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, ‘Disclosing pre-existing veterinary conditions to insurance companies’, was submitted and is discussed by Kathryn Henderson. 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.
The series is being coordinated by Steven McCulloch, senior lecturer in human animal studies at the Centre for Animal Welfare, University of Winchester. It aims to provide a framework that will help practising veterinarians find solutions when facing similar dilemmas.
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Kathryn Henderson qualified from the University of Liverpool in 2012 and is now working in first-opinion small animal practice.
Disclosing pre-existing veterinary conditions to insurance companies
A client brings her two-year-old dog in to see you regarding his ongoing lameness after long periods of exercise. This was also discussed at his registration health check the previous month. The client says her dog has been lame since she got him. On examination the left stifle is thickened and you recommend sedation and radiographs to evaluate the joint further. As the dog is due to be neutered you recommend doing both procedures at the same time. The owner says she will save up to pay for them and come back another time. The dog is not insured. A few months later she phones the practice to see what has been documented on the notes about the dog's lameness, and to enquire if her recently taken out policy would cover x-rays. After being advised that the clinical history contains information about the lameness she becomes upset as she doesn’t want the insurance company to know it is a pre-existing condition. She was hoping to claim for the radiographs on the new insurance policy, as she cannot afford to pay for these herself. She asks you ‘what shall we do then, do we leave him to suffer’? She is eligible for PDSA veterinary services but would like any treatment to be performed at your practice. What should you advise?
Issues to consider
There are two issues in this scenario. First, the issue of health insurance, and second, the welfare of the patient in your care. It is not uncommon in first-opinion practice to be asked by an owner to falsify an animal's record. Sometimes clients can present their animal for a condition having taken out an insurance policy the day before. They sometimes then blame being unable to afford treatment options on the veterinary surgeon. This can place moral stress on the vet who feels caught between wanting to maintain their integrity and wanting to please the client and help the patient. The RCVS Code of Conduct requires that ‘Any material fact that might cause the insurance company to increase the premium or decline a claim must be disclosed’ (RCVS 2018a).
Readers with views to contribute on ‘Disclosing pre-existing veterinary conditions to insurance companies’ should e-mail them toso that they can be considered for publication in the next issue. The deadline for receipt of comments is February 8, 2019. Please limit contributions to 200 words.
The other issue is the welfare of the patient if he is not receiving treatment due to cost. Cost of treatment is not an acceptable reason to leave an animal in pain. As part of our code of conduct we commit to ensure the health and welfare of animals committed to our care (RCVS 2018b). We should consider if there is a budget way to manage this condition. Does the lameness require radiographs for the animal’s welfare or could the patient's clinical signs be managed with symptomatic medical treatment? In this case, a diagnosis is ideal but if the funds are not available there is still a lot that can be done for the patient’s welfare.
If the patient deteriorates and the client cannot afford further investigation or treatment, euthanasia may be an option. However, euthanasia would only be justified if the patient’s lameness was sufficiently severe to mean that he no longer had a life worth living. The owner is eligible to use PDSA veterinary services for their pet, but chooses not to use this service. In cost-constrained cases, referral to charity services may be appropriate and a discussion could be had with the owner as to the fact that if they can’t afford private practice fees they may need to use a different practice.
Possible way forward
In this scenario the vet has been asked to omit communication between themselves and a client. In such cases there is a clear ethical guide. The condition is pre-existing so we are duty bound to disclose the communication to the insurance company. We should never adjust clinical records or neglect to record our findings to ‘assist’ an insurance claim.
In this scenario the lameness is brought on by long periods of exercise. The owner would like a diagnosis but cannot afford it. From the vet’s point of view the issue of the welfare of the patient can hopefully be easily addressed by exercise modification and the use of analgesia, for example non-steroidal anti-inflammatory drugs (NSAIDs).
A way around the situation would be to reduce the patient's exercise and use NSAIDs as required to alleviate pain. The vet could also suggest to the client that they put some money aside each month to investigate the condition further with x-rays in the future, should it be needed.
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