A question of ethics

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Jan 01, 2004

To the common equine practitioner, applying ethics in practice might mean something as simple as deciding whether to use supplements or as complicated as knowing when use of compounded drugs crosses a line.

To help decipher such familiar, yet often convoluted, scenarios, the American Association of Equine Practitioners (AAEP), invited clinical psychologist, author and consultant Dr. Bill Brown of Leesburg, Va., to keynote its annual convention in New Orleans in November.

The theme of his presentation, "Ethics in Action for Equine Practitioners" was threaded throughout the four-day meeting as a focal point at Table Topics, panel discussions and special sessions.

Brown based his presentation, which he aptly subtitled, "Choosing the Harder Right over the Easier Wrong," on interviews with numerous equine practitioners.

Ethics of euthanasiaOne ethical talking point of his presentation delved into euthanasia, which, according to Brown, should be "a humane way to treat the patient, not the client."

He continues, "Few would argue in this field that when a patient suffers from a debilitating medical condition not amenable to treatment, euthanasia might constitute the most humane treatment available. But when the horse is no longer an economic asset for the owner or for the seller, or the horse no longer provides the owner enough emotional gratification and the client requests the patient be put down, what then?"

He says in such a scenario, a client may pressure the veterinarian to put a horse down for "humane reasons," when the real issue comes down to collecting on an insurance policy.

"While it may seem humane to the client, it's inappropriate at best and blatantly dishonest at worst, even if it may have a huge economic benefit to the veterinarian," Brown says.

The "right thing" to do in such a situation is not always clear-cut, he warns.

Relevant ethical issuesDuring his presentation, Brown cited a string of ethical issues familiar to equine practice including: perceived collusion between practice and client; disparity between commissioner and practice on supplement use; cost liability of an unreadable radiograph - who should incur the expense; overuse of drug compounding; questionable oversight of Internet pharmacies; dispensing in lieu of diagnostics; honesty in client/practice relationship with exploratory surgery; alternative therapies; practitioner's responsibility for ancillary procedures (by dentists); ethical boundaries - "just this once."

When confronted with an ethical dilemma, Brown defers to what he calls the "ethical yardstick" figurative tool to determine whether you're doing the "right thing."

Ask yourself the following questions:

  • Does your course of action seem logical or make sense to you? If so, it is probably right.
  • Does the solution you choose pass the test of sportsmanship? Or, will the results be beneficial to all?
  • What effect will this decision have on others? What effect will it have on you?
  • After you've made the decision, how well do you think of yourself when you look back at what you have done?
  • Lastly, consider what difference would it make if everyone knew about your decision?

Sometimes the ethical issue is reduced to one of dollars and sense. "Where money is everything, is one more likely to do anything for money?" Brown grilled the audience.

"Ultimately, the practitioner is primarily in practice because of a love for animals and opportunities to treat those animals. Doing the right thing, even if it means turning down a client's request, to prevent a nefarious act can enhance the veterinarian's reputation long term or indeed a client's hope," he says.

Macro ethical view While Brown encouraged veterinarians to devise their own customized set of ethics pertinent to their own practice, he also charged the AAEP with an even greater duty. Referring to the group as a "stepchild of the American Veterinary Medical Association" he says the time is ripe for the equine group to revisit or address anew what constitutes the practice of veterinary medicine.

"Is it now moving on time for AAEP? Can AAEP distinguish itself to the point where in addition to existing as a professional society it becomes an effective standalone regulatory organization?" he asks the audience.

He adds, "An AAEP designation could become the platinum standard against which all horse doctors ought to be judged. Members can then say they belong to a group that reflects the very highest of standards in animal care."