Ethical and legal issues when diagnosing and treating behavior (Proceedings)

Veterinary Behavior

• That branch of veterinary medicine which deals with the prevention, diagnosis and treatment of behavior problems in non-human animals.

• Clients often have questions about animal behavior and behavior problems.

• They expect their veterinarian to provide them with accurate, useful information.

• There are a lot of pop-culture myths about animal behavior and self-professed experts in behavior who give out a lot of misinformation.

• Several million dogs and cats are euthanized or abandoned each year due to unacceptable behavior.

• Often, these behavior problems could have been treated or prevented.

• Each year, in the United States alone several million people are bitten

• 20+ people are killed by dogs

• Dog problem

• Also a people problem

Strange relationship between some people and dogs in U.S.

• Dogs are "mans best friend". Dogs love us without judging us. Dogs save our lives. Dogs are cuddly and sweet, loving and heroic. Dogs are Lassie.

• Any dog may bite, maul or kill someone. After all, they're dogs.

• Because of 1, we must accept two as an inevitable part of having such wonderful pets.

Consequence?

• The consequences of this attitude, and the presence of the attitude, often come out during criminal and/or civil legal proceedings following a dog attack.

• Owners commonly blame victim for walking past, reaching toward, or even just being near their dog.

Societal norms?

• Any good behaviorist can figure out what "provoked", i.e. caused, the dog to bite.

• As a society, we must decide what is and is not an acceptable provocation for dogs living among us.

General Practice

• First contact by pet owners confronted by behavior problems

• Presented with a chief complaint

• Diagnose

• Decide on an appropriate treatment plan

Behavior Problems vs. Training

• Veterinary Behaviorists may use certain training techniques in the treatment of certain problems, especially with dogs. However, training is only one part of a comprehensive treatment plan.

• School teachers and Psychiatrists do not do the same thing!!!!

Practice of veterinary medicine:

• To diagnose, treat, correct, change, relieve or prevent animal disease, deformity, defect, injury, or other physical or mental conditions; including the prescription or administration of any drug, medicine, biologic,...or to render advice or recommendation with regard to any of the above.

• Model Practice Act, AVMA

Psychoactive Medications

• Medications that produce changes in behavior and/or motivation

• Most use of psychoactive medications in veterinary medicine is extra-label.

• ONLY exceptions are

• Anipryl® for Canine Cognitive Dysfunction

• Clomicalm™ for Canine Separation Anxiety

• Reconcile™ for Canine Separation Anxiety

Animal Medicinal Drug Use Clarification Act (AMDUCA 1994)

• Requirements for extra-label use

• Valid client/veterinarian/patient relationship

• Behavioral history MUST be taken

• For any chief complaint which is behavioral in nature you must do an appropriate and adequate medical and behavioral evaluation to justify coming to a diagnosis.

• Just because the owner or the dog trainer says the dog has dominance aggression (or any other diagnosis) it does not mean that the dog does have dominance aggression. It may have fear aggression, hip dysplasia, be inadequately exercised, not have been appropriately trained to not jump up on people, or a variety of other problems instead.

Veterinarian has established a diagnosis

• Not the dog trainer

• Not the veterinary technician who has an interest in behavior

• Not the "behaviorist" who is not a veterinarian, even if they have some kind of certification

• Not the owner who saw on 20/20 last night that Prozac cures thunderphobia

Must be a specific rationale, and its use is accepted under current medical conditions.

• Keep up with the literature

• This is a rapidly advancing field

Extra-label usage

• Inform client of the extra-label status of the drug.

• If necessary, explain to the client what extra-label means.

• Inform the client of known side-effects.

• Signed informed consent statement.

While the veterinarian can obtain valuable information and assistance from

• Veterinary Technicians who are educated and experienced in techniques of treating animal behavior

• PhD's who focus on domestic and applied animal behavior

• Ethical trainers who use humane training techniques

• The veterinarian is legally and ethically responsible for all decisions regarding treatment of a given case.

AVSAB

• American Veterinary Society of Animal Behavior

www.avsabonline.org

for membership and other information

• American College of Veterinary Behaviorists

www.dacvb.org

for list of and contact information on behavior college diplomates

SVBT

• Society of Veterinary Behavior Technicians

www.svbt.org

for membership and other information

Veterinary Technician

• Serious treatment of serious behavior problems involves a lot of...

• Monitoring of the patient

• Education of the client

• Long-term communication with the client

The veterinary technician who is

• Skilled in the techniques of behavior modification and the handling of aggressive animals

• Knowledgeable of side-effects for which to monitor patients on medication

• A good communicator-with people as well as their pets is an essential member of the team that is treating patients with behavior problems

SVBT

• Thou Shalt Not Diagnose

• SVBT newsletter 1(2)

Veterinary Technicians do not diagnose and do not decide what the treatment plan will be

• Veterinary Technicians Do...

• Educate clients about the prevention of behavior problems

• Instruct clients in the details of the treatment plan prescribed by the veterinarian

• Educate clients in the use of various tools that have been recommended, e.g. fitting and using head collars, cribbing straps; teaching dogs that muzzles are actually 'treat baskets'

• Monitor the patient, either directly or via communication with the client, for response to all aspects of treatment, including response to medication and behavior modification techniques.

• Assist clients who are having difficulty understanding exactly how to implement the behavior modification treatment protocol

• Relay to the veterinarian in charge of the case any problems, side effects, lack of expected progress, or other issues about the case that they need to be made aware of.

When should a general practitioner call a specialist?

• Anytime you have a question about how to handle the case...

When to refer to a specialist?

• Anytime the case is so complex or presents such dangers that you feel uncomfortable attempting to pursue diagnosis and treatment yourself, with or without correspondence with a specialist, or if the patient is not responding to treatment as expected.

• Particularly consider referral in cases of serious aggression.

ACVB

• American College of Veterinary Behaviorists

• Recognized by the AVMA in 1993

• All listed in the AVMA directory and on www.dacvb.org

• One year general internship or equivalent

• 2-3 year conforming residency

• additional pre-requisites for two year residency

• non-conforming residency option exists

www.avsabonline.org for position statements on issues relevant to diagnosis and treatment of behavior problems