH (which was
> low) on a
> 20 year old patient with amenorrhoea. One participant has queried
> the ethics
> of 'add-on' tests.
> I suspect this is an area with very wide divergencies in
> practice. I
> think most of us would add on protein elctrophoresis for an
> elderly patient
> with back pain and high globulins; but few of us would add on HIV testing
> under any circumstances.
> What do people do in practice in their own laboratories. Are there
> any published ethical guidelines we should be following?
>
> Gordon Challand
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