Ethics: Our oath to advance medical knowledge creates demand for those services

Law, professional standards and personal principles, in addition to the diverse constituency the veterinary profession serves, are all driving tough ethical questions.

With duties to families and employees, to client and their animals, and to society and public health, is it any wonder practitioners face difficult ethical dilemmas every day?

Let's add one more potent ingredient to the mix: money.

Like it or not, most veterinarians in the United States practice medicine in for-profit companies. We may be a profession driving the highways of duty to animal welfare, society's benefit and public health, but capitalism fuels the engine. After-tax profit funds the resources we require to maintain the competent employees, equipment, facilities, pharmacies and other necessities for our professional journey.

We are a profession with financial burdens not matched by any other. We are a profession committed to advancement of medical knowledge and the precious investment of time and money required to maintain skill through life-long learning.

Raising the bar

We are a profession in desperate need of new talent, brilliant young men and women who can take our places and meet the demands of a global economy hungry for the wide variety of competencies to which veterinarians lay claim. How can the profession attract the best and brightest candidates when we protest that we are the "poorest" medical profession? How can we raise our economic standings in a highly inflationary medical/financial environment without charging more, without paying more taxes and without prudently mitigating the risks that any small-business employer faces?

And so the entire veterinary profession struggles with innumerable ethical dilemmas that bear important and ongoing debate. Society's gap between the "haves and have-nots" seems to be widening, and it places the financial burden of companion animal care squarely at our feet. Whether veterinarians deserve it or not, the spotlight of public perception is upon the profession, especially in the arena of affordability of health care for animals of indigent owners and the high price of rapidly escalating high-tech medical modalities.

Our oath to advance medical knowledge creates a demand for the services that spring from it. Capitalism drives competition to meet that demand. If veterinarians don't meet the consuming public's insatiable appetite, who will? Capitalism abhors a vacuum. And perhaps in the short term, it abhors ethics as well.

From a long-term perspective, all evidence suggests professional ethics are crucial to long-term survival. Profitability might not be as satisfying for those with love of immediate gratification. But the example of Aesop's tortoise truly applies for companies who view strong business ethics as crucial to long-term investment value return.

Ethics background

The Greek word "ethos" is synonymous with the Latin word "mores". The parallel derivation leads to one view that "ethics" constitutes the study of morals. But what does that mean? Let's go further to better understand the impact of "ethics" on the veterinarian's day-to-day activities as a human being, a citizen, an entrepreneur, employee, employer, parent, a professional and scientist.

In the Greek tradition, ethics is the study of the "good life". In the Judeo-Christian tradition, ethics is the study of righteousness before God. Further, Aristotle would have defined ethics as the study of the conditions necessary for man's happiness, while Kant's version would have the study of man's duties and responsibilities to one another. Although Kant's concepts about ethics more closely aligns with present societal views, law specifically sets forth the baseline of ethical duties and responsibilities for DVMs and other professionals.

Veterinarians always must remember that laws scripting professional conduct do not, and cannot, define aspirational aspects of ethical behavior. Recognize the difference between rules-based and principle-based behavior. When too many laws and standards rule the road of ethical behavior, people tend to creatively design alternative routes. They justify their unprincipled behavior by parsing words to interpret the law the way that favors them. A good example is the byzantine U.S. tax code that increasingly drives unethical, unprincipled behavior as shown in recent times by various illegal tax-shelter promoters and tax protesters.

Rules-based behavior is not principles-based behavior. Principles should trump rules to stay true to any profession's aspirations of duty and responsibility to the public good.

Unlike the veterinary profession, the accounting profession requires ethics education to renew licensure. In Ohio, the equivalent of one hour of ethics education per year must be completed and satisfactorily tested to maintain licensure as a certified public accountant. This paper's author has derived the following quote from ethics coursework completed for Ohio CPA license renewal. It captures the essence of professional and ethical behavior as an idea for the veterinary profession:

"To strive to behave not only in a manner that conforms to the minimum standards established by veterinary medical law and professional standards, but also aspire to behave in conformance with the spirit of veterinary law and professional standards. The purpose of the law and the professional standards is to protect the public and recognize the DVM's responsibility to the public."

Using core values to solve cost-of-care dilemmas

When practice leaders aspire to behave in conformance with the spirit of the law and professional standards, they usually have a strong sense of their core values. These core values are often traced to the very drivers for pursuing a career in the veterinary profession.

Although veterinary practice is predominantly based in the for-profit realm of American business, it is possible to use core values and vision to achieve philanthropic goals. We strongly encourage on-going strategic planning dialogue that leads to clear practice objectives.

Truly vibrant, strong veterinary practices have leaders with a clear sense of core values, vision and business purpose. The for-profit goal of returning value to shareholders is not exclusive of finding a way to adequately meet the health needs of "indigent pets". This is not to say a veterinary practice or veterinarian can be all things to all people; however, it is possible to establish clear delineation of practice parameters for choosing practice style, client types and financial structure that will fit with owner objectives and core values.

Core values are both a rudder and an anchor for practice directors to decide when, how, where and the extent of philanthropy. Only through a clearly stated direction can owners provide the stewardship a practice must have to financially subsidize the predetermined level of care with adequate equipment, technology, employee talent and infrastructure. Core values underlie the rules employees live by and guide their daily decisions, including how to charge appropriately for veterinary care and generate profit. Adequate cash flow gives flexibility for benevolence.

Without core values, standards of care can't exist. Doctors and other employees follow their own rules or make them up on the fly. Core values help everyone associated with the practice pull in the same direction and act out the original intent. They lead to precise goals against which to critique, measure and review employees' actions, as well as practice performance from a pure business investment perspective.

Core values are very philosophic in nature. Ask: How do we want to be? How should we act in the spirit of the law, professional standards and our core beliefs? How do we measure and hold accountable our performance against the ruler of core values?"

Let the free markets reign

Ultimately, American veterinarians practice almost exclusively in the capital arena that demands attention to competitive forces, market pressures and mounting costs of operation. To a great extent, the success of one practice as compared to another very much relates to long-term profitability.

In their personal service business, veterinary practice CFO's must be cognizant of all strategies that enhance name recognition and reputation, word-of-mouth referral and client-perceived value. We encourage positive public relations through well-planned budgets that will support philanthropic efforts.

Although we would hope the veterinary profession as a whole could widely publicize such philanthropic efforts through private for-profit ventures, the real work falls to the individual veterinary practice owner. Proactively embrace a long-term strategic plan based on inviolate core values and leadership's commitment to the spirit of civic and professional responsibility. Thoughtfully plot the financial requirements to support these values and activities. Assure positive community perception through professional, subtle, yet persistent, publicity.

Through such efforts, veterinary practices should find their appropriate service and clientele niche. Maintain the right level of fees and financial wherewithal to match the predetermined degree of philanthropic service to the practice's indigent animal and client need.

SUGGESTED READING

1. Martin SA. Professional Standards and Ethical Responsibilities for Certified Public Accountants. Columbus, OH: The Ohio Society of Certified Public Accountants; 2004:1.

2. Martin SA. Professional Standards and Ethical Responsibilities for Certified Public Accountants. Columbus, OH: The Ohio Society of Certified Public Accountants; 2004:4.

3. Martin SA. Professional Standards and Ethical Responsibilities for Certified Public Accountants. Columbus, OH: The Ohio Society of Certified Public Accountants; 2004:10.

Dr. Heinke is owner of Marsha L. Heinke, CPA, Inc. and can be reached at (440) 926-3800 or via e-mail at MLHeinke@aol.com