Veterinary Medical Ethics  Déontologie vétérinaire Ethical question of the month — May 2015 The authorship of scientific publications has changed. One to three authors of a scientific publication was once the norm. Today dozens and sometimes hundreds of individuals may be listed as authors on a single study. Authorship was once assumed to indicate a critical and specific contribution to the research process; however, recently there has developed a trend for authorship to be given to individuals for minor contributions or for providing routine services within a research establishment. Most scientific journals have lenient policies in determining authorship and some journals have no criteria whatsoever. The number of scientific publications in a researcher’s résumé is critical to their advancement within a scientific establishment and this creates a “no-cost” incentive for scientists to spread authorship widely. Recently, in cases of scientific fraud, certain co-authors listed on a fraudulent publication were exonerated after it was determined they had only the most superficial connection to the fraudulent research. Some argue that authorship should be limited to those who have made critical and specific contributions to the research. Is there any real harm in casting the authorship net widely?

Question de déontologie du mois — Mai 2015 La paternité des publications scientifiques a changé. La norme était autrefois d’un à trois auteurs pour une publication scientifique. Aujourd’hui, des dizaines, voire parfois des centaines, de personnes sont citées en tant qu’auteurs pour une seule étude. On présumait anciennement que la paternité littéraire indiquait une contribution critique et spécifique au processus de recherche. Cependant, il s’est récemment développé une tendance qui consiste à donner la paternité à des personnes pour des contributions mineures ou pour la prestation de services de routine dans un établissement de recherche. La plupart des revues scientifiques ont des politiques moins strictes pour la détermination de la paternité littéraire et certaines revues n’ont absolument aucun critère. Le nombre de publications scientifiques dans le curriculum vitæ d’un chercheur est critique pour son avancement dans un établissement scientifique et cela crée un incitatif «gratuit» en vue d’étendre la paternité littéraire. Récemment, dans des cas de fraude scientifique, certains coauteurs énumérés sur une publication frauduleuse ont été exonérés après qu’il a été déterminé qu’ils avaient seulement un lien superficiel avec la recherche frauduleuse. Certains font valoir que la paternité littéraire devrait se limiter aux personnes qui ont apporté des contributions critiques et spécifiques à la recherche. L’attribution étendue de la paternité littéraire cause-elle des torts réels? Responses to the case presented are welcome. Please limit your reply to approximately 50 words and forward along with your name and address to: Ethical Choices, c/o Dr. Tim Blackwell, 6486 E. Garafraxa, Townline, Belwood, Ontario N0B 1J0; telephone: (519) 846-3413; fax: (519) 846-8178; e-mail: [email protected]. Suggested ethical questions of the month are also welcome! All ethical questions or scenarios in the ethics column are based on actual events, which are changed, including names, locations, species, etc., to protect the confidentiality of the parties involved.

Les réponses au cas présenté sont les bienvenues. Veuillez limiter votre réponse à environ 50 mots et nous la faire parvenir par la poste avec vos nom et adresse à l’adresse suivante : Choix déontologiques, a/s du D r Tim Blackwell, 6486, E. Garafraxa, Townline, Belwood (Ontario) N0B 1J0; téléphone : (519) 846-3413; télécopieur : (519) 846-8178; courriel : [email protected]. Les propositions de questions déontologiques sont toujours bienvenues! Toutes les questions et situations présentées dans cette chronique s’inspirent d’événements réels dont nous modifions certains éléments, comme les noms, les endroits ou les espèces, pour protéger l’anonymat des personnes en cause.

Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des ­réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs. CVJ / VOL 56 / MAY 2015

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Ethical question of the month — February 2015 You are presented after-hours with a 6-year-old female poodle-cross dog that has been hit by a car. The owner is visiting a friend in your area and is several hours from home. You examine the dog and she is experiencing extreme pain over the rib cage. On palpation there is crepitus over several ribs although palpation is difficult due to the pain the dog is experiencing. The heart rate and respiratory rate are elevated and although the dog’s breathing is shallow, she does not appear to be in immediate distress if not moved. You explain to the owner that you will give the dog an analgesic and a tranquilizer and then radiograph her chest. The owner replies that she only accepts homeopathic treatments for herself and her pets and does not want any artificial chemicals injected into her animal. She asks you to refer her to a colleague who practices veterinary homeopathy. If not, she will drive the 4 hours home to her regular homeopathic veterinarian. You do not know any veterinarians in the area who practice homeopathic medicine and are convinced that the dog will be very uncomfortable during a 4-hour car ride without some type of analgesia. How should you respond? Submitted by Ann Godkin, Elora, Ontario

Question de déontologie du mois — Février 2015 On vous présente, en dehors des heures régulières, une chienne caniche âgée de 6 ans qui a été heurtée par une automobile. La propriétaire visite une connaissance dans la région et se trouve à plusieurs heures de son domicile. Vous examinez la chienne et elle éprouve une douleur intense sur la cage thoracique. À la palpation, il y a de la crépitation sur plusieurs côtes, mais la palpation est difficile en raison de la douleur éprouvée par la chienne. Le rythme cardiaque et la fréquence respiratoire sont élevés et, même si la dépression respiratoire de la chienne est légère, elle ne semble pas en détresse immédiate si elle n’est pas déplacée. Vous expliquez à la propriétaire que vous administrerez un analgésique et un tranquillisant à la chienne et que vous effectuerez ensuite une radiographie de la poitrine. La propriétaire répond qu’elle accepte seulement des traitements homéopathiques pour elle-même et ses animaux et qu’elle ne veut pas que des produits chimiques artificiels soient injectés dans son animal. Elle vous demande de la recommander à un collègue qui pratique l’homéopathie vétérinaire. Sinon, elle effectuera le trajet de 4 heures pour rentrer chez elle et consulter son vétérinaire homéopathique régulier. Vous ne connaissez pas de vétérinaires dans la région qui pratiquent la médecine homéopathique et vous êtes convaincu que la chienne sera inconfortable durant le trajet de quatre heures en automobile sans un type quelconque d’analgésie. Comment devriez-vous répondre? Soumise par Ann Godkin, Elora (Ontario)

Homeopathy — A comment The short answer is: wish the owner (and her dog) bon voyage. Given the owner’s adamant stance in the scenario, it is unlikely that you could pursue further diagnostics or palliation in a medically ethical fashion. Your only recourse is to send the owner to her home veterinarian. Furthermore, homeopathy is medical fraud, and veterinary homeopathy is an oxymoron. The only manner by which homeopathy can produce a salutary result is via the placebo effect. With respect to dogs, which are evolutionarily attuned to human companions, it is certainly possible that such placebo

effect can be “transferred” from human to dog. That might obtain in instances of psychic or physiological insult. But in this scenario one is dealing with almost certain physical injury which could prove dire and require surgical intervention in order to save the dog. Homeopathy has nothing to offer here. But the owner’s unwillingness to consider your medical advice dooms any further involvement. John B. Delack, PhD, DVM, Saskatoon SK

An ethicist’s commentary on client demands homeopathy Situations like the one described in this case are unfortunately all too common, and we have written about them on numerous occasions in this column — recall the situation of the anorexic client who brings in an emaciated dog, or the many cases in which clients demand trendy alternative therapies for their animals. When one lives in a free society, one must accept that human patients are entitled to choose whatever flaky therapy they wish for themselves. But it is quite a different situation when one is seeking treatment for one’s child or one’s animal. The difference has recently been thrown into bold relief when, 440

for whatever reason, parents refuse to vaccinate their children against measles, a very well-established modality that not only protects their child, but also other children from the spread of the virus. The client demanding homeopathic treatment for a dog hit by a car with evident fractures that are highly painful is the latest example of a client pursuing an irrational therapy at the expense of the animal’s well-being. I have written extensively along with my friend and colleague, Dr. David Ramy, DVM, on the ethics and epistemology of alternative therapies. In my view, well-articulated in a CVJ / VOL 56 / MAY 2015

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New England Journal of Medicine editorial a decade or so ago, there are no “alternative” therapies — there are only evidentially based therapies and non-evidentially based therapies. Let us recall that to be chartered as a veterinary school; an institution needs to be “science-based,” as are the therapeutic modalities taught to students. The appeal to scientific standards forestalls practitioners from utilizing bizarre and unproven therapies, a practice that could quickly devolve into DVM standing for “Doctor of Voodoo Medicine.” A responsible veterinarian limits therapies to what is scientifically established, although this ideal is not always upheld. Indeed, if some of these “alternative” treatments work, modern science is wrong! Consider, for example, homeopathy. According to homeopathic principles, one treats, for example, vomiting not with anti-emetics but with emetics, or diarrhea with laxatives. These, however, are diluted so significantly that they retain no biological activity. In some mysterious way, the water diluting them is claimed to retain a “memory” of what has been diluted, and cures the problem. Despite many studies showing lack of efficacy, people continue to believe in homeopathy — any reasonably sized city has a homeopathic pharmacy. The interested reader should consult our book, Complementary and Alternative Veterinary Medicine Considered, in which these alternative modalities are examined in detail. Everyone is, of course, entitled to go to hell in his or her own way, but is not entitled to take those who depend on them

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along with them. In this case, forcing the dog to take a 4-hour drive to the homeopathic veterinarian while it is in significant and unrelieved pain is tantamount to torture. I would telephone the homeopathic veterinarian and explain the situation, asking him or her to convince the client to allow you to perform stabilization of the animal and pain control. I would hope that he or she would agree, particularly if you point out that the animal will suffer greatly if this is not done. Indeed, failure to persuade or attempt to persuade could well be viewed as malpractice. In addition, to my knowledge, there is not a great deal a homeopathic practitioner could do for a fracture that differs significantly from what you would do, though I am not certain about this. I would hope this strategy would mitigate the situation. But if the client is completely obdurate, I would invoke the strategy of considering her behavior to be a form of cruelty and threatening to report her to the authorities. Given your respected status in the community, along with your Aesculapian authority, there is a fair chance you will get a hearing. Though this is clearly an extreme approach, it is far better than allowing her to subject the dog to 4 hours of extreme pain that can seriously impede recovery. Bernard E. Rollin, PhD

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