the AMA Department of STD and HIV, was adopted in June 1996 after contentious debate by the AMA House of Delegates, its policy setting body. The formal policy states, "The American Medical Association supports the position that there should be mandatory HIV testing of all pregnant women and newborns, with counseling and recommendations for appropriate treatment." Dr. Henning observed that the debate centered upon medical benefits to the infant versus protecting the rights of the patient (i.e., the pregnant woman).
Because the voting was very close and not all of the 550 delegates were present for the vote, the delegates reconsidered the policy at the next meeting in December 1996. They began by considering a resolution to rescind mandatory testing, but, again after heated debate, the recision resolution was successfully reversed to reaffirm the need for mandatory testing. The AMA's position on mandatory testing is an outgrowth of its earlier policy that testing should be voluntary, unless the benefits of newborn testing are demonstrated sufficiently to warrant mandatory testing.
Participants reacted to the AMA position by questioning the effectiveness of mandatory testing and the procedural impact of the AMA position. Workshop participants expressed surprise with mandatory testing in light of its possible deterrence to prenatal care; experience suggesting that women overwhelmingly agree to be tested voluntarily; and the possibility of harm to women from their partner if they proceed with testing. Dr. Henning said that the overriding impetus for the passage of the policy was the life of the newborn. In later discussion, the terms of the AMA's debate, which pit the life of the newborn against the rights of the mother, was criticized as a false dichotomy by Mr. Tim Westmoreland, a representative of the Elizabeth Glaser Pediatric AIDS Foundation. Instead, the debate over mandatory versus voluntary testing should be cast, in his view, as "what doesn't work" versus "what works." In response to other questions, Dr. Henning cited the AMA's position as a policy, not a law or mandate, for physician behavior; consequently, AMA members are not monitored for their compliance. The policy remains in force unless further action is taken by the House of Delegates.
The American College of Obstetricians and Gynecologists (ACOG) endorses voluntary, as opposed to mandatory, HIV testing of pregnant women. Its position, passed in August 1995 and reaffirmed in 1996, advocates (1) routine counseling of all pregnant women as part of prenatal care; (2) voluntary testing with consent; and (3) documentation of refusal of testing in the patient's chart. Dr. Michael Greene, an ACOG representative, also noted that ACOG recommends that pretest counseling should include information about high-risk behaviors, vertical transmission, availability and effectiveness of therapy, and the potential social and psychological implications of testing positive. ACOG also recommends, on a