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, ‘When in Rome . . . ’, was submitted and is discussed by Richard Brown. 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 ‘Delivering profit?’, which was published in the November/December issue of In Practice, appears on page 47.
The series is being coordinated by Steven McCulloch. It is hoped it will provide a framework that will help practitioners find solutions when facing similar dilemmas.
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Richard Brown qualified from the University of Cambridge in 1981. He gained an MSc in tropical veterinary medicine from the Royal (Dick) School of Veterinary Studies in 1986. He has served as a veterinarian with various overseas governments and has practised for over 20 years in the UK. He is currently an associate director at the School of Veterinary Medicine at City University in Hong Kong.
When in Rome . . .
You are in the first week of a three-week stint working for charity NGO rural small animal clinic in a developing country when a farmer walks in with a 13-week-old vaccinated and wormed dobermann puppy. He asks you to clip its ears and dock its tail and says he will pay. You respond that you are not comfortable to accede to his request. He replies that if that is your final response he will go back to his farm and give the pup half a cc of 2 per cent xylazine under the skin, give necessary local and then, with the assistance of a friend cut off and cauterise the ears and tail, that being routine in the country. To the best of your knowledge and belief, the country's legislation effectively covers cruelty to animals, but has no specific mention of docking or other cosmetic surgeries. While the farmer is sitting in the waiting room, a local veterinary colleague telephones to say if you are unhappy to perform the procedure he will drive up to do it provided you assist with the anaesthetic. How do you respond to the vet and the farmer?
Issues to consider
To understand legislation ‘to the best of your knowledge and belief’ is in almost every country a poor defence for ignorance of the law of the land. You need to contact someone who does know the law and how it is enforced in that land. In addition the charity you work for may have its own rules and you should check with local senior management.
If you carry out the procedure you may be setting a bad example. Subsequently, the farmer may inform others that a member of the RCVS performed the operation with ‘no problems at all’.
If you don't perform the operation, the farmer may consider you to be hypocritical, more concerned about your own ethics and professional standing than the welfare of the pup. He came to you to perform a procedure in the most painless and professional manner. In his country, this may be a routine occurrence.
Traditionally pups are docked at less than one week of age. The age of this pup suggests either the procedure is not routine in the country or that the pup is an import. This is worth checking.
It is difficult to work out whether the phone call from the local vet is a genuine offer of assistance in a tricky situation or an attempt to pressurise you. ‘When in Rome do as the Romans do’ is still generally a good maxim particularly if you are only a temporary visitor. Whatever your decision, be aware in the long run you won't be around to explain, defend or manage the after effects of your decision. Most likely local members of the charity and the vets following will have to handle it. Bear in mind many North American qualified DVMs may work in countries where docking is still allowed.
If you don't feel experienced enough about the procedure, the offer of the local vet may well be worth accepting.
Generally speaking when a vet practises in one country for a long period of time, he or she will carry a letter of good standing when moving to practise in another country with a different jurisdiction. This is not relevant in this case due to the short period of practice and that it is unlikely a complaint will be received by the RCVS. Should the RCVS receive a complaint, if the vet is no longer registered with the them, it has no power to act on the matter. If the vet is registered, the RCVS would usually work with the local regulatory body or veterinary surgeons' board to take action. However, any local circumstances would be considered when these types of allegations are made. The law is ‘sensible’ and this should not be taken as a carte blanche to do as you please when working abroad.
Possible way forward
This matter is not urgent. It should be possible to play for time for at least a day by explaining to the farmer and local vet that if you performed this operation in your own country you would most likely be in trouble with the authorities and hence,although it is within your scope, it is not a procedure you are well acquainted with.
You need to quickly assess, as far as possible, the requirements of the law, the charity, the local culture, your local veterinary colleagues, the local standards of welfare, and the capabilities of the farmer before making any decision. If you were staying out for a longer period of time, ie, years, you could consider ‘making a stand’, for example, keeping an undocked unclipped dobermann yourself.
While it may be against your own personal and the RCVS ethics you may conclude that, in this case, or in this particular environment, the optimum choice on welfare grounds is for you to operate on the pup giving it a high quality professional care with proper follow up rather than leave it to the uncertainties of local unqualified persons. You may not think there is any difference in ethical terms between you doing the operation and acting as an anaesthetist for a veterinary colleague.⇓
Another option is to plead with the farmer to let you off and let the next vet coming to the clinic do the operation.
Delay may also be worthwhile if the replies to some of your questions suggest that this is not a routine case in any sense at all.
Readers with views to contribute on ‘When in Rome . . . ’ should e-mail them toso that they can be considered for publication in the next issue. The deadline for receipt of comments is Friday, January 22. Please limit contributions to 200 words.
Prevention is better than cure: before you go out to a foreign country to practise even for short period of time try to find out from other vets what potential problems, both practical and ethical, you might face.
Finally you should of course keep your own private record of these events.
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