VETERINARY MEDICAL ETHICS

CommentsIn response to the July 1997 ethical question of themonth, of course she would be wiser to spend the moneyon her children or dental work for herself. Priorities haveto be made, but, this does not reduce the necessity to takeresponsible care of the dog. The client should try to pri-oritize the dog's needs and budget. Show her how to cleanthe dog's teeth and give her information on all aspectsof his needs. Keep sending her information regarding hisvaccinations, heartworm test, etc. Encourage her tounderstand and cope with her dog's requirements.

Susan Beck, DVM, Edmonton, Alberta

I would advise this client that she would be wise toconsult with a physician about receiving a complete

DEONTOLOGIE VETERINAIRE

medical and gynecological examination on an annualbasis. I am not aware of any recent statements fromthe Canadian Medical Association calling this practiceinto question. Secondly, I would reinforce the notionthat preventative health care for her dog is equally nec-essary for the long term well-being of the animal; theonly difference is that, in our society, pet care is paidfor directly by the animal's owner. A veterinarianshould not feel guilty for vaccinating, examining, ordeworming a perfectly healthy animal; instead, he orshe should take pride in helping to maintain that ani-mal's health. Due to financial considerations, it wouldbe helpful in this case for the veterinarian to cus-tomize a health program for his client's dog, perhapsomitting some of the tests or treatments of lesserimportance.

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It may be that the pets belonging to this woman'sfriends will remain healthy despite their lack of veteri-nary attention, just as a man may become an octogenarianwithout a significant medical history. It is also possible,of course, that a man or animal might suffer an earlydemise from an unrecognized medical problem. I wouldargue that the majority of pets that receive regular vet-erinary attention are healthier, live longer, and havehappier lives than animals receiving little or no vet-erinary attention. Unfortunately, this fact is often notapparent to a pet owner, until the health of their animalis comprised. This veterinarian would be remiss in hisresponsibilities, if he did not use this opportunity toeducate his client about these realities.

Jeffrey P. Gervin, DVM, Boissevain, Manitoba

Persons with limited funds have the most to gain fromannual preventative medicine, because they have nomoney to treat the pet if it becomes ill.

Like everything in life, they must weigh the costversus the benefits. They must compare the cost ofheartworm prevention with the cost of treatment and takeinto consideration the incidence of the disease; similarlywith parvovirus infection, bordetellosis, rabies, etc.

Without a doubt, the annual physical examinationand consultation is the most cost effective preventa-tive medicine. Human physicians do not advocate annualcheckups, but their patients can examine themselvesand can make an appointment for no fee any time theywant. Governments spend large amounts of tax dollarsto educate humans how to stay healthy. The only edu-cation on preventative medicine for the pet that theowner receives is during the annual consultation.

If a client has little money for treating an ill pet,hopefully, through the annual physical examination,any disease will be detected early. Also, since the clientcannot afford expensive high tech tests, the best diag-nostic tool will be an excellent history establishedthrough regular checkups.

In closing, I would tell the client with limited fundsthat if it were a decision between their child's health andthe pet's health, the child would win with no question.However, if it were $100.00 on the pet's health or$100.00 on cigarettes, videos, potato chips, etc., I wouldask which will bring the family more enjoyment?

W. Lyle Pollock, DVM, Barrie, Ontario

An ethicist's commentary on thecase of the financially stressed clientI confess to having some difficulty in identifying asignificant ethical issue in the situation described.Presumably, the question is whether or not the veteri-narian ought to do a "hard sell" on the woman andaggressively attempt to get her to part with $100 for theregimens mentioned.To me, the answer is clear. Although I am well aware

that we live in an age where a business model is ubiq-uitous in our lives, from prenuptial agreements to theindustrialization of agriculture and the aggressive sell-ing of caskets, I resist its wholesale application to pro-fessions. I once had a real estate agent ask me my occu-pation. When I said college professor, she enthusiasticallyreplied "Aha! So you're in sales also!" I concur withPlato's argument in the Republic that we should con-ceptually separate our role as professional from ourrole as wage earner, at least as an ideal. Thus, I detestadministrators who tell me to treat students as con-sumers or customers, for that invariably means pan-dering to them.From a professional perspective, we must ask if the

regimen described is necessary, and it seems clear thatit is not. Perhaps it is desirable, but this client is clearlydoing without some necessities and is missing much thatis desirable. If she cannot afford "Cadillac" medicine, sheshould not be made to feel guilty for it.Were I the veterinarian, I would spend a few minutes

educating her on what to watch for concerning thehealth of her animal. For example, I would discuss thedanger of heartworm in her area. I would then express mywillingness to work with her to resolve pressing healthproblems with her dog, either by allowing her to pay meover time, if necessary, or by my accepting barter ordoing the work for cost. Aside from being the rightthing to do, such an attitude on my part is sure to generatemuch goodwill for me in the community, though there is,to be sure, always the danger of attracting chisellers.The bottom line is that her attitude is sensible and "feet

on the ground"; she has a good sense of husbanding herresources, yet is not putting the animal in danger.Assuring that she does not, should be the veterinar-ian's primary professional goal. I would not sleep wellif I pressed her to spend the $100.

Bernard E. Rollin, PhD

You'll do rabies vaccination free of charge. Life is fullof compromises. Warn her of all risks. Buy a lotteryticket.

John Sankey, DVM, London, Ontario

Can Vet J Volume 38, October 1997 603

Ethical question of the monthOctober 1997

Responses to the case presented are welcome. Pleaselimit your reply to approximately 50 words and mailalong with your name and address to: EthicalChoices, c/o Dr. Tim Blackwell, Health Manage-ment, Ontario Ministry of Agriculture, Food andRural Affairs, Wellington Place, R.R. 1, Fergus,Ontario NlM 2W3; telephone: (519) 846-0965;fax: (519) 846-8101. Suggested ethical questions ofthe month also welcome! The situations featuredin this column are factual, but names and locationshave been changed to protect the confidentiality ofall parties.

One of the best dairy farms in your area uses your ser-

vices irregularly. The university educated owner

consults several "expert" veterinarians from out ofprovince. When talking with the owner one eveningafter a dystocia, you learn that this producer routinelytreats fevers in lactating cows with banamine, whilesaving the milk; mixes rumensin in the milking cowration without a prescription; and purchases modified-live vaccines in large vials and uses them for 4 to5 weeks after mixing to reduce the cost per vacci-nation. When you ask where all these off-label rec-

ommendations originated, he tells you they come

from his out-of-province veterinarians. He laughsabout the joke by 1 veterinarian concerning the largenumber of chickens in Wisconsin now being fedrumensin. He mentions that another consultant vet-erinarian told him that no one checks for banamine inmilk, so the 96-hour withdrawal period is meaning-less. This producer wants to produce a wholesomeproduct and is acting on the advice of "experts."What should you tell him?

Question de deontologiedu mois Octobre 1997

Les reponses au cas presente sont les bienvenues.Priere de limiter votre reponse 'a environ 50 mots etde nous la faire parvenir par la poste avec votre nomet adresse 'a l'adresse suivante: Choix deon-tologiques, a.s. docteur Tim Blackwell, Groupe de lasante des animaux, ministere de l'Agriculture, del'Alimentation et des Affaires rurales de l'Ontario,R.R. 1, Fergus (Ontario) NlM 2W3; telephone:(519) 846-0965; telecopieur: (519) 846-8101. Lessoumissions de questions deontologiques sonttoujours bienvenues! Les cas presentes dans cetterubrique sont fondes sur des faits, mais les noms despersonnes et des endroits ont ete modifiees pour pro-teger la confidentialite des personnes interessees.

Une des meilleures fermes laitieres de votre regionutilise occasionnellement vos services. Le proprietairequi a fait des etudes universitaires consulte plusieursve'trinaires <<experts>> de l'exterieur de la province.Un soir, en discutant de dystocie avec le proprietaire,vous apprenez qu'il traite regulierement la fievrechez des vaches en lactation avec de la banamine, touten conservant le lait; melange du rumensin avec laration des vaches sans avoir de prescription; et achetedes vaccins 'a virus modifie dans de grands flacons etles utilise pendant une periode de 4 a 5 semaines apresles avoir melanges afin de reduire le cou't par vacci-nation. Lorsque vous lui demandez qui lui a faittoutes ces recommandations en derogation des direc-tives, il vous dit qu'elles viennent toutes de ses

ve'trinaires-conseils de l'exterieur de la province. Ilrit de la blague d'un veterinaire sur un grand nombrede poulets au Wisconsin qui sont maintenant nourrisau rumensin. I1 mentionne qu'un autre veterinaire luia affirme que personne ne verifie la presence debanamine dans le lait; ce qui rend donc inutile ledelai d'attente de 96 h. Ce producteur veut produireun produit sain et se fie sur les conseils d'<<experts>>.Que devriez vous lui dire?

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