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G144(P) Maternal autonomy vs infant advocacy: When parents decline HIV testing
  1. TD Holliday,
  2. A Williams,
  3. B Williams
  1. Paediatric Department, Northwick Park Hospital, Harrow, London, UK

Abstract

We examine the case of a child born to an undiagnosed HIV positive mother. At the age of five, a series of admissions prompted investigation for immunodeficiency, including an HIV test. At diagnosis, the patient was profoundly immunocompromised.

The mother initially reported that an antenatal HIV test was negative, but further investigation revealed she had declined testing and was not re-offered. National data from 2006 suggest that up to two-thirds of vertically acquired HIV transmission occurs in infants born to women who are undiagnosed at the time of delivery; half of whom have refused testing.

British HIV Association guidelines state that women who decline initial HIV testing should be re-offered a test, with a third offer at 36 weeks if they decline again. It is good practice to involve the wider multidisciplinary team to explore mothers’ reasons for declining. When mothers have decided not to test antenatally, postnatal testing of the infant is strongly recommended. However, much like newborn testing for other transmissible diseases, this represents de-facto testing of the mother.

If a mother cannot be persuaded to test, her right to autonomy clashes with the principles of beneficence/non-maleficence for the baby. It is plainly in a child’s best interests to receive interventions to reduce the chance of being infected with HIV. Pregnant mothers retain the right to decline testing. However, many paediatricians feel that in a high-risk scenario testing should be considered in the best interests of the child.

Within current UK law, the unborn child has no rights until it is born alive. Despite this, there is civil precedent to suggest that it is possible to be found liable for harm caused in-utero to a baby. However, it is currently unclear what judgement would be made in the event of an application for a court order to test.

We use this case to outline the rights of parents and children with regard to HIV testing and look at legal precedent and framework in place to protect the at-risk child.

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