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Wednesday, April 27, 2016

When Helping People Gets Unethical

I came across an interesting article in one of my veterinary magazines, DVM 360.  You can read the full article here, but let me quickly summarize it for you.
 
A relief vet was working at a long-established clinic.  He discovered that the owner would do surgeries at no cost to needy clients, but was using recently expired drugs to do so.  The relief vet (Dr. Han) refused to do that and talked to the practice owner (Dr. Keets) about the issue.  Here are some quotes from that article.
 
Dr. Han was diplomatic—after all, he wanted to maintain a good working relationship with Dr. Keets. He said that he understood that Dr. Keets was well-intentioned but that substandard care of indigent patients was unacceptable.
 
Dr. Keets replied that the care was not substandard. All his patients were monitored during and after surgery. If any animals showed signs of pain or inadequate anesthesia this was addressed immediately. He went on to say that offering charitable services required realistic monetary considerations. If he could not use recently outdated medications, he could not afford to offer these much-needed services.
 
He went on to say that Dr. Han traveled from practice to practice assisting veterinarians and pets on a short-term basis. He on the other hand had a responsibility to a clientele that day-in and day-out needed services they could not afford. As a result, he had to be creative in order to assist them.
A bit frustrated, Dr. Han finally said that Dr. Keets’ practices were a violation of practice statutes. Dr. Keets’ reply? “I’ve never had a complaint, and I have scores of grateful pets and pet owners.”
 
This is a difficult situation.  Dr. Keets was doing what he thought was best for the community and was sincerely trying to help people out.  To be honest, drugs don't suddenly go bad or become dangerous at midnight on the day of expiration.  And most expired drugs would lose efficacy rather than become toxic.  However, those expiration dates are there for a reason, and they need to be followed.
 
I agree with Dr. Keets where he said "offering charitable services required realistic monetary considerations."  That's very true.  Veterinary practices can't routinely give away services for free and still expect to stay in business while maintaining high medical standards.  If he didn't use those medications, "he could not afford to offer these much-needed services".  Again, that's true.  The only way he could afford to give away these surgeries was to use drugs that were no longer valid.  If he used drugs that were still within their expiration date he would have lost money and not been able to provide these services.  I've written many times about how it isn't realistic to expect veterinarians to give away services, especially surgeries, and not have their business suffer.  So bravo to Dr. Keets for recognizing this.
 
However, was what he did ethical?  No.  And it wasn't even legal.  His reply of "I've never had a complaint, and I have scores of grateful pets and pet owners" is not a good defense.  It is an attempt at justifying an unethical behavior.  Just because someone doesn't complain about a behavior doesn't make that behavior right. 
 
Here is an analysis from the author of the article.
 
It is absolutely true that the use of expired medications is a violation of the veterinary practice act in every state. Dr. Keets was aware of this but chose to help those in need and also manage any complications that may have arisen from the use of the expired medications.
There is no doubt Dr. Keets was well-intentioned. But he could have solved his medication issues in other ways. Advising vendors of his charitable efforts and asking them to participate would have been an option, as well as soliciting his more affluent clients and enlisting them in an effort to help his good works.
Rules and laws exist to prevent abuse and protect our patients. Dr. Keets gets an “A” for effort but does not pass the profession’s ethical standards test.
 
Should a veterinarian violate ethical standards and state laws in order to help people?  Personally I don't think so.  While I'm absolutely not a "big government" sort of person, I also believe in trying to uphold the letter and spirit of the law.  It is wrong to break the law because it seems convenient or helpful to do so. 
 
It also puts that doctor on very shaky ground with his license and business.  Let's imagine for a moment that something went wrong when he was using these expired drugs.  The pet had severe complications and died, in part because the drugs were not effective and they were not able to administer proper medications in time.  The client learns that expired drugs were used and brings a lawsuit against Dr. Keets, as well as reporting him to the state board.  Because he knowingly used these drugs against state law he would have no chance of winning the lawsuit and would be facing big fines from the stat veterinary board, and possibly even be in danger of losing his license to practice.
 
To me it is not worth risking my ability to work and support my clients and family.  While I admire Dr. Keets' desire to help people, he is going about it the wrong way. 
 
Hopefully this gives pet owners some insight into the challenges of trying to help those who have few funds and are in need.  I'm not saying that vets should never make the attempt, but they need to make sure they are following legal and ethical standards.  If they have to break the law or violate ethics in order to help people, they shouldn't do so.

1 comment:

  1. I think this comes up in human care as well. I think your position is the most sensible and defensible one for both human and animal medical providers. But I recognize that we're all making choices within constraints, and the constraints stem from political and financial systems that too often do not themselves operate with the care, compassion, and long term perspective that good medical providers aim to bring to their work. So I also wouldn't say that Dr. Keets is doing a wrong thing. In the bigger scheme of things, this seems to be a great example of the imperative to 'know in front of whom you stand.' Medical providers stand before their professional regulatory bodies and their local legal jurisdiction, but I can respect if they feel that they also stand before deeper/higher moral forces. That doesn't mean that Dr. Keets shouldn't be perhaps sanctioned by the appropriate civil body, but I'm glad to not be the one with the job of judging him.

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