Horns of dilemma (Proceedings)

The veterinary practitioner is fully aware that the day to day delivery of services from the clinic are governed by a plethora of laws and regulations - employment compliance issues, drug regulation, licensing concerns. Each comes with legal consequences for the breach of the law; however, rarely does the veterinarian have a keen understanding for the manner in which an ethical breach can compromise the practice. . The practitioner and laystaff within a clinic are presented with ethical dilemmas on a daily basis which no doubt cause a great deal of moral concern and, often, some sleepless nights; the prudent technician will also understand that a breach of an ethical standard can often lead to legal consequences and that the two are closely linked. In law, the veterinarian is responsible for the acts of the laystaff; as such, it is critical that all members of the hospital "team" be aware of some of the more typical ethical dilemmas.

Ethical Standards

Most veterinary legislation throughout North America creates a positive duty on the practitioner to maintain a high level of moral standards. Indeed, some of these requirements are contained directly within the veterinary statute while other become ethical codes administered by state licensing bodies. In addition, practitioners may have membership in various professional groups and organizations that impose yet another code of conduct to which members must adhere. The sources of these ethical tenets are many and each come with a requirement that the practitioner adhere to them upon some penalty.

Penalties

There are a number of penalties which may be imposed against a practitioner who has breached an ethical standard - these penalties vary from one jurisdiction to the next but can summarized as follows:

1. A Recorded Reprimand can be imposed wherein the veterinarian found guilty of an ethical breach is rebuked with the knowledge of his or her colleagues so that deterrance objectives of the regulatory body might be enhanced.

2. A Monetary Fine can be imposed in some jurisdictions - this quasi-criminal sanction is directed to ensure that the breaching party understands the significance of the breach (often the legislation sets out maximum limits for such a penalty)

3. A License Suspension can be imposed on a practitioner for more serious offences during which the license to practice is removed for a fixed period of time and the practitioner cannot benefit from his or her practice;

4. A License Revocation can be imposed for the most serious offences; in these cases the regulatory body generally would be required to find that the conduct of the veterinarian involved a level of moral turpitude.

In some cases where the regulatory board is of the view that the practitioner is one that is likely to achieve rehabilitation, then, in most cases, the imposition of penalty can be suspended on such terms as the tribunal believes are appropriate in the circumstances. In some case, practitioners have been required to write an authoritative essay on the topic of the ethical breach as a means of assuring the tribunal that the veterinary professional understands and appreciates the issues. Clearly, the imposition of a suspension from practice for even a short period of time affects the financial status of the clinic and impacts on both the professional and laystaff.

Typical Ethical Breaches

There are a number of common mistakes within the veterinary hospital setting that give rise to concerns by clients and regulators alike.

Confidentiality

Every practitioner is aware of the need to maintain client and patient information on a confidential basis; that is, not to release such information unless the consent of the client has been first obtained. There are often a number of legislative exemptions to the confidentiality rule including when one is required to release information by law (that is, under a court order or subpoena) or when you are required by legislation to report certain information (for instance, whether or not a dog has been vaccinated for rabies as if often required). Barring any exemptions, all information must be kept secret. This ethical tenet is breached regularly within the clinic when, for example, a receptionists speaks to a client on the phone and releases information in circumstances where other clients can overhear the conversation. As well, confidentiality is breached when one merely tells a person that they provide veterinary services for another. Medical charts left on a desk or treatment room which can be viewed by other clients often lead to complaints.

Conflict of Interest

One has a conflict of interest when information obtained from a party can be used in a manner which affects the judgement of another. A common example is in the context of performing a pre-purchase examination in an equine transaction - clearly, the veterinarian cannot be engaged by both the seller and the buyer. Beware the circumstance where you are directed to provide the opinion to the buyer but the inspection is paid for by the seller.

Professional Judgement Compromise

Another example of ethical breaches occurs when the owner of a clinic attempts to compromise the professional judgement of a subordinate veterinarian, typically one that is employed by the clinic. This occurs when the owner suggests a treatment plan that involves the sale of more medications or further laboratory work when, in fact, the attending veterinarian believes that he or she is doing a competent job and thinks that the additional expense is not justified. The powerful position of the practice owner is being used to compromise the professional judgement of the staff veterinarian.

Veterinary practitioners must be aware that it is necessary to practice with medical competency but also with a determination to maintain appropriate professional conduct in order to avoid legal consequences.