Stories involving ethical decisions can frequently be found in the news, usually because someone’s ethics have been found wanting. And, although some people either intentionally make unethical choices and/or don’t spend enough time determining the appropriate behaviors, even the most ethical people can sometimes struggle with deciding what actions are most appropriate to take.

To add to the mix: in the professional arena, few industries have as many ethical and legal obligations to as many parties as those in the veterinary field. Veterinary professionals must consider:

  • Wishes of their clients
  • Obligations to:
    • the animals
    • the general public
    • professional colleagues

In situations where all of the interests mesh, then ethical practices are fairly easy to uphold. But, when interests and obligations conflict, then ethical dilemmas arise. For instance, perhaps a client doesn’t authorize treatment that you know is in the best interests of the pet. What do you do?

When a moral dilemma arises, it’s important that you ensure you are thoroughly familiar with the AVMA Principles of Veterinary Medical Ethics, and then apply those ethics to the situation at hand. Note that collective ethical rules have, at times, been given the force of law when adopted by veterinary medical boards.

Also, what state laws apply? All fifty states have some statutory framework focusing on veterinary practices, creating licensing procedures and establishing basic governance of veterinary medicine. State boards of examiners enforce and administer the laws under the state’s practice act, and include these codes of professional conduct. Also, non-veterinary-specific state laws also need considered; malpractice laws are just one example. And, what local laws also need to be considered?

Although laws and professional codes are crucial to consider when making ethical decisions, these decisions often go beyond codification. They also include a person’s moral convictions, ones that aren’t – assuming that laws and codes are met – enforceable from an outside body.

Decision-Making Analysis

Although no one ethical dilemma is exactly the same as another, we recommend the following eight-step approach to solving the ethical problem you’re facing.

  • First, clearly define the core ethical question, typically framed using what “should” or “ought” to be done.
  • Next, determine who is affected by this issue. Who are the major stakeholders? Minor ones?
  • Take a look at each of the major stakeholders. What are each of their primary interests and/or concerns?
  • Examine the facts you have. What else do you need to know? How can you get this information?
  • Brainstorm! What are your goals? What potential solutions are available to you? Alternative courses of action?
  • Now it’s time for moral discernment. Which moral values, principles and/or rules are relevant? How would you prioritize them?
  • Go back to the list you created in response to number five and eliminate any alternatives that aren’t feasible. With your remaining list, how would you assess each of the solutions when evaluated using the values you prioritized in number six? Which solution is most acceptable when viewed through the lens of your priorities? Which one satisfies the greatest number of stakeholder interests? The solution that is doable, respects the broadest array of priority values and satisfies the greatest number of major stakeholder interests is the most ethical choice.
  • Finally, it’s time for moral closure. Review your process. Have goals from step five been accomplished by your proposed solution? Are they compromised in any way? Have all parties’ views been represented, whether they were actively participating in the decision making or not? Can this alternative truly be implemented as proposed?

VHMA Guidance

If a practice manager genuinely follows this pledge, then ethical decisions will naturally follow.

I pledge myself to:

  • Comply with the principles and declarations of the Veterinary Hospital Managers Association, Inc.’s code of professional ethics.
  • Maintain and promote the profession of veterinary practice management.
  • Assure my continued growth and development as a professional by utilizing, to the highest extent possible, the facilities offered to me for continuing the professional education and refinement of my management skills.
  • Seek and maintain an equitable, honorable and co-operative association with fellow members of the Veterinary Hospital Managers Association, Inc. and with all others who may become a part of my business and professional life.
  • Play a fundamental role in maintaining excellence and quality of care to our clients and their animals.
  • Place honesty, integrity and industriousness above all else, and gainfully pursue my profession with diligent study and dedication so that service to my employer shall always be maintained at the highest possible level.
  • Keep all information concerning the business or personal affairs of my employer confidential, except as may otherwise be required or compelled by applicable law or regulation.
  • Protect the employer’s funds and property under my control. Information gathered, maintained or produced within the veterinary practice is the property of the practice owner and will not be reproduced, shared or distributed outside the practice without consent of the owner.

This session will discuss multiple ethical scenarios such as: custody disputes, clients who do not pay, unauthorized use veterinary equipment, misuse of controlled substances, and more.  Read two of scenarios below.

Ethical Scenario #1: Custody Disputes

When a couple is divorcing, plenty of complicated issues can arise. This can affect your veterinary practice, especially if one member of a couple is requesting irreversible procedures on a pet and the other may disagree. These procedures include euthanasia, spay/neuter, cosmetic (ear cropping, tail docking, and declaw), and relinquishing the pet for adoption. Furthermore, courts are increasingly considering animals to be subject to custody laws, rather than as personal property, which makes this an even more pressing issue.

Here’s a worst-case scenario: a longtime client, Mrs. Jones, is the documented owner of Olli, a ten-year-old male toy poodle. There is no mention of a Mr. Jones. One day, though, Mr. Jones bring in Olli for euthanasia because the dog is urinating on the carpet and barking too much. To make matters more complicated, a relief veterinarian was on duty; this veterinarian presented alternative options, but Mr. Jones could not be swayed and he signed the consent form.

People in the practice knew that this couple was in the middle of a heated divorce, but the relief veterinarian did not, and he euthanized Olli. Mrs. Jones subsequently filed a lawsuit against the practice, saying that Mr. Jones took this action to spite his wife.

Using the decision-making model described above, what alternate solutions would you have presented? What actions would have been reasonable, ethics-wise? What safeguard procedures would you implement?

Ethical Scenario #2: Human Medicine

It isn’t unusual for a frightened cat to lash out and, even when safe-handling procedures are followed, someone gets bit. So, how much treatment can a veterinary practice employee offer, given that veterinarians are not permitted to practice human medicine? Clearly, someone can assist the person with washing the wounds thoroughly with soap and water, and applying bandages, since procedures that any “reasonably competent” individual can undertake are not considered practicing medicine. And, as many veterinary practices have staff members certified in standard first aid, this is clearly within scope.

But, what about applying an antibiotic, such as cephalexin? It’s easy enough to apply and readily available, and saves time for the person who was bitten. To balance clinic inventory, a prescription could be written for that person’s animal. If all heals well and no one says anything, this is unlikely to cause problems for anyone. This, though, however well intended, violates multiple professional ethical tenants. These include practicing medicine on a human and writing a false prescription.

Run this scenario through the decision-making analysis. What conclusions do you have? Then, throw in this added twist: what if this happens during a raging blizzard and the wound looks fairly serious? Does this change anything?

Decision-Making References

  1. Tannenbaum, Jerrold. Veterinary Ethics. Baltimore: Williams & Wilkins, 1989.
  2. Rollin, Bernard E. An Introduction to Veterinary Medical Ethics: Theory and Cases. Ames: Iowa State UP, 1999.