In December 2010, the World Health Organization (WHO) endorsed the use of a new DNA-based test for tuberculosis (TB), the Gene Xpert [1]. This test is expected to revolutionise the care of TB and, especially, multidrug-resistant (MDR)-TB, by providing accurate diagnoses in less than 2 h [2]. As healthcare professionals begin to incorporate rapid TB testing into clinical practice, questions about the need for informed consent will inevitably arise. Yet, despite decades of debate about informed consent to HIV testing and screening [3], informed consent to TB testing and screening has received virtually no discussion in the ethical or legal literature.
In this editorial, we argue that, in most situations, TB testing and screening does not require a specific informed consent process, but that patients should be notified about testing and given the opportunity to object. If an objection is raised, the burden should be on those proposing coercive testing to show that the expected public health benefits are sufficient to justify overriding the individual's choice. We conclude by identifying limited circumstances in which specific informed consent to TB testing should be required.
BACKGROUND
When the HIV diagnostic test was first developed, many jurisdictions enacted laws requiring written informed consent to testing [3]. The rationale was that HIV was untreatable, and individuals who tested positive faced a significant risk of stigmatisation and discrimination [3]. Moreover, because HIV was not transmissible by casual contact, the public health rationale for facilitating testing was weaker than with more easily transmissible infectious diseases.
As HIV has become more treatable and less stigmatised, policy makers have begun to shift their approach. In 2006, the US Centers for Disease Control and Prevention (USCDC) recommended that HIV testing should routinely be performed in all healthcare settings [4 …