Veterinary Medical Ethics Déontologie vétérinaire Ethical question of the month — August 2013 Two months ago you changed employers from a mixed animal veterinary practice to a food animal exclusive practice. During a routine herd visit a client shows you his new farm dog that he bought for $20 from a neighbor. The dog is persistently scratching and the farmer has dusted it for fleas several times with no response. From the lesions and your previous small animal experience in this region, you are confident the animal has sarcoptic mange, a common condition you diagnosed and treated successfully in your previous practice. The young dog seems healthy and happy, in the owner’s opinion, and will receive no additional medical care as the owner does not spend money on what he perceives as minor problems in his farm dogs and cats. You have an appropriate insecticide in the truck with which to treat the dog. Your regulatory body says that since your clinic is not licensed for the practice of companion animals, you are not allowed to treat this dog. However, your professional mandate is to alleviate animal suffering where possible. Additionally, your individual veterinary license is a general license and does not designate species. Should you follow your professional responsibility and treat the animal, or abide by the position of the regulatory body and recommend a referral, which you know will be ignored? Submitted by Andrew MacLeod, DVM, Linwood, Ontario
Question de déontologie du mois — Août 2013 Il y a deux mois, vous avez changé d’employeurs pour passer d’une pratique vétérinaire mixte à une pratique se consacrant exclusivement aux animaux destinés à l’alimentation. Durant une visite régulière du troupeau, un client vous montre son nouveau chien de ferme acheté pour 20 $ auprès d’un voisin. Le chien se gratte constamment et le fermier lui a administré de la poudre contre les puces sans obtenir de résultat. D’après les lésions et votre expérience antérieure en pratique des petits animaux dans cette région, vous êtes confiant que l’animal souffre de la gale sarcoptique, une affection fréquente que vous avez traitée avec succès dans votre pratique antérieure. Selon le propriétaire, le jeune chien semble en santé et heureux et il ne recevra aucuns soins additionnels car le propriétaire ne dépense pas d’argent pour ce qu’il perçoit comme étant des problèmes mineurs chez ses chiens et chats de ferme. Vous disposez d’un insecticide approprié dans le camion pour traiter le chien. Votre organisme de réglementation dit que, vu que votre clinique ne possède pas de permis pour traiter les animaux de compagnie, vous n’êtes pas autorisé à traiter ce chien. Cependant, votre mandat professionnel stipule que vous devez soulager les souffrances animales dans la mesure du possible. De plus, votre permis de vétérinaire individuel est un permis général et il ne porte pas sur une espèce particulière. Devriez-vous vous acquitter de votre responsabilité professionnelle et traiter l’animal ou respecter la position de l’organisme de réglementation et donner une recommandation dont le propriétaire ne tiendra pas compte? Soumise par Andrew MacLeod, D.M.V., Linwood (Ontario) 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, Veterinary Science, Ontario Ministry of Agriculture, Food and Rural Affairs, 6484 Wellington Road 7, Unit 10, Elora, Ontario N0B 1S0; 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 Dr Tim Blackwell, Science vétérinaire, ministère de l’Agriculture, de l’Alimentation et des Affaires rurales de l’Ontario, 6484, chemin Wellington 7, unité 10, Elora, (Ontario) N0B 1S0; téléphone : (519) 846-3413; télé copieur : (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 54 / AUGUST 2013
725
D É O N TO LO G I E V É T É R I N A I R E
Ethical question of the month — May 2013 It is a busy day in your small one-person small animal clinic. The receptionist has booked more elective surgeries than you wish to perform, and the patients have already been admitted. You examine the preanesthetic blood work and see that a 6-month-old mixed breed dog scheduled for an ovario-hysterectomy is mildly anemic. You find no other abnormalities on physical examination or blood chemistry. You ask the technician to contact the owner and explain the added risks of anesthesia due to the mild anemia. The owner is concerned and when he arrives to take his dog home he is instructed to return the dog in 2 weeks for a follow-up hematocrit. Later that week, when only one elective surgery is scheduled, pre-anesthetic blood work reveals a mild anemia in another young dog scheduled for ovario-hysterectomy. You proceed with this surgery without contacting the owner. No mention of the anemia is made when the dog is discharged. When the first dog is re-examined 2 weeks later, the hematocrit is unchanged, but the dog is nevertheless scheduled for surgery the following day. The technician is fully aware of what is going on but is mildly uncomfortable with the way in which the two cases were handled. Is there a problem here?
Question de déontologie du mois — Mai 2013 C’est une journée chargée dans votre petite clinique pour animaux de compagnie d’une personne. La réceptionniste a pris plus de rendez-vous de chirurgies non urgentes que vous ne le souhaitiez et les patients ont déjà été admis. Vous examinez l’hémogramme préanesthésique et vous constatez qu’une chienne de race croisée âgée de 6 mois devant subir une ovariohystérectomie est légèrement anémique. Vous ne constatez aucune autre anomalie à l’examen physique ou dans la chimie du sang. Vous demandez à la technicienne de communiquer avec le propriétaire et d’expliquer les risques supplémentaires de l’anesthésie en raison de l’anémie légère. Le propriétaire est inquiet et lorsqu’il arrive pour ramener son chien à la maison, on lui demande de revenir avec le chien dans 2 semaines pour un hématocrite de suivi. Plus tard la même semaine, lorsque seulement une chirurgie non urgente est prévue, l’analyse sanguine préanesthésique révèle une anémie légère chez une autre jeune chienne devant subir une ovariohystérectomie. Vous effectuez cette chirurgie sans contacter le propriétaire. Aucune mention d’anémie n’est faite lorsque la chienne obtient son congé. Lorsque le premier chien est réexaminé deux semaines plus tard, l’hématocrite est inchangé, mais la chirurgie est tout de même fixée au lendemain. La technicienne est pleinement consciente de ce qui se passe, mais elle est un peu mal à l’aise avec la façon dont les deux cas ont été gérés. Y a-t-il un problème avec cette situation?
Comment This is not an isolated problem. The latest example was an SPCA adoption I saw. The SPCA took the dog to their usual hospital for dental work. Blood tests were done, a liver problem identified (high ALP and ALT), and the dog was put under anesthetic for the work. No further tests (liver function) were done. No change in the anesthetic took place. No follow-up was suggested to the shelter. The new owners weren’t told of an issue. Blood tests can be done for the right reasons, but also for two inappropriate reasons: one is for income generation; the
other is for defensive medicine. Blood tests should not be done unless the results could change what you were planning to do or confirm the course of treatment. This case exemplifies a linked concern — there is no consistency and the results were ignored, so why do them? Jeff Grognet, DVM, BSc(Agr), Mid-Isle Veterinary Hospital, Qualicum Beach, British Columbia
An ethicist’s commentary on mildly anemic dogs As a beginning philosophy student, one of the first things I learned is to avoid the dire sin of contradicting oneself. Inconsistency is to a philosopher, or indeed to anyone attempting to make a rational case, as kryptonite is to Superman. As patently true as this dictum is for rational argument, it is equally true for the behavior of any professional. As a university professor, for example, you learn quickly that, when grading students, you must avoid even the appearance of not being impartial. In general, treating relevantly similar cases in a similar way is presuppositional to conducting oneself in a just manner. During the last 50 years in North America, this point has been repeatedly underscored in social ethics, be it in terms of racial or gender 726
equality. Differences between individuals that are cited to justify differential treatment must be morally relevant to the treatment in question. It will not, for example, work morally to justify overcharging a given client for a procedure that you routinely charge other clients less for, by citing the fact that the client in question is unusually homely. Consistency is therefore basic to fairness, and being perceived as fair is essential to success in one’s chosen vocation. The fact that you are pressed for time in the case of the first dog but not in the case of the second ovario-hysterectomy does not warrant or even permit a difference in how one approaches the two cases. If one’s clients were to learn that your surgical behavior in two CVJ / VOL 54 / AUGUST 2013
CVJ / VOL 54 / AUGUST 2013
In a situation such as this one, I am told by my veterinarian friends that the danger of any harm coming to either dog as a result of the inconsistency is quite small — the mild anemia could well result from numerous benign causes. But once it has been noted, you are professionally obliged to follow up on it in both cases. Failure to do so could lead to a malpractice claim, as well as result in a permanent erosion of respect for you on the part of the technician, which can in turn result in significant change in attitude towards your practice that can only harm you in the long run. Bernard E. Rollin, PhD
727
V E T E R I N A RY M E D I CA L E T H I C S
very similar cases varies with how pressed for time you are, your reputation could well be permanently sullied, in just the same way as if what you charged fluctuated. In addition, what your technician thinks of your medical practices can have a major influence on the image projected to your clients. For this reason, it is essential that you discuss the situation with your technician in total candor. You should admit that you acted hastily and improperly under the pressures of time, and that you will never make that mistake again. In fact, you can use this occasion, as Plato says, to make a virtue of necessity, explaining the dangers of inconsistency. This can remove what could well turn into an attitudinal tension and conflict between you and your technician if left undiscussed, and in fact turn a potential danger into a salubrious learning experience.
Question de déontologie du mois — Août 2013 Il y a deux mois, vous avez changé d’employeurs pour passer d’une pratique vétérinaire mixte à une pratique se consacrant exclusivement aux animaux destinés à l’alimentation. Durant une visite régulière du troupeau, un client vous montre son nouveau chien de ferme acheté pour 20 $ auprès d’un voisin. Le chien se gratte constamment et le fermier lui a administré de la poudre contre les puces sans obtenir de résultat. D’après les lésions et votre expérience antérieure en pratique des petits animaux dans cette région, vous êtes confiant que l’animal souffre de la gale sarcoptique, une affection fréquente que vous avez traitée avec succès dans votre pratique antérieure. Selon le propriétaire, le jeune chien semble en santé et heureux et il ne recevra aucuns soins additionnels car le propriétaire ne dépense pas d’argent pour ce qu’il perçoit comme étant des problèmes mineurs chez ses chiens et chats de ferme. Vous disposez d’un insecticide approprié dans le camion pour traiter le chien. Votre organisme de réglementation dit que, vu que votre clinique ne possède pas de permis pour traiter les animaux de compagnie, vous n’êtes pas autorisé à traiter ce chien. Cependant, votre mandat professionnel stipule que vous devez soulager les souffrances animales dans la mesure du possible. De plus, votre permis de vétérinaire individuel est un permis général et il ne porte pas sur une espèce particulière. Devriez-vous vous acquitter de votre responsabilité professionnelle et traiter l’animal ou respecter la position de l’organisme de réglementation et donner une recommandation dont le propriétaire ne tiendra pas compte? Soumise par Andrew MacLeod, D.M.V., Linwood (Ontario) 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, Veterinary Science, Ontario Ministry of Agriculture, Food and Rural Affairs, 6484 Wellington Road 7, Unit 10, Elora, Ontario N0B 1S0; 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 Dr Tim Blackwell, Science vétérinaire, ministère de l’Agriculture, de l’Alimentation et des Affaires rurales de l’Ontario, 6484, chemin Wellington 7, unité 10, Elora, (Ontario) N0B 1S0; téléphone : (519) 846-3413; télé copieur : (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 54 / AUGUST 2013
725
D É O N TO LO G I E V É T É R I N A I R E
Ethical question of the month — May 2013 It is a busy day in your small one-person small animal clinic. The receptionist has booked more elective surgeries than you wish to perform, and the patients have already been admitted. You examine the preanesthetic blood work and see that a 6-month-old mixed breed dog scheduled for an ovario-hysterectomy is mildly anemic. You find no other abnormalities on physical examination or blood chemistry. You ask the technician to contact the owner and explain the added risks of anesthesia due to the mild anemia. The owner is concerned and when he arrives to take his dog home he is instructed to return the dog in 2 weeks for a follow-up hematocrit. Later that week, when only one elective surgery is scheduled, pre-anesthetic blood work reveals a mild anemia in another young dog scheduled for ovario-hysterectomy. You proceed with this surgery without contacting the owner. No mention of the anemia is made when the dog is discharged. When the first dog is re-examined 2 weeks later, the hematocrit is unchanged, but the dog is nevertheless scheduled for surgery the following day. The technician is fully aware of what is going on but is mildly uncomfortable with the way in which the two cases were handled. Is there a problem here?
Question de déontologie du mois — Mai 2013 C’est une journée chargée dans votre petite clinique pour animaux de compagnie d’une personne. La réceptionniste a pris plus de rendez-vous de chirurgies non urgentes que vous ne le souhaitiez et les patients ont déjà été admis. Vous examinez l’hémogramme préanesthésique et vous constatez qu’une chienne de race croisée âgée de 6 mois devant subir une ovariohystérectomie est légèrement anémique. Vous ne constatez aucune autre anomalie à l’examen physique ou dans la chimie du sang. Vous demandez à la technicienne de communiquer avec le propriétaire et d’expliquer les risques supplémentaires de l’anesthésie en raison de l’anémie légère. Le propriétaire est inquiet et lorsqu’il arrive pour ramener son chien à la maison, on lui demande de revenir avec le chien dans 2 semaines pour un hématocrite de suivi. Plus tard la même semaine, lorsque seulement une chirurgie non urgente est prévue, l’analyse sanguine préanesthésique révèle une anémie légère chez une autre jeune chienne devant subir une ovariohystérectomie. Vous effectuez cette chirurgie sans contacter le propriétaire. Aucune mention d’anémie n’est faite lorsque la chienne obtient son congé. Lorsque le premier chien est réexaminé deux semaines plus tard, l’hématocrite est inchangé, mais la chirurgie est tout de même fixée au lendemain. La technicienne est pleinement consciente de ce qui se passe, mais elle est un peu mal à l’aise avec la façon dont les deux cas ont été gérés. Y a-t-il un problème avec cette situation?
Comment This is not an isolated problem. The latest example was an SPCA adoption I saw. The SPCA took the dog to their usual hospital for dental work. Blood tests were done, a liver problem identified (high ALP and ALT), and the dog was put under anesthetic for the work. No further tests (liver function) were done. No change in the anesthetic took place. No follow-up was suggested to the shelter. The new owners weren’t told of an issue. Blood tests can be done for the right reasons, but also for two inappropriate reasons: one is for income generation; the
other is for defensive medicine. Blood tests should not be done unless the results could change what you were planning to do or confirm the course of treatment. This case exemplifies a linked concern — there is no consistency and the results were ignored, so why do them? Jeff Grognet, DVM, BSc(Agr), Mid-Isle Veterinary Hospital, Qualicum Beach, British Columbia
An ethicist’s commentary on mildly anemic dogs As a beginning philosophy student, one of the first things I learned is to avoid the dire sin of contradicting oneself. Inconsistency is to a philosopher, or indeed to anyone attempting to make a rational case, as kryptonite is to Superman. As patently true as this dictum is for rational argument, it is equally true for the behavior of any professional. As a university professor, for example, you learn quickly that, when grading students, you must avoid even the appearance of not being impartial. In general, treating relevantly similar cases in a similar way is presuppositional to conducting oneself in a just manner. During the last 50 years in North America, this point has been repeatedly underscored in social ethics, be it in terms of racial or gender 726
equality. Differences between individuals that are cited to justify differential treatment must be morally relevant to the treatment in question. It will not, for example, work morally to justify overcharging a given client for a procedure that you routinely charge other clients less for, by citing the fact that the client in question is unusually homely. Consistency is therefore basic to fairness, and being perceived as fair is essential to success in one’s chosen vocation. The fact that you are pressed for time in the case of the first dog but not in the case of the second ovario-hysterectomy does not warrant or even permit a difference in how one approaches the two cases. If one’s clients were to learn that your surgical behavior in two CVJ / VOL 54 / AUGUST 2013
CVJ / VOL 54 / AUGUST 2013
In a situation such as this one, I am told by my veterinarian friends that the danger of any harm coming to either dog as a result of the inconsistency is quite small — the mild anemia could well result from numerous benign causes. But once it has been noted, you are professionally obliged to follow up on it in both cases. Failure to do so could lead to a malpractice claim, as well as result in a permanent erosion of respect for you on the part of the technician, which can in turn result in significant change in attitude towards your practice that can only harm you in the long run. Bernard E. Rollin, PhD
727
V E T E R I N A RY M E D I CA L E T H I C S
very similar cases varies with how pressed for time you are, your reputation could well be permanently sullied, in just the same way as if what you charged fluctuated. In addition, what your technician thinks of your medical practices can have a major influence on the image projected to your clients. For this reason, it is essential that you discuss the situation with your technician in total candor. You should admit that you acted hastily and improperly under the pressures of time, and that you will never make that mistake again. In fact, you can use this occasion, as Plato says, to make a virtue of necessity, explaining the dangers of inconsistency. This can remove what could well turn into an attitudinal tension and conflict between you and your technician if left undiscussed, and in fact turn a potential danger into a salubrious learning experience.
