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, ‘Looking a store horse in the mouth’, was submitted and is discussed by Joe Collins. 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 ‘The case of the whelping bitch’, which was published in the February issue of In Practice, appears on page 159.
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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Joe Collins qualified from Dublin veterinary school and has worked in private practice, academia and industry. He has completed the CertEP, CertVR and a PhD in equine health and welfare. He runs a veterinary consultancy, undertaking teaching, legal and research projects.
Looking a store horse in the mouth
You are a partner in a large hospital-based equine practice, and conduct mostly ambulatory work yourself. You are called one wet windy morning by a regular client, experienced in the business of sales preparation, who is eager to have you vet a well-bred, four-year-old, National Hunt filly for the premier sales. Something about the client's manner during the lunge phase of the examination (fussing over whether the horse wears a bit in its mouth) makes you suspicious all is not as it should be. The horse sounds a bit ‘thick of her wind’ but there is no evidence of a surgical scar or other abnormality on palpation of the laryngeal area. You now recall your hospital-based partner saying he scoped some of the client's horses at the previous month's endoscopy and laser surgery clinic. How should you proceed?
Issues to consider
You have various, and potentially conflicting, responsibilities to consider. The first is your responsibility to the horse: on the one hand, not to condemn it unfairly from a rewarding career (if such a thing can be postulated for a horse); but equally to safeguard its welfare by ensuring it isn't prematurely subject to post-operative strenuous exercise.
You likewise have a responsibility to your clients – both to your immediate practice clients and less directly to the sales company. You wouldn't want to unfairly bring upon your client the financial consequences of withdrawing a valuable four-year-old National Hunt store horse (that could be clinically normal) from the premier sale; the client is paying for the vetting after all.
However, the sales company requires the vetting to weed out ‘unsound’ horses before sale and it might take a dim view of professional incompetence or, worse yet, of perceived connivance. The same conflict arises with vettings conducted, or subsequently used, for insurance purposes.
Another dimension is the potential responsibility to other horse owners and the equine industry in general. For instance, there are people on the waiting list for highly coveted, vacated slots at the premier sale. You should also keep in mind those who might unsuspectingly purchase ‘damaged goods’ if they buy the filly. And there is the issue of potentially perpetuating a suspected heritable condition should the filly go on to breed.
Moreover, there are a myriad of veterinary stakeholders who you might be responsible to as well. Colleagues at the sales will inevitably re-examine this animal and they could unknowingly deem it suitable for sale, despite the corrective laryngeal surgery. (If it passed the ‘wind test’ they wouldn't have a reason to scope it and discover the problem.) Alternatively, they might be placed in the invidious position of conflicting with you. Colleagues in other practices could also be asked to ‘vet’ the filly in your place before the sales and take on the task in good faith. Your practice and partnership colleagues could become the subject of a negligence claim and all that that confers.
Finally, you also have your own potential consequences to think about. You must first consider the importance of squaring your actions with your conscience. Not to mention that your professional responsibility to ask about and then disclose previous relevant treatment will be closely scrutinised if a complaint is made to the RCVS. And indeed, your professional indemnity insurance providers deserve a thought; they will foot the cost of mounting a defence against litigation or complaint.
Possible way forward
You might suggest that you can hear an abnormal respiratory noise rather than simple ‘thickness’ (during the exercise test) such that it is necessary to scope the filly at this point in order to make sure that there is nothing amiss. This way both you and the client have a way out. You will be satisfied as to the filly's status. Meanwhile the client will have a way out (if unknowing) by agreeing, or alternatively (if quick-thinking) by finding some excuse to stop proceedings at this point, or (if dull-witted) by later claiming to having ‘forgotten this filly was in the batch sent to the hospital last month’.
Alternatively, you could make your excuses and sit in your car (‘to prevent the forms being destroyed on such a wild day’), then access the practice's records via your smart-phone or phone the all-knowing receptionist in the old-fashioned way to find out the filly's status. You could then proceed to ‘give the filly the all clear’, or revert to Plan A and suggest an endoscopic examination.
The client could then of course either find an unsuspecting vet to examine the filly on another day and/or refuse to pay for the examination (especially the scoping) so the dilemma might still be passed onto someone else and you might see no financial reward for your morning's work.
Either way, unless very careful and skilled in the art of veterinary practice, you might lose with this immediate client – by the fallout from a refusal to certify the filly as ‘sound’ or from the loss of respect from so doing! You shouldn't forget the over-riding duty to behave in a professionally responsible manner: if you decide to let this one go, thinking that the vets at the sales will sort it, you risk jeopardising your credibility and reputation with partners, colleagues, insurers, regulators and the sales company. In the scenario described here, the various veterinary responsibilities to the animal, client, other horse owners and the wider public are sufficiently diverse, uncertain and, in some instances, remote that you are unlikely to be able to reconcile them all, but such is veterinary practice.
Readers with views to contribute on ‘Looking a store horse in the mouth’ should e-mail them toso that they can be considered for publication in the next issue. The deadline for receipt of comments is Friday, March 21. Please limit contributions to 200 words.
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