Basic ethics and veterinary medicine

Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health, the relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge.

I will practice my profession conscientiously, with dignity and in keeping with the principles of veterinary medical ethics.

I accept as a lifelong obligation the continual improvement of my professional knowledge and competence.

— VETERINARIAN'S OATH

Memorize the Oath, because upon graduation, new veterinarians routinely recite this solemn pledge, originally adopted in 1959 by the American Veterinary Medical Association, amended in 1999 and re-affirmed in 2004.

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One major direction and premise of the Oath is to "practice my profession ... in keeping with the principles of veterinary medical ethics." Fully understanding what this implies requires an examination of several definitions of ethics.

Webster's International Dictionary defines ethics as a group of moral principles or a set of values. It's the discipline of dealing with what is right and wrong or associated with moral duty and obligation. It's also the principles of conduct governing an individual or a profession.

Dr. Albert Schweitzer, a noted theologian, philosopher, musician, physician and Nobel Peace Prize recipient, wrote the following: "Ethics is the name that we give to our concern for good behavior.

We feel an obligation to consider not only our own personal well-being, but also that of others and of human society as a whole."

To further understand the meaning of ethics in veterinary medicine, we must consider animal ethics versus veterinary ethics.

Jerrold Tannenbaum's book "Veterinary Ethics-Animal Welfare, Client Relations, Competition and Collegiality" defines animal ethics as the moral obligations that people have for animals, while veterinary ethics relate to veterinarians and others directly involved in the provision of veterinary care.

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Four branches of ethics

Tannenbaum further defines veterinary ethics as having four branches and describes them as follows:

1. Descriptive: values or standards of the profession outlining what is acceptable behavior determined by peers. The Veterinarian's Oath is an example.

2. Official: values formally adopted by organizations composed of members of that profession. The AVMA Principles of Veterinary Medical Ethics is an example.

3. Administrative: rules set by governmental bodies that regulate veterinary medicine. Licensure requirements or Drug Enforcement Agency registration protocols define this category.

4. Normative: the individual's attempt to discover what he or she believes to be the correct moral standard and norms for professional behavior and attitude.

A practitioner's stance on convenience euthanasia is an example.

Ethics or the law

There often is a fine line between ethical and legal violations. A breach of descriptive or official ethical values would not be enforced by a court of law but might be cause for dismissal from the association.

Such a violation would rarely cause a practitioner to lose his or her license to practice veterinary medicine.

Yet violations of administrative rules and regulations determined by governmental bodies would be enforced by the regulatory agency overseeing licensure as well as the courts system. A violation could result in a loss of licensure, jail time and fines.

Conflicts

There are many instances facing our society and personal lives where a situation might be considered unethical but legal and vice versa.

Perhaps the most common conflicts facing new graduates are between his or her normative ethics and the applied standards of the society in which veterinarians find themselves.

For example, AVMA's protocol on ethics states, "Humane euthanasia of animals is an ethical veterinary procedure." The group's animal welfare position, also an example of official ethics, includes the statement, "The AVMA is not opposed to the euthanasia of unwanted animals, when appropriate, by properly trained personnel, using acceptable humane methods."

Many veterinarians and AVMA members would not agree with this stance. How and when should this conflict be addressed?

Adherence to normative standards, as determined by the individual, are a matter between a practitioner's conscience, clients, patients and employers.

Newly employed veterinarians should not expect their employers or clients to uphold the same standards they do.

For example, when working in a practice where euthanasia of unwanted animals is an accepted procedure, the new employee will be expected by his or her employer to comply with a client's request to euthanize the patient.

Therefore, during the pre-employment interview period, prospective employees should disclose their normative ethical standards and make sure the employer accepts them.

Some examples of ethical and philosophical issues that should be addressed by a prospective employee include:

• Are surgeries such as ear cropping, declawing or debarking routinely performed?

• Are individual surgery packs mandatory for all animal surgeries?

• Are animals routinely hospitalized overnight without nursing supervision?

• Are animals given chemical restraint for radiographs to lessen human exposure?

If your normative ethical standards are nonnegotiable, you should not accept a position in a practice that does not share your views. Do not expect the practice to change for you.

Ethical challenges

Ethical challenges often faced by new graduates in practice include:

• Efforts to elevate the status of companion animals: Many states and municipalities already have made or are considering legal changes to classify those who harbor companion animals as guardians instead of owners.

What effect will this have on a veterinarian's ability to provide medical care to an animal? What effect will this have on a guardian's right to determine care for the animal? What effect will this have on society's responsibility to protect and provide for the animal? Will food animals be next?

• Importance of the human side of the human-animal bond: Animals are becoming increasingly important and involved in the lives of the humans. This is particularly true of the aged and infirmed. The veterinarian's role and responsibility in understanding and protecting this bond becomes more vital each day.

• Technological, medical advances: Veterinary medicine today is capable of practically every medical technique and advance known to human medicine. However, financial considerations often prevent the veterinarian from carrying out these procedures. What is the answer to the ethical dilemma a veterinarian faces when he or she knows a treatment is available, but the owner cannot or will not pay for it?

• The emergence of animal-welfare science and the role of food-farm and sport-animal practice: Factory farming, confinement rearing, ear cropping and tail docking, rodeos, horse racing, dog races, circuses, zoos and other uses of animals are increasingly coming under attack by a portion of the public that deems them inhumane and immoral.

What should animals be allowed or compelled to experience? What role will veterinarians play regarding these questions?

• Pain in animals: Should pre- and post-surgical pain-relieving medication be routine in companion-animal medicine? Should pain drugs be routinely used on all species? Is this a medical question or an ethical question?

• Animal activism: Debate concerning animals' rights is fueled by a handful of activists who carry out criminal activities to further their cause, while most, including many members of the veterinary profession, seek answers to the questions concerning an animal's basic right to live free of pain and discomfort.

Tannenbaum states: "The concept of animal rights is essential in the proper identification and weighing of animal issues."

Conversation and determination concerning the semantics and rightful meaning of the term animal rights will continue to evolve within the profession.

• Horse slaughter: The U.S. Congress is considering a ban on slaughter of horses for food.

Although this might appear to be a societal matter, AVMA opposes the legislation based on care and feeding concerns for the nation's unwanted equine if they are no longer euthanized in the current system. A large consortium of activists pushes the emotional angle, working to end the slaughter of horses for human consumption.

• Competing models of practice: Corporate practices owned by non-veterinarians are not likely in the future.

Concern about non-veterinarian control of patient care, as has occurred in some human facilities, will require diligent observation and control by the veterinary profession.

AVMA's Principles of Veterinary Medical Ethics states: "Regardless of practice ownership, the interests of the patient, client and public require that all decisions that affect diagnosis, care and treatment of patients are made by veterinarians."

• The business of veterinary medicine: Not too long ago, advertising, promotion, marketing and even profit were dirty words in veterinary medicine. In today's market, they are necessary to drive business, especially in densely populated areas.

Veterinarians must be aware of the need for their practices and hospitals to be successful businesses. Only successful practices will be able to provide the care and services needed by patients.

Many larger practices, and certainly the corporately owned practices, will turn to non-veterinary managers to carry out business processes.

Will these non-veterinarians understand the nuances of medicine and veterinary ethics?

• Promotion and collegiality: Veterinary medicine has become a large and, in some areas, crowded business.

Are veterinarians colleagues or competitors? Will the collegiality fostered in veterinary school and within our professional associations continue or will the cut-throat nature of the business world take its place?

• Employer-employee relationships: Many veterinarians are employees and not practice owners making the decisions for the practice.

Employed veterinarians often are paid based on their production for the practice.

The system, while relatively new, can create competition and tense relationships among practice co-workers, which can lead to ethical consequences.

• The importance of communication with other staff: Practices with many professional and lay employees are commonplace. Clear, honest and meaningful communication among all staff members is an absolute necessity.

• The importance of communication with clients: Veterinarians must remain aware of their ethical and legal responsibilities to provide clients with sufficient information to allow them to make informed decisions on the care and treatment their animal is receiving.

Today's animal owners are more medically informed than ever as a result of the Internet, books, kennel clubs and various support groups.

• Widening horizons: Ecological, international, public health and environmental issues all provide new ethical challenges to our profession.

How will veterinarians comply with efforts to change in these arenas?