Sunday, February 7, 2016

compulsory testing?

What about compulsory HIV testing in extreme cases?

One kind soul approached me at my PlanetRomeo HIV account, let's call him F, and asked about the early symptoms of HIV onset. Since I am no doctor but a disciple of law, I could not be too exact as to what the "symptoms" are regarding HIV. HIV could be asymptomatic. But it could also show early signs when we are properly informed about HIV literature as applied to how raunchy we are in bed.

Fast forward, I told F that I had rashes back then in my chest area which actually were not itchy. He inquired if I have had fever. None, I said. The conversation went on and finally into its climax. F said that his late partner died, but up until now he and the people around him and his late partner cannot be fully sure if it were AIDS behind the late partner's passing because the significant other refused treatment. Even refused to take the HAT or the HIV Anti-bodies Test. The only speculation he had, and mine as well, was that it was AIDS as it already shown dire complications (as what F told me at least). I asked F if he tried talking down his partner to at least get an HAT; he did to no avail and no change of heart. One then can only speculate as much--even the doctors who I think at that moment had the hunch--because the patient waived his right to treatment. At that point and on hindsight, I saw how doctors could be bound by what is only permitted by the patient. A more existential question then: In cases like that, where do we draw the line for doctors to truly heal and to strictly adhere the decisions of their patients? I am in absolutely no position to answer.

Enter law. It is well-within the Philippine Patient's Bill of Right for a patient to refuse treatment, as can be gleamed in paragraph 5, "The patient has the right to refuse treatment/life-giving measures, to the extent permitted by law, and to be informed of the medical consequences of his action."

But, take heed readers of the one important passage: "to the extent permitted by law." That is an important statutory phrase in paragraph 5 because then we ask, which law permits refusal and which law overrides a patient's refusal to treatment? I think there is none yet to date because it would be highly controversial to think of the least if a doctor, who in his utmost good faith and impelled by the good intent of the law, to do what the patient otherwise permits.

Apply it to the scenario of F's partner, what if his doctors, with their healthy medical reasoning, conducted a HAT despite the stern refusal of the patient? Would that be allowed?

Be that as it may, weeks passed and F's story had me thinking, what if there is a law that actually does not permit refusal of patient as regards their care management when life and death is on the line? Are we to look at it on a moralistic viewpoint or on a legal philosophical view of crafting laws for people's sake? I bet it would be a tough consideration because moralists have been on the look out as regards our health laws in this country.

It fancy me to think about the unpopular opinion. Let's give compulsory testing a chance to save lives in dire cases of death. But right now, no law actually permits that unsavory opinion of mine. The rule under the Philippine HIV/AIDS Law (Republic Act 8504) is that it is prohibited to conduct compulsory testing. The last thing I've heard as regards development of RA 8504 is an amendatory bill filed by Rep. Teddy Baguilat of Ifugao province. As to the bill's content, I am not privy to it.

But again, take heed, because Sec. 2(b)(1) of RA 8504 admits of an exception to prohibition against compulsory testing, that is, unless otherwise provided in this Act.

Down in Section 17 of the Act, there are three instances where the Act may allow compulsory HIV testing: criminal charge of rape and injurious substance; relevant issues as regards the Family Code; and compliance as regards organ and blood donation.

The exceptions, in legal parlance, methinks, are not a closed-list exception, which means, instances to allow compulsory testing may still be added as lawmakers have the good faith to include those new instances as worthy exceptions, and, in my whimsical thoughts, in articulo mortis.

The way I see it, if our lawmakers only have the balls to consider--of course, always reaching out to public consultants and experts--the need to have a compulsory testing to determine if a patient's disease is caused by HIV, it will make care management more efficient. Of course, what is only made compulsory is the testing, not the treatment. If after testing and results showed that the patient is reactive to HIV anti-bodies, then this information may be used to properly inform the patient of his situation. Only then will the patient be allowed to choose whether to opt for treatment or not because with HIV now a reality after testing, doctors can now move to explain how HIV in these day and age can be manageable as diabetes or hypertension.

What is important, methinks, is that there is a testing done per se. This may give the patient a new perspective as to his survival if done with the guidance of doctors. Unlike if the testing--not the treatment--is made to depend on the decision of the patient, doctors have no slim chance to fight for the survival of the patient. Doctors are immediately bound to wait for the patients to die.

Surely, after testing, and reactivity, a patient can still choose whether to move on to the treatment. If he opts to, good. If he doesn't, the doctor has done his fair share.

If this is the way, we can save people such as F's partner. If we are to include in articulo mortis as an exception in RA 8504, we can save lives. And since the Patient's Bill of Right is a general law, and HIV Law is a special one, any first year law student will know that special law overrides a general law.

If this is a way to save lives and truly make doctors as lifesavers we can fancy the thought of how long the shot is and try to shorten it by making it a reality. This is where HIV/AIDS and law intersects. This is HIV policy-making and lawmaking. This is where the law can actually respond to a medical phenomenon.

So I ask, how about compulsory testing urgente mortis periculo, any takers?

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