Hacker News Reader

Comment by indymike | Hacker News Reader

> a doctor does have the wide authority to order tests with some manner of invasivene

False. A doctor has zero ability to order tests without patient consent (or consent of a guardian) in the US.

> Patients don’t want to disclose illegal drug use,

This is why medical care should NEVER be directly connected to law enforcement or make conclusions. For a care provider to thing that a patient waking up, handcuffed will make that patient EVER come back for care again is insanity. Medicine should not be about punishment, ever.

View on HN

> False. A doctor has zero ability to order tests without patient consent (or consent of a guardian) in the US.

Ability isn't the right word, because they absolutely do it. It's unethical and perhaps illegal in some places, but they are able.

I've personally been administered a test non-consensually: I showed up at a hospital with severe pancreatitis, the doctors seemed convinced it was due to alcoholism but I (and my partner who they questioned privately) both reported that I don't drink at all. After several days they suddenly started aggressively treating me, performing tests, etc. I wondered what changed and got hold of my chart-- without my knowledge or consent they took a hair test to assay long term alcohol use and suddenly wanted to treat me when it came back negative.

I get that they needed to exclude an obvious potential cause and couldn't trust the patient to give an honest answer... but the non-consensual test really destroyed my trust. Of course, if they'd asked I would have readily agreed and it isn't as if their skepticism wasn't already apparent.

> It's unethical and perhaps illegal in some places, but they are able.

Able does not always refer to physical ability. It can refer to legal ability.

To the chagrin of “may I”/“can I” pedants everywhere…

In the US system, do you get to pay for the pleasure of having a test you don’t want?

> I get that they needed to exclude an obvious potential cause and couldn't trust the patient to give an honest answer

I disagree with this resigned acceptance to medical paternalism. The basic situation is that you are the patient, and all care should be per your direction. The doctors' responsibility is to treat you based on what you've told them. If you're actually lying, the responsibility for misdiagnosis rests entirely on you.

Doctors hedging against a patient lying should only ever be considered within this larger backdrop. For example independent of the nonconsensual sample and testing, it was severely unethical for them to have delayed your care by several days while indulging their own curiosity.

> A doctor has zero ability to order tests without patient consent (or consent of a guardian) in the US.

Huh? So if they pickup my comatose body in an alley, the doctor (or medic!) can’t take test my blood sugar?

That falls under implied consent. In the case where youre unable to give consent, medical providers are given license to provide care that would be considered reasonable and necessary given your condition. Once you are conscious you can withdraw consent for treatment at any time.

A secret drug test on a conscious person who is not showing symptoms of intoxication is pretty far outside of the limits of implied consent.

People can be dependent on all kinds of drugs without symptoms of intoxication.

Irrelevant to know for say, a job (if you can do the work; who cares?) but could be quite relevant if you’re hospitalized, or your new child needs to be treated for withdrawal from it.

What’s the withdrawal like coming off lemon poppy seed muffins? Poor kids.

Probably nothing with the cutoffs they're using here, but neonatal opioid abstinence syndrome is absolutely a thing. And not all necessarily by "drug addict" mothers, but lots of legitimate long-term opiate use. But one would hope they would be up-front about the latter at least.

That’s irrelevant to legality, which is what I was talking about.

Medical consent is more complicated than just this, and what you’re talking about crosses into doctor patient confidentiality as well.

Suffice it to say that testing patients without informed consent and sharing that data with law enforcement is not something that most ethical review boards would condone.

From a practical and moral point of view this kind of incident is what keeps people from telling their doctor all of the relevant information for best care. If you have a drug problem and think a medical provider will work to have your child taken away if you are honest about it, will you ever seek treatment or be honest?

If you don’t have a drug problem, but still think that what you say to your doctor or kids doctor will get used against you, will you hesitate to get care in the future?

Do you think these mothers will ever interact with another pediatrician with full trust again?

> but still think that what you say to your doctor or kids doctor will get used against you, will you hesitate to get care in the future?

> Do you think these mothers will ever interact with another pediatrician with full trust again?

These are already issues. Only what you share with your lawyer is truly privileged. Everything else might get fanned out in a court.

Indeed, if you talk about your seizure with your doctor, your driver's license might get suspended. If you share that your medical condition isn't stable anymore, you may lose your travel health insurance (or pay for it but still get rejected when you make a claim).

In this case the guardian is either the person who brought you in or the hospital itself.

No, some rando that comes across your comatose body in an alley isn’t your guardian.

> False. A doctor has zero ability to order tests without patient consent (or consent of a guardian) in the US.

Hospitals generally require a very broad consent at admission.

Advance consent isn't legally or ethically valid unless it's informed and the procedure is actually medically necessary and appropriate. Being tested actively contrary to your own interests would never, ever qualify.

Reply on news.ycombinator.com