Consider the following corollaries of Rule No. 4:
Hippocrates provided the following advice to his colleagues: "As to diseases, make a habit of two things — to help, or at
least do no harm." When confronted with situations in which therapeutic options are associated with significant risk to the
patient, we must use caution to avoid the mindset of "Just don't stand there — do something". Why? Because, although the psychological
pressure imposed on veterinarians to do something is occasionally overwhelming, our desire to do something must be evaluated
in light of the potential benefits and risks to the patient. There are times when it is in the patient's best interest to
"don't just do something — stand there." We must not misplace emphasis on "what treatment to prescribe", when the fundamental
question is "whether or not to prescribe".
Too often, justification for unproved therapy is the belief that some treatment is better than nothing at all. However, the
prognosis of few diseases is so uniformly poor that any form of therapy is justified.
Just because two events occur in consecutive order does not prove a cause-and-effect relationship. Unrelated coincidences
commonly are associated with the treatment and subsequent clinical course of diseases. Therefore, we must use appropriate
caution in interpreting uncontrolled empirical observations. Just because a favorable outcome occurs in association with our
treatment does not prove that our treatment was effective. Why? Diseases are often self-limiting. In fact, the severity of
many disorders declines within a day or two. In this situation, any treatment may appear to be beneficial as long as it is
We should conscientiously apply the same standard of care for our patients that we would use if we were implementing therapeutic
plans for ourselves. When we offer to provide the type of care for our patients that we would select for ourselves, then at
the very least, our clients know that our primary motive for doing so is based on the golden rule. Clients are more likely
to have confidence in our recommendations and comply with them if they know that our actions are based on serving their best
We should strive for a realistic view of our professional competency and technical skill. When uncertainty exists as to whether
a particular drug, or medical or surgical procedure is in the best interests of our patients, we should contemplate the answers
to the following questions:
1) Based on available information and my knowledge of my own skill and experience with this type of problem, would I consent
to the proposed therapeutic plan of action if I were in this patient's situation?
2) What therapeutic goals are likely to be achieved?
3) If I follow the proposed plan of action, in all probability will the overall benefits justify the associated risks and
Treating our patients as we would be treated also encompasses patient referrals. No veterinarian has perfect knowledge, understanding
and wisdom about all healthcare problems. Will Rogers' statement applies: "We are all ignorant, only on different subjects."
It is unethical to mislead a client by indicating our ability to manage a case, which is beyond our expertise or the capability
of our hospital. Clients must be clearly advised about benefit/risk probabilities in such situations. When specialty care
is reasonably available, ethics requires that the alternatives of specialty versus non-specialty care be discussed with clients.
We must also strive to be aware of the client's ability to pay for veterinary services. Rather than recommending continued
long-term care that is of questionable efficacy, it may be more ethical to refer a patient to a specialist with the goal of
rapid diagnostic resolution and more effective management. In addition to improved patient care, overall costs may be less.
Care about others, as we want them to care about us.