David W. Ramey Ethics is a very old field of philosophy that involves systematizing, defending, and recommending concepts of right and wrong conduct. Etymologically, the term ethics originates with horses, coming from the Greek word ethos, meaning “accustomed place” (as in “the habitat of horses,” Iliad 6.511, 15.268).1 One of the earliest examples of a code of professional ethics is the Hippocratic Oath, sometimes summarized as, “Above all, do no harm.” Ethical concepts are commonsense, but they can be very difficult to apply, especially in some areas of equine practice. A more detailed explanation of the principles of ethics is found in Chapter 4. One of the easiest ways to offend someone is to call them unethical. Furthermore, a suggestion of even marginally unethical behavior often leads to a defense along the lines of, “Everyone has their own ethics.” The inherent assertion is undoubtedly true; one person’s moral and ethical judgments may clearly differ from another’s. As a result, even if individuals share some of the same ethical beliefs, they may disagree about how to behave in certain moral or ethical situations. But while people may have their own sense of ethics – that is, their own sense of right and wrong – some practices are clearly better (and therefore more ethical) than others. Practices that are kinder, fairer, in the interest of the horse’s long-term health, supported by sound scientific evidence, and more honest are generally more ethical than practices that are mean-spirited, unfair, destructive to the horse’s health, not supported by science, or untruthful. While everyone involved in the care of horses should strive to be ethical, this goal applies especially to veterinarians, who claim to be experts in horse health and welfare, and who expect people to trust them based on that assertion. People who are perceived as being more ethical – kinder, fairer, etc. – are generally thought of more highly than people who are considered less ethical. In surveys of professions, nurses generally get high marks because (i) they are thought of as honest, and (ii) they do so much for other people (Gallup 2020). On the bottom end of the scale tend to be professions such as lawyers, used car salesmen, and members of the United States Congress: these individuals may have the reputation of being in their job mostly for their own benefit. Veterinarians tend to rate up near the top of professional surveys in ethical behavior, even higher than physicians (Kedrowicz and Royal 2020). In equine clinical practice, many people claim to have expertise: some of these individuals work in areas that are legally considered the practice of veterinary medicine. These people, many of whom do not have veterinary degrees, may claim special knowledge, or even a level of skill higher than veterinarians, including “dentists,” “chiropractors,” “massage therapists,” “laser therapists,” etc. As a result, it is important that veterinarians distinguish themselves from other, self-proclaimed experts in horse health. Veterinarians can be distinguished from other individuals who claim to be experts in animal health in three primary areas: ethics, scientific research, and because of their education, in medical and welfare concerns of all animals (a sort of special knowledge). Thus, ethical practice offers veterinarians a unique opportunity to distinguish themselves as trusted providers of equine care. On the other hand, unethical conduct threatens to undermine the special status given to veterinarians. If veterinarians are perceived as acting unethically (i.e. not acting in the best interest of horses), society may be (and has been) motivated to act. In fact, people do not have to use veterinarians. Ethical conduct is one good reason why people might be inclined to use veterinary services; thus, ethical conduct is not only an ideal it is also good business. Perhaps most importantly, ethical conduct builds trust. A strong veterinarian–client relationship, which is essential to building and maintaining a successful clinical practice, relies on trust. While it can be hard to gain and maintain, trust can be easily lost, particularly if a veterinarian is perceived as being dishonest or unethical. Ethical standards and behavior provide confidence to the public about the reliability and actions they can expect when using the services of a professional. Professional organizations break down their ethical codes of conduct into discrete components (American Veterinary Medical Association [AVMA] n.d.). These components include: The horse as a biological system has been studied for centuries. That study has resulted in a great deal of special knowledge that is not easy for lay people to understand or apply. Veterinarians are generally qualified to provide veterinary care based on their special knowledge; that is, veterinarians know how to anticipate what will happen to a horse after various pharmaco-medical interventions. However, there is no clear social consensus when it comes to how horses should be considered and treated. Part of the difficulty with discussing ethics in equine practice is that there are at least two very disparate opinions as to the status of horses in society. There are also different opinions about what constitutes appropriate care. One view would be that horses are akin to companion animals (e.g. dogs and cats). Under such a view, horses are animals to be kept and cared for, essentially in perpetuity. These horses are essentially considered to be part of an extended human family and may be treated accordingly with little consideration of pecuniary measures of value. Another perspective would be that horses are valued primarily for their ability to perform, either in various types of work, or in various competitions for money and/or prizes. As such, these horses may be viewed more like commodities.3 That is, their inherent value may not be so much as an individual animal as it is a means to make a living and/or to bring acclaim to the humans that use them. Any number of “performance” horses may fall under this heading: racehorses, jumping horses, cutting horses, etc. There are various types of working equids as well. Working and performance horses may be well attended while they are active, but such attention may not always be in the best interest of their long-term health (e.g. stress from prolonged stall confinement, inability to move freely, a variety of medications given to enhance performance or being fed high amounts of grain concentrates). In addition, horses that may be somewhat unhealthy, e.g. a horse with an osteoarthritic joint, may be treated in hopes of prolonging their performance lives without consideration of the long-term aspects of such treatment. For some of these horses, once their performance days are finished, their usefulness may be finished as well. Ethical equine veterinary practice would be much easier if veterinarians could always simply do what is in the best long-term health interests of the horse and not charge for doing so. However, the fact is, veterinary medicine is a business. While horse owners typically don’t begrudge veterinarians the right to make a living, and while veterinarians have an ethical obligation to take care of themselves and their families, ethical lines can become blurry if the primary focus in taking care of or using horses is to make money. In an ideal world, the best ethical conduct benefits everyone involved in the clinical interaction. However, in equine practice there are often many interested parties involved in therapeutic decisions regarding horses: owners, trainers, and riders, as well as independent entities, such as those who manufacture products. These individuals may have different interests. Unfortunately, due to various pressures from interested parties, the individual who may receive the least consideration – at least in the long term – is the horse. If it is reasonable to assert that veterinarians should act ethically, and if ethical practice improves the public’s perception of professions, one might reasonably wonder why it is necessary to have discussions on ethics at all, and why ethical practice may sometimes seem to be such an elusive goal. To answer these questions, it is necessary to look at the participants in clinical transactions in equine practice and then examine the obstacles to ethical behavior. The veterinarian’s ethical responsibility to him- or herself, as well as to the horse, should ideally come before the demands of the client. Otherwise stated, a veterinarian shouldn’t do what he or she doesn’t feel is right. Unfortunately, clients can put a good deal of pressure on veterinarians to provide treatments, not only to enhance performance, but also in end-of-life situations, where clients may push to prolong a horse’s life even at the cost of its suffering. While doing what the client wants may increase client satisfaction, at least short term, in human medicine working to make the client happy is associated with worse outcomes and greater costs (Fenton et al. 2012). In veterinary medicine, client satisfaction has been inversely associated with the mental health of the veterinarian (Perret et al. 2020). In addition to an intellectual and emotional undertaking, equine practice is also a business by which veterinarians support themselves and their families. As such, the veterinarian’s obligation to him- or herself may be used as justification for putting the veterinarian’s needs above ethical obligations to the horse, the horse owner, or society. However, ethics that is overly self-directed tends to foster irresponsible and dishonest conduct. Ultimately, conduct that considers only the veterinarian undermines the integrity of both the individual and the veterinary profession. Veterinary medicine differs from most of human medicine in that the client and the patient are not the same individual (or species). The human medical model most closely aligned with veterinary medicine is pediatric medicine. In pediatric practice, patient decisions are made without the input of the patient: someone else makes treatment decisions and pays the bills. Although many clients want only what is best for their animals, others – particularly in performance horse disciplines – may have competing interests. For example, the goal of getting to the next show, the next race, or the next event may be more important to a client or trainer than the long-term health of the horse. Some clients may even be willing to risk injury to the animal in the pursuit of short-term gain. In addition, clients can sometimes stand in the way of effective treatment, often demanding treatment – or lack of treatment – because of their “love” for their horse(s). A veterinarian is not ethically obliged to simply accede to a client’s demands. The veterinarian’s ethical responsibility to self and to the horse supersedes such demands. Veterinarians who act at the whim of a client also put themselves in a vulnerable position should a procedure go wrong: the defense, “I was just doing what the client wanted,” is not tenable should an adverse reaction occur, and the procedure is not justifiable medically. The law generally assumes that the veterinarian’s primary duty is to the animal and not to the client (McEachern and Weedon 2004). Still, in the eyes of the law, owners have virtually complete autonomy regarding their animals, except for laws prohibiting overt cruelty and neglect. Owners may choose not to treat a sick horse, not to euthanize a suffering horse, or may demand therapy that may not be in accordance with the best interests of the horse, or that is even allowed by law. This situation can create a major problem for veterinarians who want to act only in the interest of the horse. The veterinary clinician does not often have the power of law behind them to force the owner to take (or prevent) action. Thus, although some veterinarians may see their role as analogous to pediatricians, society (i.e. the legal system) has not yet caught up with the ethics underlying that view, even though many members of society would probably agree with it. The veterinarian’s most powerful tool for getting clients to act in the best interest of the horse is their Aesculapian authority. This is the traditional “godlike” place of honor given to physicians in society, referring to Aesculapius, the Greek and Roman god of medicine and healing (Rollin 2002). However, this authority can easily fail if veterinarians do not fulfill their ethical responsibilities. For example, a veterinarian could advocate for an unproven therapy without disclosing this, causing the client to waste time and money, with no benefit for the animal. This action would be clearly unethical, lacking both honesty and transparency. If such actions were discovered, this would reflect poorly on the veterinarian as well as the veterinary profession. Clients have few ethical responsibilities to their veterinarians. For example, one would hope that clients might be ethically obliged to pay their bills, to tell the truth about their horse(s), as well as to share information with the veterinarian about their concerns and expectations. However, in equine practice, one quickly realizes that in some cases, these hopes are futile. In fact, horse owners have neither the ethical responsibility nor legal obligation to employ veterinarians. In veterinarian–client relations, ethical obligations can be something of a one-way street. Thus, it is in the self-interest of veterinarians to seek out clients who act responsibly and who also have the best health interests of their horses in mind. When members of the public lack training and expertise, they can be easily exploited. Thus, to prevent exploitation of the public and to preserve their own integrity, most professions have internally enforced ethical codes of practice to which members of the profession are expected to adhere. These codes allow a profession to define a standard of conduct. Ethical standards also help maintain the public’s trust in a profession, encouraging the public to continue seeking their services. The equine world is filled with various breed organizations and competition bodies that have their own rules and standards pertaining to the care and treatment of horses. For example, tail blocking is prohibited by law in several states and is against the rules of most show and breed organizations (Hepworth-Warren 2017). Ethical conduct on the part of veterinarians would mandate that they follow those rules (American Association of Equine Practitioners [AAEP] 2010). Veterinary organizations have their own codes of ethics and have the authority to enforce those codes, usually by not allowing or rescinding membership. Self-policing allows a profession to maintain control over the standards to which they are held. Stringent self-policing serves as one way to handle internal problems within a profession and is an alternative to public relations campaigns to repair the damage that can occur when such internal problems are exposed. Unfortunately, self-policing attempts often fail because of the inherent conflicts of interest that occur. For example, whereas the legal profession has a model ethical code and more than 400,000 members, its members are not held in high esteem: in fact, the legal profession is routinely the brunt of jokes about its lack of ethics. An organization may be loath to criticize the unethical practices of its members because of fears of bad publicity or loss of revenue. Consequently, in cases in which professional bodies are expected to regulate their own ethics, there are opportunities for such bodies to become self-serving. If professional bodies fail to regulate their own ethics, it can cast an entire profession into disrepute and lead to onerous external regulation. In the world of equestrian sport, this has happened and is happening. For example, the Horseracing Safety and Integrity Act was signed into law at the end of 2020, in part to address society’s ethical concerns about horse racing (United States Congress 2020). It would follow that veterinarians should also be active in self-policing their colleagues to maintain a high standard of practice. However, individuals may also be reluctant to criticize colleagues because of fear of being ostracized or of reprisal. Even the vernacular used to describe individuals who point out unethical practice is couched in pejorative terms (e.g. “ratting out,” “snitching,” “squealing”). Regardless, outside agencies are more than happy to make sure that veterinarians practice ethically and responsibly; veterinary malpractice law is rapidly evolving in the United States. Thus, it is as important for professional organizations to act ethically and responsibly as it is for its individual members. Advertising and sponsorship are everywhere in equestrian events: manufacturers even serve as sponsors for many breed and professional organizations. This is ethically problematic since it may make unsuspecting horse owners more likely to purchase products that may not be effective treatments for their horses. From an ethical point of view, advertising should always be truthful and not make false or misleading claims: however, this is often not the case. The primary goal of manufacturers is to sell products. As a result, advertisers may fail to provide information about the risks of treatment or may not disclose that a product has not been shown to be effective. This is particularly problematic in the supplement industry, which, because of federal legislation is loosely regulated to the point that products do not have to meet scientific standards for efficacy, purity, quality, or content, provided they do not make direct therapeutic claims (United States Congress 1994). It follows that those veterinarians who recommend – or worse, sell and profit from – such products are acting in an ethically questionable manner. Social responsibility is the concept that an individual has a responsibility to society: these responsibilities are beyond the individual’s immediate self-interest (profit, professional success, etc.). Ethically speaking, “success” should be measured not only by how much money is made or how many horses are seen, but also by how many horses and people are helped. As such, “Equitarian” endeavors, or providing volunteer assistance at rescue facilities, pony clubs, or other organizations, are good examples of veterinarians fulfilling their ethical responsibilities to society. Such actions benefit the veterinary profession as well as the individuals who participate in such endeavors by generating goodwill and positive press. Society largely allows veterinarians to regulate themselves based on two perceptions: (i) that veterinary medicine is a profession with “special knowledge”; and (ii) that veterinary medicine fulfills its obligations (including ethical ones) to the horse, horse owners, and society. Even so, society does not necessarily grant veterinarians a free pass pertaining to special knowledge. Indeed, laws pertaining to the regulation of veterinarians are mutable and have been amended to allow the practice of various modalities by non-veterinarians in individual states. The mere holding of a veterinary license does not guarantee that the practice of veterinary medicine will retain its protected status. To help retain that status, veterinarians should consider it their ethical responsibility to society to advance knowledge of the practice of veterinary medicine. Veterinarians should use their knowledge to come up with better approaches for diagnosis and treatment, to confirm the utility of existing treatments, and to discard ineffective treatments. Perceptions of how the veterinary profession is fulfilling its obligations to society are also important. It has been said that “Perception is reality”; the way others perceive veterinarians is “reality” for the veterinarian. For example, if veterinarians are perceived as “in it for the money” or as acting in ways deemed merely to protect their own turf – as opposed to acting in the best interest of the horse – society may choose to ignore the veterinarian’s voice when discussing its concerns about horses, and it has frequently done so. Whereas veterinarians may have ethical obligations to society, society has essentially no ethical obligations to veterinarians, or even to horse owners. Since most of society does not own horses, societal concerns are directed to the perceived welfare of horses, often without the benefit of direct experience or knowledge. In addition, societal concern for equine welfare appears to be increasing. For example, society regulates how owners can keep horses; there are laws pertaining to horse welfare and abuse. Owners who fail to care for their horses in accordance with societal standards can have their horses taken away from them; individuals who treat their animals in a particular fashion can be fined or jailed. There are numerous examples of society’s interest in the ethical treatment of horses. For example, the failure of the Tennessee Walking Horse industry to protect horse welfare led to federal legislation banning the practice of “soring.” Soring is the practice of inflicting pain on the legs and hooves of horses with caustic chemicals, chains, and other objects to artificially create the high-stepping gait known as the “Big Lick” (United States Department of Agriculture/Animal and Plant Health Inspection Service [USDA/APHIS] 2020). Numerous other examples of societal regulations in the horse world – made with or despite advice from the veterinary community – include: The ethical responsibilities of horse ownership, societal interests in horse welfare, and veterinary medical treatment should dovetail, all working together for the best interest of the horse’s health. The veterinarian’s ethical duty is to the horse: consequently, veterinarians must avoid orders or requests from a third party that are not in the best interest of the patient. Unfortunately, client demands – for example, for “better” performance – may not be in the best long-term health interest of the horse. This fact sometimes makes the veterinarian’s goal of ethical practice in the best interest of the horse’s health difficult. In addition, societal concerns – even if they are well-meaning – may not be expressed in ways that are beneficial for the horse. For example, while the goal of allowing horses to run free on the range in the American West may be laudable, it may not be in the best interest of the horses if there is not sufficient range to sustain them or there is a lack of sufficient predators to control their herds (Bureau of Land Management [BLM] 2020). Nevertheless, by virtue of their special knowledge about horses, ethical veterinarians are in the best position to advocate for the welfare of the horse, and it is to the ultimate advantage of both the horse and the veterinary profession that they do so. The fact that veterinarians profit from what they sell is full of ethical landmines. For ethical reasons, physicians cede the prescription of, and payment for, medications to pharmacists so that they will not be perceived as having a conflict of interest. While veterinarians can ethically both sell and prescribe prescription medications, and while horse owners usually don’t mind paying for something that was prescribed for a horse, the inherent conflict of interest is apparent. Keeping the horse’s and owner’s best interests at the forefront of treatment decisions may help alleviate ethical concerns. There are several advantages when clients purchase their medications from veterinarians, all of which are consistent with good medicine and ethical practice: There are many businesses that show little concern for any of these ethical issues associated with selling prescription medications. However, “fighting fire with fire” by offering drugs on demand, or as an agent of a pharmaceutical company not directly involved in clinical care of the horse, is unethical. Furthermore, in most states it is unlawful for a veterinarian to write a prescription or dispense a drug outside a veterinarian–client–patient relationship (AVMA n.d.). On the other hand, in most states, when a client requests a prescription from a veterinarian for a horse that is under the veterinarian’s care instead of purchasing the medication directly from the veterinarian, the veterinarian is generally obliged to provide it. The fact that veterinarians may ethically sell products does not mean that all products are sold or recommended ethically. When horses require treatment for disease or injury, it is in their best interest, and an ethical imperative, that they receive the treatments that are most likely to be effective and that they are not given treatments which have no measurable effects. Furthermore, if a treatment has not been shown to be effective, ethical principles of informed consent demand that clients be told about its potential limitations (see Chapter 5). A person selecting a therapy for a horse must fully understand: The failure to provide necessary information so that the client fully understands what is known about the potential risks and benefits of a treatment is an ethical failure on the part of the person providing treatment. Furthermore, from an ethical perspective, therapies should neither be promoted nor prescribed based on criteria that are not relevant to the likelihood of a successful outcome for the horse. Promoting or prescribing a therapy using terminology such as, “new,” “natural,” “holistic,” “not ‘Western’ medicine,” “cutting edge,” or “ancient” is ethically questionable. None of these adjectives – even if accurate – has anything to do with whether the treatment helps the horse. Instead, it is an effort to promote a therapy to people of a certain mindset. Any term has ethical implications if it implies a level of expertise that other veterinarians do not have. Except for veterinary specialists certified by the AVMA, descriptive titles may only reflect the personal philosophy of the veterinarian, or the circumstances under which they have chosen to practice. Such titles can be ethically troublesome if they are used primarily for public relations purposes. It is an unfortunate fact that not all conditions of the horse have cures. Furthermore, some treatments available for horses result in healing that may be less than ideal (e.g. treatment for injuries to the digital flexor tendons). As a result, all parties in equine medical transactions are eager for better alternatives for many conditions. Experimental treatments are an ethical dilemma in equine practice. There is a high degree of uncertainty with many treatments currently being advocated. Under such circumstances, it is impossible for an owner to give truly informed consent. Influenced by the promotion of and desire for newer and more effective treatments, veterinarians may have to choose between using a treatment of proven effectiveness and one with medical “promise.” In equine medicine, treatments are usually released well in advance of a significant body of research, and such research as may be conducted is usually based on small sample sizes. Long-term follow-up is generally lacking. Furthermore, conflicts of interest can arise when the veterinarian owns (and must pay for) the product or service that the veterinarian is also recommending. Unfortunately, the search for newer, “cutting-edge” treatments can be an ethical trap. Misleading and/or unclear information can skew owners’ expectations of experimental treatments (Marks and Hahn 2020). Marketing for such treatments usually reaches the horse-owning public well in advance of any evidence for their effectiveness. Horse owners may be willing to try to do anything for their horse, even without knowing if the proposed treatment is safe or effective, and even if such treatments are expensive. However, ethical veterinary practice requires balancing the hopes of clients against ensuring that clients are properly informed and that the horse is not put at risk of harm. Such treatments may simply increase the cost of care with no measurable benefit to the horse. Veterinarians should act in the best interest of the horse and the client, and not in their own self-interest. If a therapy offers only promise and the effects haven’t been scientifically proven, the correct term for the treatment is “experimental.” There is nothing wrong with an experimental treatment, of course. Experimental therapies such as stem cells, gene therapy, and platelet-rich plasma (PRP) are currently employed in the treatment of conditions such as osteoarthritis or injuries of tendons and ligaments (to name a few). One benefit of such treatments is that they are individualized: that is, they are made from the horse’s own cells. However, the marketing of such products is often ethically questionable. Implying that a therapy is “new,” “promising,” or “advanced,” or that it is “regenerative” (implying that the treatment replaces the lost or injured tissue with new tissue that is the same as the lost tissue, or at least improves the speed or quality of healing) might inappropriately influence an owner’s expectation of success and lead them to choose such therapies, even when there is no advantage compared with conventional treatments. It is certainly possible to provide such products or services ethically. However, providing treatments of unknown benefit to the horse carries many ethical responsibilities. It is important that clients have access to impartial and accurate information and are made aware of uncertainties about possible outcomes when deciding about trying an experimental treatment. Clients should be advised that: Many conditions of the horse require better treatments. But it is one thing to have a person agree to participate in an experiment with their horse: it is quite another to sell that person on the “promise” of an attractively named therapy and not bother to keep track of the results. Due to such concerns, in 2019, the FDA issued a warning to consumers about stem cell therapies (USFDA 2019). From an ethical point of view, the level of evidence for an experimental therapy must be communicated to the client. Ethical veterinarians should operate according to their best assessment of the current data, considering the relative risks and benefits of different strategies and the evidence for them. Healthcare decisions made for the horse should be made with the horse’s best interests in mind and should not be influenced by extraneous factors such as the veterinarian’s self-esteem. If one believes that it is acceptable for horses to be used in sporting activities for the enjoyment of people (a hotly contested topic), then it seems inarguable that those animals should be as healthy as possible when they perform. As such, treatments to restore health and welfare where disease previously existed – antibiotics to treat respiratory infections, surgeries to correct repairable fractures, etc. – are certainly not only ethical, but part of the veterinarian’s responsibility to the horse, themselves, and society. However, returning a horse to normal so that they can perform to their capabilities is not necessarily the goal of treating horses in competitions. For example, some clients may want “increased performance” so that they can get a ribbon, belt buckle, money, or some other prize. Other horses have demonstrable musculoskeletal problems and may be expected to perform despite those problems if competition circumstances demand. Veterinarians may get in an ethical bind by attempting to provide treatments to enhance performance, or to provide treatments to allow a horse to perform despite ongoing injury. Unfortunately, care of performance horses may result in inherent conflicts of interest. While the primary duty of the equine veterinarian is to the horse, the goal of long-term good for the horse’s health and having it compete may conflict. Since the veterinarian may be employed by individuals whose primary interest is short-term gain, the professional success of a veterinarian working under such circumstances may rely on keeping the horse in competition, which may also mean advocating for short-term success at the risk of long-term detriment. If this conflict influences the veterinarian’s actions, the veterinarian can ultimately be held accountable. Similarly, the veterinarian may be involved when a horse is returning to competition after injury. In most cases, owners and trainers want to return the horse to competition as soon as possible. Rest and rehabilitation might be best for the horse’s long-term health: however, rest might mean the horse misses an important competition. If the horse wins, it’s value may increase: if it competes, it risks reinjury. Under such circumstances, the veterinarian can find themselves in a difficult dilemma, risking criticism if advising that the horse is held out of competition, but also if the horse is returned to work too early and sustains additional injury. Awareness of these conflicts is the first step to acting ethically. Horses have no knowledge of the nature of performance and competition. A horse who finishes last in a race is not concerned by their “failure” to win; a horse who doesn’t switch their leads behind is clearly not hampered by the “problem.” Horses who fail to perform to expectations, although otherwise healthy, are a clear target for those who claim to be able to affect performance by some intervention, be it a veterinary treatment, a supplement, or some form of “alternative” therapy (see Case Study 13.1). Without evidence that a problem really exists, and that the treatment might be effective, promoting such a therapy would likely waste time and the owner’s money, and subject the horse to risk (of treatment) without expected benefit. Those circumstances may seem unethical, but they form the focus of a good deal of product and service promotion, and, unfortunately, occur in every segment of the equine industry.
13
Equines
Introduction – What is Ethics?
Why Are Ethics Important in Equine Practice?
What Behaviors Characterize Ethical Professional Conduct?
What Is a Horse?
What Makes Ethical Discussions in Equine Practice so Difficult?
The Stakeholders in Ethical Discussions About Horses
Veterinarians
Clients, Owners, and Trainers
Organizations
Breed Associations and Competition Bodies
Veterinary Professional Organizations
Manufacturers
Society
Horses
Relevant Ethical Issues
Selling, Promoting, and Prescribing Products
Experimental Treatments
Performance Horses
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