Your next door neighbour calls to ask your advice. Her grandson, who is living in another town, has taken his six-year-old rabbit to the local vet. It was in good health, bright, alert and eating normally, but with a swelling on the side of its face. The practice diagnosed an abscess and offered to remove it surgically for £300. You are not sure you would have recommended this had the rabbit been presented to you. How should you respond?
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David Williams teaches veterinary ophthalmology at Cambridge Veterinary School and is director of studies in veterinary medicine at St John's College, Cambridge. He is also involved in animal ethics and welfare teaching and research at both undergraduate and postgraduate levels.
Issues to consider
This presents us with a clinical issue as well as an ethical dilemma. These abscesses, quite probably arising from an infected tooth root, can be very difficult to manage successfully and different veterinary surgeons will have different therapeutic strategies. Personally, I feel that in a healthy, happy ageing rabbit surgery is probably not called for and the prognosis for cure with surgery is poor. Then again, as an ophthalmologist, I do not see many rabbits unless they have retrobulbar abscesses, which are notoriously difficult to manage. Thus, my view may be unduly negatively biased. I must also admit that £300 for surgery without a reasonable prognosis in a pet rabbit seems like a lot of money.
This brings us to the even more taxing ethical issue. Is advice given to my next door neighbour over the garden fence, as it were, a second opinion? I guess it has to be, and whatever I say will have repercussions in terms of the management of the rabbit and the relationship between the veterinary surgeon who has seen it and the client.
The RCVS Code of Professional Conduct (RCVS 2012) states that we should make animal health and welfare our first consideration – but this is for animals committed to our care and clearly this animal is under someone else's care! It also underlines that we should foster and endeavour to maintain good relationships with our professional colleagues, communicate with our colleagues to ensure the health and welfare of animals or groups of animals, and that we should not speak or write disparagingly about another veterinary surgeon.
Possible way forward
One option would be to refuse to give an opinion, but this seems rather hard-hearted.
Another would be to ask the neighbour to contact the vet involved before giving an opinion, but we are talking about an informal request for friendly advice and not a formal request for referral.
It would probably be easiest to preface your comments with a disclaimer that different vets have different views on treatment options, without one being wrong and the other right, and to emphasise that you are making suggestions without even having seen the animal. You could suggest that the grandson might return to the vet and ask whether this is the only treatment option, or if a ‘watch and wait’ policy might be appropriate, given that the animal, at six years old, is apparently healthy and happy in other respects.
Even if you agree that £300 seems a lot for treatment of a pet rabbit, you could also explain that rabbit medicine and surgery has advanced considerably over recent years and that this amount may well include radiography, surgery under general anaesthesia and hospitalisation.
Most of us are asked our opinion in many and diverse situations and, it is hoped, can give one in a suitably informal manner in such circumstances, keeping the Guide to Professional Conduct's notes about good relationships and disparaging comments at the forefront of our minds.
Readers with views to contribute on ‘Offering neighbourly advice’ 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, July 6. 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 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, ‘Offering neighbourly advice’, is presented and discussed by David Williams. 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 ‘Accommodating cultural differences of opinion’, which was published in the May issue of In Practice, appears on page 367.
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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