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, ‘Always tell the truth?’, was submitted by Richard Brown and is discussed by Gwen Rees. 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 ‘Emergency exsanguination of working equids’, which was published in the February issue of In Practice, appears on page 151.
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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Gwen Rees qualified from the University of Liverpool in 2009 and worked in a mixed, rural practice in Wales, before spending a year as a dairy veterinarian in New Zealand. She is currently a teaching fellow in farm animal population medicine at the University of Bristol.
Always tell the truth?
You are called to a small herd of organic milkers to attend to a six-year-old cow that had a difficult and stiff calving three months earlier. She milked well but hasn't been seen in oestrus. A colleague examined her over a week ago and, finding nothing wrong, inserted a progesterone releasing IUT. A week later, he injected the cow with prostaglandin and, a day after that, removed the IUT and gave an injection of equine chorionic gonadotrophin (as per manufacturer's guidelines).
Forty-eight hours later, the cow now appears to be in heat. The owner has called you in, because if all is fine, the artificial insemination technician can be called to insert an expensive straw, as the cow comes from a good line of milkers.
On examination by rectum, the cow appears in heat but you cannot detect a follicle. During a vaginal examination, you are surprised to find what seems like a small elongated vesicle about three inches long. You believe it is a complete conceptus. There is a bull present on the farm and it seems that the cow was about three weeks pregnant when your colleague injected her. The owner is not present in the byre at the time. What do you do?
Issues to consider
The immediate temptation in this situation would be to say nothing. By simply suggesting that oestrus seemed to have been missed but that the cow now seems to be cycling and that it would be worth scanning her again at observed heat in around three weeks, you would likely save a large headache for yourself, your colleague and your practice.
The farmer has not seen the presumed conceptus, there are no other visible indications of abortion and many animals suffer early embryonic losses before anyone even realises they are pregnant. Your colleague may not have specifically asked about potential pregnancy or warned the client about the consequences of prostaglandin, but you are sure that your colleague would not have administered it if he thought the cow was in calf. Plus the client should probably have known enough to mention the possibility of pregnancy. These situations are not unheard of; they are simply bad luck and you don't believe anyone was at fault here.
At this point nothing can be done as the pregnancy is already lost. The cow is likely to cycle again normally and her fertility should not be adversely affected. Is it worth the stress and potential litigation that could result from a full explanation? What is the benefit of angering a client and creating problems for your practice?
While this might be a reasonable thought for anyone to fleetingly contemplate, the potential consequences of keeping quiet and the issue of professional integrity must be considered.
When we are admitted to the RCVS, we all make a declaration: ‘I promise and solemnly declare that I will pursue the work of my profession with integrity’. We have all promised to act with integrity, which is defined by the Oxford English Dictionary as ‘the quality of being honest and having strong moral principles’. Therefore, in this dilemma, we must surely be open about what exactly has taken place. In the unlikely event that the client or the RCVS were to find out that you had failed to tell the truth, it would be very difficult to argue that you were acting with integrity.
It is also not impossible that the farmer is already aware of what has happened and has called you out in order to see what you say. This may seem like a trick, but it is also a pretty good test of the honesty of the vets serving his farm. However, if no one has seen you find the conceptus, you could argue plausible deniability. Therefore, the risks are low but the potential consequences could be high.
Possible way forward
Simply asking the farmer if he was aware that this cow had been pregnant would probably be the best way to start the conversation. It might help to place at least some of the onus on him but in general laying the cards on the table and explaining exactly what you think has happened would be the only reasonable course of action.
Make your practice and colleague aware of the situation as soon as possible, and make sure to have accurate and in-depth records in place. It might also be wise to place a call to the Veterinary Defence Society in case a complaint or further action is taken.
Although the ‘easy road’ of keeping quiet may seem harmless and lead to an easier work day for you, your colleague and your client, a line would have be crossed. The fundamental principles of practising veterinary medicine would have be disregarded, an action which would be difficult to justify. As Mark Twain once said ‘When in doubt, tell the truth’.
Readers with views to contribute on ‘Always tell the truth?’ should e-mail them toby March 20 so that they can be considered for publication in the next issue. Please limit contributions to 200 words.
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