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Comments on the dilemma in the January/February issue: Clients who cannot afford to pay
  1. Steven McCulloch

Abstract

In the dilemma discussed in the January/February issue of In Practice, Anne Fawcett and Myles Chadwick describe a scenario where a four-month-old puppy is presented with parvovirus. The veterinary surgeon works in a veterinary shelter that also provides a private service. Practice policy stipulates that clients must pay 50 per cent of the estimate on admission (IP, January/February 2018, vol 40, pp 38-39). Alternatively, the client can seek treatment elsewhere, euthanase the animal, or surrender it to the shelter. The owner insists that the puppy is treated at the shelter. Colleagues are overhead accusing the owner of being irresponsible, and one advises including everything in the estimate, which would effectively double the cost, to cover costs in the event that the dog is later surrendered. The increased cost may mean that the dog is surrendered in the first place.

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IT is instructive to question the motivation to inflate the estimate, which itself will resolve any feeling of moral conflict. The dog has not yet been diagnosed as being infected with parvovirus. If the dog is suffering from parvovirus infection, it may have been vaccinated, as the vaccine is not 100 per cent effective. If the dog is suffering from parvovirus and not vaccinated, the owner may have good reason for this. For instance, he may have rescued the dog from irresponsible owners. Finally, the reference to a ‘young man’ is perhaps a suggestion he is less likely to be able to pay the bill. This is problematic as he may have sufficient funds for treatment. Arguably, these reasons in isolation remove any motivation to be dishonest in this scenario, and so appear to resolve the moral conflict.

On a more philosophical level, Fawcett and Chadwick are investigating the moral virtue of honesty, and the poll asks if it is ever morally justifiable to inflate treatment estimates to influence client decision making. The question, in effect, is whether honesty in this context is, or should be, an absolute principle or virtue. This means that honesty should always trump other principles or virtues in the veterinary context, and specifically when advising about estimates. I would argue that honesty, when in conflict with other principles or virtues, should not always trump them. My claim is not based on any particular medical scenario, but on the following two arguments.

First, in general it is problematic to claim that virtues or principles should be absolute. In virtue theory, for instance, the right act is what the virtuous person would do. Honesty is a virtue and the virtuous person would be inclined to be honest. However, virtue theorists put a lot of emphasis on context or situation. Thus, the truly virtuous person might be dishonest in exceptional circumstances if there was some overriding reason to do so. Similarly, a moral philosopher that followed a principles-based system, such as the medical ethicists Beauchamp and Childress (2001), would not claim that one principle should override others in all situations. Beauchamp and Childress follow W. D. Ross in considering principles as prima facie. Thus, they give way to more important principles depending on the salient moral features of the situation.

Second, if there is an absolute virtue or principle in a veterinary code of ethics, it would not be honesty. In the context of virtues we might call it compassion to animals under the care of the veterinarian. In the context of principalism it would be the principle of beneficence and non-maleficence to patients. It is translated in the UK RCVS Code of Conducts as ‘Above all, my constant endeavour will be to ensure the health and welfare of animals committed to my care’ (RCVS, 2012).

Everyday Ethics Poll

Last month’s poll asked:

Is it ever morally justifiable to inflate treatment estimates to influence client decision making in veterinary practice?

0% of respondents say it is morally justifiable on a fairly frequent basis

21% of respondents say it is morally justifiable only in exceptional circumstances

79% of respondents say it is never morally justifiable

(53 respondents)

Vote for this month’s online poll at:

https://twitter.com/Vet_Record

References:

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