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Decision making
Comments on the dilemma in the September issue: ‘Can’t pay, won't pay?'
  1. Siobhan Mullan

Abstract

The dilemma in the September issue concerned a vet presented with a dog with dystocia (In Practice, September 2010, volume 32, pages 413–414). The client was not previously registered with any practice. Clinical examination revealed an oversized puppy impacted in the birth canal and the vet advised an emergency caesarean. The owner said she was claiming benefits and had no savings with which to meet the cost. Chris Barker commented that legal responsibility for the welfare of the bitch lay entirely with the owner. While it was the responsibility of the vet to make immediate provision for the welfare of the bitch, this required simply the provision of immediate first aid and pain relief, or euthanasia. Veterinary surgeons had no obligation to help others without financial recompense, and potentially writing off the financial loss as a bad debt was not always an option. A possible way forward would be to investigate other ways in which the owner might secure payment – perhaps by means of a loan from family or friends, a credit card, seeking charity support or coming to some financial arrangement with the practice. If payment was not possible, it was acceptable to refuse to perform the caesarean without payment and prevent the suffering of the bitch through euthanasia. Experience suggested that, even with promises of payment, the debt would generally remain unpaid and the owner would never return to the clinic. Unless the profession took a stand and forced pet owners to recognise their responsibilities towards their pets, nothing would change.

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Siobhan Mullan works part-time in small animal practice, as well as at the University of Bristol. She holds the RCVS diploma in animal welfare science, ethics and law.

Siobhan Mullan comments: One strand of Chris Barker's argument for not performing a caesarean on this bitch free of charge is that if vets take a stand on such issues they will promote responsible pet ownership and therefore help prevent future welfare problems. The motive here is clearly a good one so, assuming the logic to be correct, taking a stand appears to be justified. But even good decisions should be reviewed to see if it is possible to further enhance them; this is sometimes termed ‘refinement’. An example of this on an individual basis might be the use of an improved analgesic regimen for a procedure that, even under the original analgesic protocol, would be justified.

In the case of ‘taking a stand’ it may be possible to carry this out in such a way as to improve the impact of this sort of gesture. Collective stand-taking, such as when following RCVS or legislative guidance, must be assumed to be effective. But can we engage in collective stand-taking for other less regulated scenarios? To do so, it might help us to know how many other like-minded individuals there are. If we find, for example, that we are in a majority, this may help give us the confidence to stick to our convictions in tricky situations when coming under some pressure from our client. It will also help us to know that our client cannot just pop down the road to the next vet who will act in the opposite way to us.

If, on the other hand, we find we are in a minority, this should prompt a more critical evaluation of our views, truly considering our motives and potential outcomes of our actions. So, all we need is an ethical barometer for our profession – now, where would we get one of those?

Have you faced a dilemma that you would like considered in a future instalment of Everyday Ethics? If so, e-mail a brief outline to inpractice@bva-edit.co.uk

Notes

THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved. In addition, a possible way forward is suggested; however, there is rarely a cut-and-dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘To treat or not?’, is presented and discussed by James Yeates. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue. Discussion of the dilemma ‘Can’t pay, won't pay?', which was published in the September issue of In Practice, appears on page 459.

The series is being coordinated by Siobhan Mullan, of the University of Bristol. It is hoped it will provide a framework that will help practices find solutions when facing similar dilemmas.

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