This op-ed piece exposes the fiscal motives behind, and the harmful consequences of, legislative efforts to routinize HIV testing and eliminate written consent. The author, a bio-ethicist at the Cato Institute, notes that a bill before the California Assembly in 2007 is driven by the federal Ryan White CARE Act funding requirements that penalize jurisdictions that do not maximize finding new HIV cases and reporting them by name. To increase testing, California lawmakers are seeking to eliminate written consent for HIV related testing and with it candid discussions with patients about HIV risk, whether HIV testing is appropriate for them, and the meaning and possible consequences of a positive test, including discrimination. Unnecessary testing and the withholding of information foster mistrust and deter those most at risk from seeking medical care. Moreover, with the volume of names reported to the CDC, the loss of confidentiality and the stigma and discrimation that follow are serious and predictable risks. Refusing to explain these risks to patients because they might not consent to HIV testing if they knew about them removes the informed part from informed consent.
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