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Thursday, October 24, 2013

Interview On Ethical Issues

Yes, I'm still around, and yes, I know I haven't been blogging much.  I'll admit that after five years of regular writing I'm starting to lose some motivation.  But I'm not out of the game yet.

I recently received a series of questions from Amy, who is doing a report in college on ethical situations vets face in everyday practice.  I agreed to answer them and found them very interesting and challenging.  I hadn't thought of some of these issues to a great degree, so it made me think hard about my answers.  I thought it would be interesting to share them in this blog.

What do you believe the veterinary oath is trying to convey?  Does it say that veterinarians have a duty to animals or to their owners?

The oath is trying to emphasize that our focus is on helping animals and the public health, and if we can't help them we need to at least relieve suffering.  It also emphasizes the need for ethical behavior and life-long learning since medicine is constantly changing.  The oath itself does seem to indicate that our primary responsibility is to the animal, not the owner.  However, the oath is a starting point and isn't meant to be the only thing we consider with deciding responsibility, and is also not legally binding like a law.  So there is room for interpretation.

Do you believe that veterinarians should meet the needs of the furry patient first or to the owner?  

This is actually not a clear-cut issue.  Personally I believe that our first responsibility is to the patient, but we also cannot remove the owner from the discussion.  If the owner cannot afford treatment we cannot proceed with a surgery or even diagnostics.  Yes, we feel that we should be able to just treat the patient as would be best, but the owner has primary decision making and we can't supersede their right.  But when making the recommendations to the owner we should always state what is best for the animal and not consider the client's financial situation ahead of time.

In real life, do veterinarians try to meet the needs of the furry patient or the owner?

This varies between situations and doctors.  I'd like to think that we always put the patient first, but sometimes we do think of the client when making recommendations.  In the end, the reality is that we can't meet the patient's needs if we haven't met the owner's.

How do you handle patients that cannot afford to pay the medical bill?  Is there any sort of health care or insurance plan for pets?

Unless heavily subsidized through grants or donations, veterinary practices have to make money in order to pay their staff, buy supplies, cover rent and costs, and otherwise stay open.  If we give away too many services we will end up going bankrupt and closing our doors.  It may be a harsh reality, but that's the way things are.  Looking at this business aspect most vets treat clients like any non-medical business.  If a client can't pay but they agreed to treatment, they may face being sent to a collections agency for non-payment.  Most vets don't do payment plans because of the risks of losing money, which happens more times than not.  However, some vets will work individual deals with a good client.  There are several companies that sell pet insurance, though they vary widely in what they cover.  Many vets also accept credit cards or Care Credit, something specific to human and veterinary medical fields.

What are possible cases where you step in for the patient instead of the owner? (When do you say that a patient needs a treatment instead of listening to the owner, if ever?)

We as veterinarians have no legal right to make decisions for the pet if the owner is present or able to be reached.  Legally an animal is considered a special category of property, not a legally separate individual.  A vet deciding to treat a pet without consent would be like a mechanic deciding to repair an engine on a car without the owner's permission.  Without the consent of the pet owner we can only make decisions for the pet in rare circumstances.  That may be in cases of verifiable abuse where the client is potentially legally liable, or in situations where immediate therapy is needed (such as life-threatening cases) and the client can't be reached.  If a client declines a truly necessary treatment and decides to leave the office, there really is very little that we can legally do to stop them or otherwise intervene.

Do you personally report cases of abuse when you see them?   What cases do you consider abuse?

This is actually something that can be tricky to determine.  A vet might suspect criminal abuse or neglect, but proving it can be difficult.  The animal can't tell us that they were abused and the client can easily tell a lie about what happened.  If we don't have a witness or other record of the abuse, it is difficult for us to report a case.  Some of them may be obvious, such as severe malnourishment or repeated bite wounds consistent with deliberate animal fighting, but not all of them are.  If it is truly abuse I feel that we do have an ethical responsibility to report the case to authorities.  However, sometimes we will give the client an opportunity to fix the problem with the understanding that if they don't or if it happens again they will be reported to police.

Are there conflicting culture views on how pets should be treated, both in everyday care and health care?

Absolutely!  Sometimes it is a different attitude based on non-native cultures, such as someone of Asian or Arabic origins who moved to the US.  Sometimes it's age-related, such as older generations who aren't used to extensive pet care and grew up just keeping pets in the yard and putting out table scraps for them to eat.  Sometimes it's a personal background where someone grew up believing "it's just a dog".  All of these differing views can make it challenging to talk to some clients when they have a bias of some sort against treatment that might be necessary.

Do you think society looks down on people who cannot pay for advanced medical care for their pets? (Advanced medical care being major surgeries and expensive treatment plans for diseases)

At this point, no I don't.  It's still uncommon for people to spend thousands of dollars on a single surgery or course of treatment and society doesn't yet hold the standard of "treatment at all costs" for pets.  It's acceptable in society and veterinary medicine for a person to decide that they can't afford treatment and elect euthanasia as a humane option.  But as animals are seen more as family members and not just pets, I anticipate that expectations will change, especially if people are able to sue for pain and suffering rather than just financial loss or damages.  In the future there may be more societal pressure for people to go further with treatment.

What are society's expectations of veterinarians and do veterinarians compete with this view?

I believe that society expects vets to be compassionate, have extensive knowledge, provide fast, skilled treatment, and do all of that at a low cost.  For the most parts I and other vets would agree with the first part, but disagree with the last.  High quality doesn't come cheaply and we have huge loan burdens to repay.  The profession as a whole is trying to move away from the "cheap" idea and focus on the compassion and quality.

I hear the word "client" used very often on your blog.  Why do you (and others I have read) use "client" even though you are in a medical setting?   

It's a common convention that has to do with who our patient really is.  In human medicine the patient is generally the person giving the information and making the decisions.  In most situations the patient and "client" are the same.  But in veterinary medicine our patients do not tell us what has been happening, do not make treatment decisions, and do not pay the bills.  We have a distinction between "client", meaning the owner, and "patient", meaning the animal.  Our relationship with our patient is a more traditional medical one, and the relationship with the pet owner is closer to one seen in business.

Do you think people who can afford basic supplies and medical care for their pet(s) but not advanced treatment like serious medical injuries or accidents should own pets?

That's a tough one.  Personally if a client is unable to do treatment for a broken leg, bite wound, or ear infection they shouldn't own a pet.  But that's hard to say to people.  Most pets will only need vaccines, heartworm prevention, dental cleanings, and other routine preventative care.  Truly serious medical conditions are uncommon in an average pet and so many people feel that they only need to prepare for basic preventative costs.  But injuries or serious illnesses happen often enough that clients absolutely need to be prepared for this eventuality.  While I can be understanding about someone who can't afford extensive cancer treatment, being able to handle an average injury is something every owner should be able to do.  When someone accepts a pet they are committing to handling certain responsibilities and care.  If they can't do so, they shouldn't take on the care of that animal.

If the owner refuses medical care other than for financial reason, is that considered animal abuse?  Is that person considered a "bad" person and pet owner?

That's difficult to answer based on the question.  There are legitimate reasons for declining care other than financial.  Maybe the owner won't be able physically provide a certain treatment because of physical limitations or an aggressive pet.  Sometimes the pet simply doesn't allow treatment and and a client risks injury in the attempt.  I've had cases where a client isn't going to be home often enough to consistently treat a condition.  Simple refusal to treat isn't automatically "abuse" or neglect as it depends on the case, condition, and other factors.  But there are clients who just don't want to do any treatment and the pet suffers.  Depending on the nature of the problem and degree of pain or illness, this could potentially be considered criminal neglect.  The difficulty comes when the client wants a different option for some reason, especially one that may not be the "best".  If they are wanting to pursue some form of treatment even if we don't agree completely with their decision we can't consider them as being abusive.

How do you handle strays that people find off the street?  Do the people who bring them in pay or are there other means?

We're not a shelter or rescue group and so we are not set up to handle and adopt out strays.  Most of the time the person bringing the stray in will pay for initial exams and treatment, even if they don't plan on keeping the animal.  For more long-term solutions we maintain contact information for local organizations that provide this service and will refer people to these groups.