You are further advised not to treat the cattery's animals. Is it ethically correct to turn a .... nostic work-up reveals a strangulated inguinal hernia. (not noted on the ...
VETERINARY MEDICAL ETHICS
-A ik
DEONTOLOGIE VETERINAIRE
Ethical question of the month - October 1995 Question de deontologie du mois - octobre 1995 A client presents you with a mature cat suffering from feline infectious peritonitis (FIP). The only other cases of FIP in the community have come from a local cattery. The history reveals that this cat has been in contact with a cat from this cattery. Although you have recommended to this cattery on several occasions the need to control or eradicate this disease, the owners have declined to follow your advice. You call your veterinary association regarding what actions you may take regarding this irresponsible breeder. You are advised not to mention your concerns to anyone, including your veterinary colleagues within the community, because of the possibility of a libel suit. You are further advised not to treat the cattery's animals. Is it ethically correct to turn a blind eye to this source of infectious disease that threatens the health of cats in your practice area?
Comments The veterinary association is quite right in raising the possibility of a libel suit, since no substantial proof exists that the cattery has been the source of infection. That being said, I feel the advice given attempts to shirk the ethical obligations of the veterinarian. If an infectious disease threatens the health of local cats, the veterinarian has an obligation to the community to present the facts: 1. Cases of feline infectious peritonitis (FIP) have been seen in the area. 2. Feline infectious peritonitis is an infectious, incurable, and fatal disease. 3. The risk of being infected is higher in cats living in high density areas, such as kennels and catteries. 4. The risks in these high density areas can be minimized with proper measures to control the disease. There is an obligation to the owners of the cattery to make them aware of these 4 facts and suggest methods of control. If they refuse your advice, you must choose between withdrawing your services and offering the cats a lower standard of care.
Mike High, Sidney, British Columbia Can Vet J Volume 37, January January 1996
Un client vous amene un chat adulte qui souffre d'une peritonite virale du chat. Les seuls autres cas de cette maladie dans la communaute venaient d'une chatterie locale. L'historique demontre que ce chat a ete en contact avec un fMlin de la chatterie. Bien que vous ayez recommande 'a plusieurs reprises que la chatterie controle ou elimine cette maladie, les proprietaires n'ont pas suivi vos conseils. Vous communiquez avec votre association veterinaire pour savoir quelles actions peuvent etre entreprises contre cet eleveur irresponsable. On vous avise de ne pas discuter de vos inquietudes avec quiconque, y compris vos collegues veterinaires au sein de la communaute, en raison de la possibilite d'une poursuite pour diffamation. On vous avise egalement de ne pas soigner les animaux de la chatterie. Du point de vue deontologique, est-ce acceptable de fermer les yeux sur cette source de maladie infectieuse qui menace la sante des chats dans votre region?
An ethicist's commentary on the case of the veterinarian who suspects a local cattery of being a source of feline infectious peritonitis Feline infectious peritonitis (FIP) is a devastating, incurable, and tragic disease. I watched helplessly as my small son's kitten, afflicted with FIP, deteriorated before his eyes, while he begged me for help. "You have so many friends in the veterinary school, Daddy, can't anybody do something?" Here we have a situation where a veterinarian is in a position to do something, indeed can pursue the only available course for limiting the spread of the disease, which is to eradicate the disease at its source. Furthermore, in this case, all the usual pulls creating ethical tensions for veterinarians are convergent in pointing out the practitioner's duty. As we have mentioned in previous columns, veterinarians have obligations to clients, animals, peers, society as a whole, and to themselves. While there is often significant conflict among these obligations indeed, that is frequently the stuff of this column such is not the case here. The obligation to clients is patent one clearly must do all one can to avoid disease in people's -
7
7
animals. As the case indicates, you have already had clients lose animals (and money) to the source of the disease. The same point applies to one's obligation to animals - it is certainly against their interests to ignore the reservoir of FIP. Again, one's obligations to one's fellow veterinarians is clearly to help them protect their clients and patients. Similarly, public health obligations incurred by veterinarians in virtue of their station militate in favor of closing the door on sources of infection. Only the obligations to oneself may give the veterinarian pause. After all, why risk a libel suit? Why make oneself a target? Why not look to other way? The answer, of course, is that oftentimes one does run a risk by doing the right thing; a point vividly illustrated in Ilsen's classic play, An Enemy of the People, where the town doctor in a tourist city incurs the wrath of the community by bringing to light the fact that the baths the town's major attraction - are contaminated. If doing the right thing did not often exact risk and cost, it would be easy, indeed possibly automatic, and surely not praiseworthy. As citizens, we deplore those urban dwellers who do not respond to cries for help from victims of muggings, and do not excuse the response that asserts "I didn't want to get involved," because I might have to lose time testifying, interrupt my dinner, or, even, risk recriminations
y?INK
from the mugger. Similarly, it is ignoble to be paralyzed by fear of lawsuits, unfortunately epidemic in our society. Part of my obligation to myself is to be able to look myself in the mirror. Were I the veterinarian, I would approach the cattery firmly and decisively, marshalling the relevant evidence and demanding that they address the problem. If they refuse to do so, I would point out to them that they are in a highly vulnerable position. After all, the situation is very newsworthy, and adverse publicity would be likely to put them out of business. Again, they are extremely susceptible to lawsuits from the many people who have lost animals. And, in fact, such lawsuits would be far more plausible than one they might bring against me for libel. I would also confront the veterinary association with the same logic I have detailed above. The stance they have taken is professionally irresponsible and pusillanimous. It is their job to join with you to stop such irresponsible behavior, and to help protect you from or support you during a lawsuit that might ensue from doing the right thing, not to counsel you (and themselves) away from a veterinarian's clear duty in such a case.
Bernard E. Rollin, PhD
UP
4,, :._,,
g
T
8 0
Can Vet J Volume 37, January 1996
Ethical question of the month - January 1996 Question de deontologie du mois - janvier 1996 Responses to the case presented are welcome. Please limit your reply to approximately 50 words and mail along with your name and address to: Ethical Choices, c/o Dr. Tim Blackwell, Health Management, Ontario Ministry of Agriculture, Food and Rural Affairs, Wellington Place, R.R. 1, Fergus, Ontario NlM 2W3; telephone: (519) 846-0965; fax: (519) 846-8101. Suggested ethical questions of the month also welcome! Les reponses au cas presente sont les bienvenues. Priere de limiter votre reponse 'a environ 50 mots et de nous la faire parvenir par la poste avec votre nom et adresse a l'adresse suivante : Choix deontologiques, a.s. docteur Tim Blackwell, Groupe de la sante' animaux, Ministere de l'Agriculture et l'Alimentation et des Affaires rurales de l'Ontario, R.R. 1, Fergus (Ontario) NlM 2W3; telephone: (519) 846-0965; telecopieur: (519) 846-8101. Les soumissions des questions deontologiques sont toujours bienvenues! You are an associate veterinarian working in a day clinic from which an affiliated emergency clinic operates on evenings and weekends. Monday morning a vehicular trauma case is transferred to your care from the emergency clinic. The dog is depressed and in pain. It is lying in its own feces and urine. Intravenous fluids and antibiotics are being administered. No analgesics have been given. Your diagnostic work-up reveals a strangulated inguinal hernia (not noted on the emergency clinician's record) and a tibial fracture (amputation recommend by the emergency clinician). Surgical correction of the strangulated hernia, including an intestinal anastomosis, is performed. When you mention your findings to the emergency clinician, he states there was no hernia present over the weekend nor did the dog show signs of pain. The owners are not dissatisfied with the emergency treatment. The close affiliation between your clinic and the emergency clinic makes it difficult to criticize the service provided, even though you feel a proper workup was not performed. How should you respond?
Vous etes un veterinaire-associe et travaillez dans une clinique de jour affiliee a une clinique d'urgence ouverte les soirs et les fins de semaine. Le lundi matin, la clinique d'urgence vous refere un animal victime d'un accident de la route. Le chien est depressif et souffrant. Il est couche dans ses feces et son urine. Un liquide intraveineux et des antibiotiques lui sont administres; il n'a requ aucun analgesique. Votre examen diagnostique demontre la presence d'une hernie inguinale etranglee (non indiquee sur le rapport du ve'trinaire de la clinique d'urgence) et une fracture du tibia (le veterinaire de la clinique d'urgence a recommande l'amputation). L'hernie etranglee est soignee par une chirurgie qui comprend une anastomose intestinale. Lorsque vous discutez de votre diagnostic avec le veterinaire de la clinique d'urgence, il repond que l'animal n'avait pas d'hernie au cours de la fin de semaine et ne demontrait aucun signe de douleur. Les proprietaires ne se sont pas plaints du traitement d'urgence. L'affiliation de votre clinique et de la clinique d'urgence vous met dans une position relativement difficile pour critiquer le service offert, meme si vous ne croyez pas que l'animal ait ete soumis a un examen convenable. Quelle devrait etre votre reaction?
Comments/Commentaires:
Name/Nom: Address/Adre sse:
Can Vet J Volume 37, January 1996
9
