In this new DVM Newsmagazine column, Dr. Marc Rosenberg explores common and sometimes problematic ethical dilemmas encountered in veterinary practice.
But he needs your opinions in an effort to dissect different solutions or approaches to communication. Post your comments
at http://dvm360.com/thedilemma/ or e-mail them to bhoward@advanstar.com
. We'll use your insight as a way to facilitate the discussion in print and online. The names used in this column are fictitious.
The dilemma
Dr. John Thompason was on duty when Mrs. Jane Collins brought her 11 lb. male Miniature Poodle into the veterinary hospital
after it had a seizure and fell down the stairs. The doctor immediately evaluated and stabilized the dog. The dog is 3 years
old and is visiting from out of state. The pet is basically healthy, but does have a history of intermittent seizures starting
at 8 months old. Epilepsy was diagnosed. Since the diagnosis, the dog has had two seizures occurring seven months apart. The
owner was advised that the seizures were too infrequent to medicate at the time. Mrs. Collins was advised to simply observe
and wait out the occasional episode.
Three days ago, Mrs. Collins went to see her family veterinarian to get her poodle a sedative for a long trip in the car.
The veterinarian examined her dog and was aware of his seizure history. The doctor dispensed acepromazine and advised that
she give the dog the medication two hours before travel. Mrs. Collins followed the directions and gave the medication as instructed.
Soon after giving the acepromazine, the dog had a seizure and fell. The dog broke his radius bone as a result of the fall.
Dr. Thompason X-rayed the dog, stabilized the fracture and informed the owner of the necessary post-operative care. It was
now time for Dr. Thompason to decide whether to share his thoughts concerning the role of the recently used acepromazine and
the seizure. This drug has been known to potentiate an epileptic's tendency to have seizures. If this in fact did happen,
the broken leg that followed could have been avoided if the initial veterinarian considered the potential for the drug to
lower the seizure threshold. (Note: This dilemma occurred five years ago. At the time, it was generally accepted that acepromazine
did lower the seizure threshold in epileptic patients. This assertion, however, has been challenged in recent studies.)
Outcome
Dr. Thompason chose to tell Mrs. Collins that he felt she should call her veterinarian and inform him that the dog had a seizure
and broke his leg in a fall. This, he said, would allow the doctor to give her any followup advice as to future care of the
pet in subsequent visits. In addition, Dr. Thompason recommended that Mrs. Collins discontinue use of acepromazine to sedate
the dog for travel.
After the client left, Dr. Thompason called the prescribing veterinarian and told him what had happened. He also said he believed
that the seizure might have been potentiated by the acepromazine given to the dog. The prescribing doctor thanked him for
the call.
The discussion
Did Dr. Thompason act in the best interests of his client and patient? The dog was presented to him with a fractured leg.
He evaluated and treated the dog successfully, and he advised the owner to discontinue the use of the phenothyazine tranquilizer
for this epileptic patient. Did he have an obligation to disclose his opinion that the acepromazine may have led to the dog
having a seizure that ultimately led to the fracture? Did the client retain him not only to diagnose and repair her dog's
fracture, but to share his clinical impressions concerning the etiology of the seizure? Did Dr. Thompason act in an ethical
manner or was he unprofessional in not sharing all of his clinical observations with the client that retained his services?
Dr. Rosenberg's response
The veterinary clinician's obligation to the patient and client is one of honesty and assistance. The veterinarian advised
the pet owner to contact her hometown veterinarian and inform him what occurred. He also mentioned that he would not recommend
using acepromazine for future sedation. He gave his honest opinion and made recommendations that he felt would prevent any
injuries of this nature from happening in the future. It would not be appropriate to advise the client that he felt the broken
leg was directly related to the use of an ill-advised sedative for this patient. Hopefully this will ultimately lead to a
discussion between the pet owner and her regular veterinarian at which time any further questions can be answered.
Dr. Rosenberg is director of the Voorhees Medical Center in Voorhees, N.J. He is vice president of the New Jersey Board of Veterinary Medical
Examiners. Notably, he also hosted the national PBS TV series People, Pets and Dr. Marc.
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