In the dilemma discussed in the January/February issue of In Practice, Kathryn Henderson described a scenario where a client brings her two-year-old dog in to see you regarding his ongoing lameness after long periods of exercise. 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 ask what has been documented 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 because she was hoping to claim for the radiographs on the new insurance policy. She asks you ‘what shall we do then, do we leave him to suffer’? (IP, January/February 2019, vol 41, pp 46-47). What should you advise?
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In the scenario from last month's issue, Kathryn Henderson claims there are two issues to consider: health insurance and the welfare of the patient. In the poll for this article on the Vet Record Twitter page, 94 per cent of respondents said that veterinary surgeons should always disclose pre-existing conditions, with the remaining 6 per cent saying they would accede to the client’s request, since insurance companies are wealthy and the dog will benefit.
The scenario is a good example of deontological and utilitarian thinking. Deontological ethics prescribes right action based on a system of rules. In this case, Henderson cites the RCVS Code of Conduct: ‘Any material fact that might cause the insurance company to increase the premium or decline a claim must be disclosed’. The must is imperative and effectively absolute; in all cases the veterinary surgeon needs to disclose the fact.
As veterinary surgeons, given that we practice according to a system of rules, we are effectively forced to be deontologists. The tension in this scenario that results in the ‘moral stress’ that Henderson discusses arguably arises because of the utilitarian lurking in some of us. We might feel that in such a scenario to not disclose a pre-existing issue will result in the greater good.
My own view is that a good understanding of the RCVS Code, which sets a framework for our professional ethics, in this way can serve to reduce professional stress. We don’t need to, and shouldn’t, agonise about how we might affect the greatest good in each decision we make. We are constrained by the Code and there are good reasons that veterinary surgeons should act with honesty in disclosing pre-existing conditions.
Everyday Ethics Poll
Last month’s poll asked:
A client with a recently purchased insurance policy asks you to not disclose a pre-existing condition. How do you respond?
6% of respondents said they would accede the request as insurance companies are wealthy and the dog will benefit.
94% of respondents said they would refuse the request as you have a duty to always disclose pre-existing conditions.
Vote for this month’s online poll at:
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