hi all,
i thought of another example--but even more extreme than the rhesus screening--on when screening is done for others' benefit. blood product screening is an example of this, and i am not sure that the donor is always fully informed of the procedure or potential consequences.
when i was in chad for 6months in 2008 with MSF, we were able to start giving transfusions to kids with hemolytic malaria. it was a small miracle that we could do so in the middle of the desert, and i remember rapid testing donor blood by candlelight for HIV, HepC, syphilis and malaria before transfusions.
the controversy in my mind is this:
- if we found malaria, we would treat both donor and recipient. that's fine.
- if we found syphilis, we would treat the donor and obviously not give the blood
- if we found hep C, we would throw out the blood as well, and counsel the donor (although there is not a whole lot you can do for Hep C, this is certainly true in parts of Africa. i wondered whether we made these people feel sick for not very much benefit)
- most controversially in my mind, we were told to tell HIV+ donors that their blood was "not possible to give" without specifying why. the reasons given for this were - the extreme stigma involved - lack of facilities able to treat the disease in that country - possible false positives of the rapid screening. i kept protesting that surely the risk of further transmissions, and the fact that we initiated the process meant that we should fund further testing and treatment, back in europe if necessary, but those guidelines remained. thankfully, no donors tested positive during my 6 months.
this may surprise a lot of you for a respected organisation such as MSF, but i doubt they are the only ones to bend if not shatter the rules of informed consent when trying to save lives in emergencies.