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, ‘Questioning morals’, 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 ‘Changing established protocols’, which was published in the February issue of In Practice, appears on page 151.
The series is being coordinated by Steven McCulloch, a practising vet with a PhD in the ethics of veterinary policy. 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.
A dairy client who has a 200-strong herd of Friesians phones to ask you to bring out an equine flu booster vaccine on your upcoming visit. After the routine herd fertility work, you clean yourself up and then look for the client's wife who, you are told, is with the horse and certificates. You find her in a horse box with an eight-year-old pony. This is the first time you have seen the pony, although your colleagues have seen it before and one vetted it before purchase two years ago. She explains that her disabled teenage daughter, who has a significant disability, has been riding the animal at local pony club events. Recently, she has demonstrated great competence and so has been invited to take part in the pony club summer camp. You check the passport and find everything in order, except that the flu cover is out-of-date by two days. The pony will have to recommence the vaccination course and the earliest date it will be eligible to compete is in four week's time. The mother is extremely upset and blames the practice. She suggests you have two options: either vaccinate the pony today and fill in the form certifying it was vaccinated two days ago, or leave the farm immediately. If you chose the last option she will find a more ‘compassionate and understanding’ vet who will do what she requires. As the daughter's condition may affect lifespan, the mother states that her daughter's quality of life is a greater moral good than any negligible risk of equine flu that a two day out-of-date booster represents.
Issues to consider
In this scenario, the potential for losing a dairy client who is significant to the business should be irrelevant. In such cases, professional ethics should trump business considerations. It is ultimately the responsibility of the owner to ensure an animal is up-to-date with immunisation schedules. The exception being if a practice has a system of booster reminders and, after consultation with clients, has formally taken on the responsibility. Veterinary surgeons are liable to be removed from the register if they issue false certificates. There is a temptation to ‘help out’ clients in such cases, as outlined in the scenario. However, alarm bells should ring if you are asked to ‘help out’ in the case of certification. On most occasions, the request is a prelude to being asked to alter a certificate so that it does not represent the truth. A further, more self-interested consideration is that such actions can give ammunition to a client to use against you in the future. Even if the current relationship is good, if it turns sour in the future, the client may hand over evidence which will demonstrate your negligence. Even worse, the client could use this matter to later threaten you and force you to commit further actions that are against professional codes of conduct.
If you are tempted to risk sacrificing your career over this issue you should consider another factor: ‘No man is an island unto himself’. This includes you and your career. You may have dependents, and you certainly will have friends, relatives and university lecturers who have assisted you in becoming a vet. Whenever you risk damaging yourself or your career through poor decision making, you should con-sider the hurt and pain this action might cause to such individuals. Furthermore, if you were to accede to the client's request, you ought not to inform other members of staff, since this would place them in a difficult situation. They can either inform relevant parties about your false certification, or be complicit with your negligent act.
A further point is that a very recently vaccinated pony should not undergo severe exercise. Assuming the pony does not have a stiff neck or pyrexia post-vaccination, two or three days light work can be followed by a resumption of full exercise.
Possible way forward
It is certainly worth attempting a calm discussion with the client to see if there is a third way. This may involve making phone calls. These could be to your colleagues or the organisers of the pony club summer camp. This is assuming the mother's description of her daughter's recent success is true. Your colleagues may have additional solutions and two or more heads are often better than one. The organisers of the next event may agree to a special isolation and quarantine protocol for this pony at the event. This may be facilitated, for instance, if the pony has been the only one on the dairy farm for a long period and your practice can certify to that effect. An out-of-date booster is not exceptional but the daughter's situation is, and this will be one of the levers you can use in your discussions, as well as the low risk the pony represents. The pony club may have spare ponies they could allow the daughter to use. This would represent an extra opportunity for her to demonstrate her talents. You should, of course, also politely advise the owner that you could be struck off for false certification and that in the past vets have been struck off for it. This explains your actions and may also help to avoid a similar situation in the future.
At some stage, a discussion on how to avoid a repeat of this situation is important, but this is best left to another day. The immediate aim is to solve the current problem. One issue worth regularly reminding all horse and pony owners about is that it is the owner's responsibility to ensure the animal is up-to-date, unless alternative arrangements have been made. It is also worth regularly reminding clients that if a horse or pony changes its status, it may well have to change or adjust its vaccination schedules. This is in order to comply with the requirements of the relevant governing body. As a practice you may be willing to offer free advice to owners who bring a certificate to your clinic for you to examine in this regard. You may then have to spend some time on the phone or e-mailing the governing body in trying to clarify a matter on behalf of the owner. However, to re-emphasise, this is ultimately the client's responsibility.
Thanks to Rebecca Parkes, Equestrian Veterinary Surgeon of the Hong Kong Jockey Club, for assistance with this article.
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