Your manager reprimands you for including details of a newly identified condition in the clinical notes of a client's dog. The client has very recently taken out pet insurance and thus risks being refused cover for the investigations and treatment you are proposing. This is a long-standing client with limited means. Your manager suggests that you omit such details in future until the owner has secured the necessary pet insurance and points out that any misrepresentation would therefore be committed by the owner. You feel uncomfortable with this instruction. How should you proceed?
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Glen Cousquer graduated from Edinburgh in 1997 and worked in mixed practice for two years and as a wildlife veterinary officer for the RSPCA for four years. Since 2003, he has worked in exotic referral practice and gained additional zoo and exotic animal experience in the UK, South Africa and France. He holds the RCVS certificate in zoological medicine and an MSc in education. He is currently pursuing research interests in ethics and education at the University of Edinburgh's Moray House School of Education.
Issues to consider
From a legal perspective, you are, in this scenario, essentially being asked to defraud the insurance company. It is suggested that your duty to help the client and their pet (your patient) and provide them with the care and treatment they need requires you to turn a blind eye. You are being asked to overlook certain findings, thereby giving the impression that the patient is only diagnosed with the condition after it has become covered by the insurance policy.
The fact that your manager is recommending this course of action to you creates an additional pressure, for he or she is making it clear that they believe your duty to the client and, by implication, the practice, requires you to be ‘economical with the truth’. Some might suggest that the insurance system is a game that needs to be played … and played to win. Some may question why you should care about a faceless institution when you have to answer to the very real cares and concerns of a client, a patient and your employer? Finally, some may take the view that, as long as you do not falsely certify that an animal is in good health, you would simply be ensuring that there is nothing in the clinical records to suggest that the clinical problem predated the insurance coming into force!
A utilitarian approach to this dilemma might well try to weigh up the good that might arise through turning a blind eye and judge that the benefits to the patient, client and practice outweigh the damage to the insurance company. This is, unfortunately, overly simplistic, for the veterinary employee also has duties to the profession, society and the greater good. These wider duties are easily overlooked, especially when faced with more immediate concerns, including the veterinary employee's wish to please their employer (or at least not displease them) and avoid placing their own employment in jeopardy.
Possible ways forward
It should be remembered that the ideology of professionalism asserts, above all else, devotion to the use of disciplined knowledge and skill for the public good (Freidson 2001). In many cases, professionals will concern themselves with the good of individual patients, students or clients, in other cases of companies or groups and in others the general good. In all cases, however, ‘such service must be balanced against a still larger public good, sometimes one anticipated in the future’ (Freidson 2001).
It is only by confronting such dilemmas and applying the virtues that one can develop one's phronesis (practical wisdom). In doing so, we must have the courage to confront our own fears and learn to conduct ourselves wisely, courageously, honestly and justly. To abjure such values can only lead to our integrity, honesty and professionalism being brought into question.
The need to behave honestly does not preclude trying to assist the client as much as possible of course. The need for honesty can be gently explained and help provided to check the terms of any insurance policy. A careful evaluation of all the clinical options can then be made and the client fully supported in making the right decision for their pet. It would also be appropriate to carefully review the advice and information provided to clients about pet insurance, the costs of veterinary care and how they can plan to meet the anticipated costs of veterinary care over the lifetime of a pet.
A complex triangular relationship exists between the veterinary profession, clients and the insurance industry. Fundamentally, we are all in it together and the veterinary professional needs to work closely with both parties, thereby maintaining their trust and respect. This means that they must be wary of taking sides and should ensure that their conduct is honourable and professional at all times.
Readers with views to contribute on ‘Pet insurance problem’ should e-mail them toso that they can be considered for publication in the next issue, or fax comments to 020 7383 6418. The deadline for receipt of comments is Friday, June 3. Please limit contributions to 200 words.
THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that might 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-anddried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Pet insurance problem’, is presented and discussed by Glen Cousquer. 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 ‘Social media menace?’, which was published in the April issue of In Practice, appears on page 238.
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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