The dilemma in the May issue concerned a veterinary surgeon who was reprimanded by their manager for including details of a newly identified condition in the clinical notes of a long-standing client's dog (In Practice, May 2011, volume 33, pages 237–238). The owner had recently taken out pet insurance and risked being refused cover for the investigations and treatment being proposed. The manager suggested that such details should be omitted until the owner had secured the necessary pet insurance, but the veterinary surgeon was uncomfortable with this instruction. Glen Cousquer commented that, from a legal perspective, the practitioner was essentially being asked to defraud the insurance company. However, a utilitarian approach to the 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 outweighed the damage to the insurance company. He noted, however, that this might be an overly simplistic view of the problem, as the veterinary employee also had duties to the profession, society and the greater good. These wider duties could be easily overlooked, especially when faced with more immediate concerns, including the veterinary surgeon's wish to please their employer (or at least not displease them) and avoid placing their own employment in jeopardy. As a possible way forward, the need to behave honestly could gently be explained to the client, with help provided to check the terms of any insurance policy. A careful evaluation of all the clinical options could 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 and the anticipated costs of veterinary care, and how they could plan to meet these costs over the lifetime of a pet.
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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: The strictly impartial approach advocated by Glen Cousquer aimed to preserve the profession's relationship with both insurance companies and clients alike. At times, this goes against our natural instincts to help our client, the person we have the direct relationship with and whom we may perceive as ‘the little guy’ caught up in all this. So, can this ever be right? Perhaps it depends on the ‘fairness’ of the system. If you perceive that insurance companies operate in a transparent and fair way towards your clients, then there could be little justification for taking sides. If, on the other hand, you perceive an injustice in the system, then it might seem right to attempt to tackle that injustice. This could be done in a number of ways. The least compromising approaches would include things like lobbying professional bodies to take a stand against the system as a whole or taking on a strong advocacy role for individual clients and ‘doing battle’ with insurance companies on their behalf. Although we can all imagine how time-consuming and ineffective this might be, it might serve to highlight problems to the insurance company involved and encourage it to change its procedures. Once we are considering options such as falsification of clinical notes to erase record of a significant pre-existing condition, we are into professionally risky territory that also seems hard to justify.
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
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, ‘Financially strapped owner with a suffering cat’, is presented and discussed by Steven McCulloch. 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 ‘Pet insurance problem’, which was published in the May issue of In Practice, appears on page 298.
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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