Are you practicing veterinary medicine conscientiously?

"If your conscience is clear, you'll have nothing to fear, when it's time to rest at night.What strength it can give, when we strive to live, according to what is right."

The Veterinarian's Oath states in part, "Being admitted to the profession of veterinary medicine... I will practice my profession conscientiously..."

Likely you repeated this oath, as I did, at the time of graduation and receipt of the DVM degree.

But, what is involved in fulfilling our promise to practice veterinary medicine conscientiously?

Can we depend on our conscience to ethically guide the diagnostic and therapeutic decisions we make for our patients?

What role should our conscience play in deciding what fees we request from clients?

Is the establishment of fees based on the often-cited principle of "charge according to what the traffic will bear" consistent with practicing conscientiously?

What is conscience? How would you define it? Before continuing to read this essay, contemplate its meaning.

The word conscience is derived from the Latin term "scire" and implies knowledge from within. According to Webster's Dictionary, conscience is the power or principle within a person that differentiates right from wrong conduct, with a compulsion to do right.

It follows that the conscientious practice of veterinary medicine is based on a moral standard of judgment that opposes violation of previously recognized ethical principles. Since our conscience provides an inward realization of right or wrong that excuses or accuses our actions, it judges our thoughts and actions.

Notice the complementary meanings of the word "conscience" and the word "conscious." Webster's New World Dictionary of the American Language (College Edition) observes that both words have their origin in Latin, and both contain the root term "scire," meaning "knowledge" or "to know." Both terms encompass knowledge, recognition or awareness of inner feelings. Although we may be conscious of our conscience, only our conscience provides an inward realization of right or wrong that excuses or accuses our actions. Only our conscience judges our thoughts and actions.

How conscience functions

How did our conscience develop?

Who determines what is right and what is wrong?

Consider he following: We are born with a conscience that has the potential to guide us to do what is right. However, before it is trained it cannot tell us what is right or wrong. In the context of practicing veterinary medicine conscientiously, our conscience can properly guide us only if we have been taught to recognize, accept and follow ethical principles. Therefore, possession of a good conscience is not an innate quality.

To function properly, our conscience must be trained by proper thoughts, acts, convictions and rules that are implanted in our minds by study and experience. Once trained, our conscience can then compare various courses of action with previously learned rules or ethical principles.

When an ethical course of practice conflicts with the action we are considering, a properly trained and functioning conscience sounds a warning. Our conscience also has the capacity to allow us to retrospectively judge the choices we have made.

Although training our conscience to recognize standards based on truth is essential if it is to safely guide us in the practice of our profession, it is not enough for us to possess the truth about right and wrong conduct. The truth must possess us in the context of motivating our conduct. Therefore, if our conscience is properly trained we must listen to it and allow it to guide our actions.

In health and disease

How can we apply these principles to the conscientious practice of veterinary medicine?

Consider the following illustration of three states of normal function and dysfunction of a conscience applied to establishing fees for various diagnostic tests and treatments.

»THE HEALTHY CONSCIENCE: If our conscience is well-trained and if we allow it to guide our actions, it will prevent us from performing diagnostic tests and treatments for the primary purpose of monetary gain. It will help us avoid unethical practices, even when our actions will not be found out. Our conduct will attest (i.e., bear witness) to the fact that we are practicing our profession conscientiously.

» THE GUILTY CONSCIENCE: If our conscience is properly trained, yet we do not let it guide our actions, it will often make us feel guilty after we have willfully recommended and performed needless or risky diagnostic and therapeutic procedures. If we listen to our conscience and take action to correct our errant choices, our conscience can be restored as a reliable guide for ethical conduct. However, if we repeatedly ignore our feelings of guilt, we may move to a state of "un-conscience-ness."

» THE SCARRED CONSCIENCE: If our conscience is properly trained, but we abuse it by repeated acts of wrong conduct, it may no longer be able to sound warnings and give us ethical guidance. The conscience then may become figuratively scarred. Like literal scar tissue that no longer has a functional sensory nerve supply, the conscience becomes progressively insensitive to various stimuli. In fact, if others discover that we care more about our profits than our patients, they may say that we "lack feelings" about the welfare of others.

A scarred conscience fed by misinformation that tickles our ears by arousing a highly competitive spirit may allow us to rationalize that to sustain and/or improve the financial health of our veterinary practice, it is acceptable (and in fact at times necessary), to defraud our clients by charging them excessive fees for services or by performing unnecessary diagnostic tests and treatments.

Today's consumer-oriented culture kindles the fires of greed. Influenced by subtle but powerful ways, many believe that whatever they have is not enough. In my opinion, if this philosophy underlies our intent, we have deviated from conscientiously practicing the art and science of veterinary medicine. Our conduct may then become influenced by fear of exposure.

A reliable guide

Can you trust your conscience as your ethical guide in the practice of veterinary medicine? The answer largely depends on how your conscience has been trained, and whether you allow it to guide you.

To help guide us, broad-based and general principles of veterinary medical ethics have been adopted by the American Veterinary Medical Association. However, they do not cover all facets of our profession. Thus we must rely on our conscience to guide our course of conduct when existing rules and guidelines do not apply.

If we, as veterinarians, accept the Golden Rule as a guide for our conscience, and take the lead in applying it, we likely will be able to fulfill our promise to practice our profession conscientiously. In context of ethical interactions with our patients, clients and associates, the ultimate test of our conscience is the conduct that it dictates or inspires.

Our conscience will then be a source of protection for all.

Adapted from an article in JAVMA Volume 215: pages 1238 – 1239, 1999.

Dr. Osborne, a diplomate of the American College of Veterinary Internal Medicine, is professor of medicine in the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Minnesota.