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Ethical dilemmas in practice
To refer or not?
  1. David C. J. Main1
  1. 1 University of Bristol, Bristol BS40 5DU


The dilemma in the March issue concerned a client presenting a cat that had a heavily infected descemetocele (In Practice, March 2010, volume 32, page 122–123). In the primary vet's opinion, a conjunctival pedicle flap was required, a procedure they had performed six times previously, with four of the cases healing successfully. The nearest referral practice was 40 miles away. Michael Stevenson commented that referral might be especially attractive to new graduates, and increasing the numbers of referred cases could decrease experience levels in general practice, possibly leading to a fall in service quality. Both the welfare of the animal and the wellbeing of the client should be considered, as well as the probability of a good outcome. A possible way forward would be for the primary vet to perform the operation him or herself, having gained informed consent. Even if the surgery did not go to plan and required enucleation, then, so long as the vet assessed his or her chances as acceptable, they were justified in proceeding. Assessing welfare compromise was retrospective and there was no way of knowing if alternative therapeutic strategies would have been more successful. However, such retrospective judgements were useful for determining the success of similar procedures carried out subsequently — if the vet should have referred the case in hindsight, then henceforth he or she should do so.

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