Veterinary Ethics and Legal Issues

CHAPTER 4


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Veterinary Ethics and Legal Issues



Learning Objectives


Mastery of the content in this chapter will enable the reader to:


• Differentiate ethics and law.


• Define the branches of ethics.


• Identify a veterinary practice act.


• Differentiate criminal and civil law.


• Describe informed consent.


• Develop an informed consent form.


• Clarify methods used to prevent malpractice and negligence.


• Manage abandoned animals.


• List the most common complaints in veterinary medicine.



Key Terms



Three areas of ethics exist and affect each team member on every level. Social, personal, and professional ethics are interrelated, yet they affect each person differently. Social ethics are the consensus principles adopted or accepted by society at large and codified into laws and regulations. Laws include those against murder, rape, and stealing along with ordinances such as those that regulate pets on leashes. Personal ethics define what is right or wrong on an individual basis. This can include religious beliefs and values as they relate to relationships and marriages. Professional ethics, as stated, are



image PRACTICE POINT


Professional veterinary ethics are developed by veterinarians to cultivate rules, codes, and conducts for the profession.


developed by the professionals of a particular discipline, developing rules, codes, and conduct for the profession to follow.



CODE OF ETHICS


Ethics is a branch of philosophy and a systematic, intellectual approach to the standards of behavior. The purpose of a professional code of ethics is to help members of a profession achieve high levels of behavior through moral consciousness, decision making, and practice. A sense of ethics in daily practice challenges veterinarians to determine right from wrong. Each organization within the profession also has a code of ethics for its members and is based on moral principles that reflect concern and care for the client and patient.


Historically, ethics relate to standards of conduct promoted by and demanded of members of veterinary associations. The American Veterinary Medical Association (AVMA) Principles of Veterinary Medical Ethics is a document on ethical issues in veterinary practice focusing more on the relationships one has with colleagues than on the broader range of moral and ethical issues relating to animals (Box 4-1).



Box 4-1   AVMA Principles of Veterinary Medical Ethics


Introduction


Veterinarians are members of a scholarly profession who have earned academic degrees from comprehensive universities or similar educational institutions. Veterinarians practice the profession of veterinary medicine in a variety of situations and circumstances.


Exemplary professional conduct upholds the dignity of the veterinary profession. All veterinarians are expected to adhere to a progressive code of ethical conduct known as the Principles of Veterinary Medical Ethics (the Principles). The basis of the Principles is the Golden Rule. Veterinarians should accept this rule as a guide to their general conduct, and abide by the Principles. They should conduct their professional and personal affairs in an ethical manner. Professional veterinary associations should adopt the Principles or a similar code as a guide for their activities.


Professional organizations may establish ethics, grievance, or peer review committees to address ethical issues. Local and state veterinary associations should also include discussions of ethical issues in their continuing education programs.


Complaints about behavior that may violate the Principles should be addressed in an appropriate and timely manner. Such questions should be considered initially by ethics, grievance, or peer review committees of local or state veterinary associations, when they exist, and/or when appropriate, state veterinary medical boards. Members of local and state committees are familiar with local customs and circumstances, and those committees are in the best position to confer with all parties involved.


The Judicial Council may address complaints, prior to, concurrent with, or subsequent to review at the state or local level, as it deems appropriate.


All veterinarians in local or state associations and jurisdictions have a responsibility to regulate and guide the professional conduct of their members.


Colleges of veterinary medicine should stress the teaching of ethical and value issues as part of the professional veterinary curriculum for all veterinary students.


The National Board of Veterinary Medical Examiners is encouraged to prepare and include questions regarding professional ethics in the National Board Examination.


The AVMA Judicial Council is charged to advise on all questions relating to interpretation of the Bylaws, all questions of veterinary medical ethics, and other rules of the Association. The Judicial Council should review the Principles periodically to ensure that they remain complete and up to date.



Professional Behavior


Veterinarians should first consider the needs of the patient: to relieve disease, suffering, or disability while minimizing pain or fear.


Veterinarians should obey all laws of the jurisdictions in which they reside and practice veterinary medicine. Veterinarians should be honest and fair in their relations with others, and they should not engage in fraud, misrepresentation, or deceit.


Veterinarians should report illegal practices and activities to the proper authorities.


The AVMA Judicial Council may choose to report alleged infractions by nonmembers of the AVMA to the appropriate agencies.


Veterinarians should use only the title of the professional degree that was awarded by the school of veterinary medicine where the degree was earned. All veterinarians may use the courtesy titles Doctor or Veterinarian. Veterinarians who were awarded a degree other than DVM or VMD should refer to the AVMA Directory for information on the appropriate titles and degrees.


It is unethical for veterinarians to identify themselves as members of an AVMA recognized specialty organization if such certification has not been awarded.


It is unethical to place professional knowledge, credentials, or services at the disposal of any nonprofessional organization, group, or individual to promote or lend credibility to the illegal practice of veterinary medicine.


Veterinarians may choose whom they will serve. Both the veterinarians and the client have the right to establish or decline a Veterinarian-Client-Patient Relationship (seeSection III) and to decide on treatment. The decision to accept or decline treatment and related cost should be based on adequate discussion of clinical findings, diagnostic techniques, treatment, likely outcome, estimated cost, and reasonable assuranceof payment. Once the veterinarians and the client have agreed, and the veterinarians have begun patient care, they may not neglect their patient and must continue to provide professional services related to that injury or illness within the previously agreed limits. As subsequent needs and costs for patient care are identified, the veterinarians and client must confer and reach agreement on the continued care and responsibility for fees. If the informed client declines further care or declines to assume responsibility for the fees, the VCPR may be terminated by either party.


In emergencies, veterinarians have an ethical responsibility to provide essential services for animals when necessary to save life or relieve suffering, subsequent to client agreement. Such emergency care may be limited to euthanasia to relieve suffering, or to stabilization of the patient for transport to another source of animal care.


When veterinarians cannot be available to provide services, they should arrange with their colleagues to assure that emergency services are available, consistent with the needs of the locality.


Veterinarians who believe that they haven’t the experience or equipment to manage and treat certain emergencies in the best manner, should advise the client that more qualified or specialized services are available elsewhere and offer to expedite referral to those services.


Regardless of practice ownership, the interests of the patient, client, and public require that all decisions that affect diagnosis, care, and treatment of patients are made by veterinarians.


Veterinarians should strive to enhance their image with respect to their colleagues, clients, other health professionals, and the general public. Veterinarians should be honest, fair, courteous, considerate, and compassionate. Veterinarians should present a professional appearance and follow acceptable professional procedures using current professional and scientific knowledge.


Veterinarians should not slander, or injure the professional standing or reputation of other veterinarians in a false or misleading manner.


Veterinarians should strive to improve their veterinary knowledge and skills, and they are encouraged to collaborate with other professionals in the quest for knowledge and professional development.


The responsibilities of the veterinary profession extend beyond individual patients and clients to society in general. Veterinarians are encouraged to make their knowledge available to their communities and to provide their services for activities that protect public health.


Veterinarians and their associates should protect the personal privacy of patients and clients. Veterinarians should not reveal confidences unless required to by law or unless it becomes necessary to protect the health and welfare of other individuals or animals.


Veterinarians who are impaired by alcohol or other substances should seek assistance from qualified organizations or individuals. Colleagues of impaired veterinarians should encourage those individuals to seek assistance and to overcome their disabilities.



The Veterinarian-Client-Patient Relationship


The veterinarian-client-patient relationship (VCPR) is the basis for interaction among veterinarians, their clients, and their patients. A VCPR exists when all of the following conditions have been met:


The veterinarian has assumed responsibility for making clinical judgements regarding the health of the animal(s) and the need for medical treatment, and the client has agreed to follow the veterinarian’s instructions.


The veterinarian has sufficient knowledge of the animal(s) to initiate at least a general or preliminary diagnosis of the medical condition of the animal(s). This means that the veterinarian has recently seen and is personally acquainted with the keeping and care of the animal(s) by virtue of an examination of the animal(s), or by medically appropriate and timely visits to the premises where the animal(s) are kept.


The veterinarian is readily available, or has arranged for emergency coverage, for follow-up evaluation in the event of adverse reactions or the failure of the treatment regimen.


When a VCPR exists, veterinarians must maintain medical records (See Section VII).


Dispensing or prescribing a prescription product requires a VCPR.


Veterinarians should honor a client’s request for a prescription in lieu of dispensing.


Without a VCPR, veterinarians merchandising or use of veterinary prescription drugs or their extra-label use of any pharmaceutical is unethical and is illegal under federal law.


Veterinarians may terminate a VCPR under certain conditions, and they have an ethical obligation to use courtesy and tact in doing so.


If there is no ongoing medical condition, veterinarians may terminate a VCPR by notifying the client that they no longer wish to serve that patient and client.


If there is an ongoing medical or surgical condition, the patient should be referred to another veterinarian for diagnosis, care, and treatment. The former attending veterinarian should continue to provide care, as needed, during the transition.


Clients may terminate the VCPR at any time.



Attending, Consulting and Referring


An attending veterinarian is a veterinarian (or a group of veterinarians) who assumes responsibility for primary care of a patient. A VCPR is established.


Attending veterinarians are entitled to charge a fee for their professional services.


When appropriate, attending veterinarians are encouraged to seek assistance in the form of consultations and referrals. A decision to consult or refer is made jointly by the attending veterinarian and the client.


When a consultation occurs, the attending veterinarian continues to be primarily responsible for the case.


A consulting veterinarian is a veterinarian (or group of veterinarians) who agrees to advise an attending veterinarian on the care and management of a case.The VCPR remains the responsibility of the attending veterinarian.


Consulting veterinarians may or may not charge fees for service.


Consulting veterinarians should communicate their findings and opinions directly to the attending veterinarians.


Consulting veterinarians should revisit the patients or communicate with the clients in collaboration with the attending veterinarians.


Consultations usually involve the exchange of information or interpretation of test results. However, it may be appropriate or necessary for consultants to examine patients. When advanced or invasive techniques are required to gather information or substantiate diagnoses, attending veterinarians may refer the patients. A new VCPR is established with the veterinarian to whom a case is referred.


The referral veterinarian or receiving veterinarian is a veterinarian (or group of veterinarians) who agrees to provide requested veterinary services. A new VCPR is established. The referring and referral veterinarians must communicate.


Attending veterinarians should honor clients’ requests for referral.


Referral veterinarians may choose to accept or decline clients and patients from attending veterinarians.


Patients are usually referred because of specific medical problems or services. Referral veterinarians should provide services or treatments relative to the referred conditions, and they should communicate with the referring veterinarians and clients if other services or treatments are required.


When a client seeks professional services or opinions from a different veterinarian without a referral, a new VCPR is established with the new attending veterinarian. When contacted, the veterinarian who was formerly involved in the diagnosis, care, and treatment of the patient should communicate with the new attending veterinarian as if the patient and client had been referred.


With the client’s consent, the new attending veterinarian should contact the former veterinarian to learn the original diagnosis, care, and treatment and clarify any issues before proceeding with a new treatment plan.


If there is evidence that the actions of the former attending veterinarian have clearly and significantly endangered the health or safety of the patient, the new attending veterinarian has a responsibility to report the matter to the appropriate authorities of the local and state association or professional regulatory agency.




Therapies


Attending veterinarians are responsible for choosing the treatment regimens for their patients. It is the attending veterinarian’s responsibility to inform the client of the expected results and costs, and the related risks of each treatment regimen.


It is unethical for veterinarians to prescribe or dispense prescription products in the absence of a VCPR.


It is unethical for veterinarians to promote, sell, prescribe, dispense, or use secret remedies or any other product for which they do not know the ingredient formula.


It is unethical for veterinarians to use or permit the use of their names, signatures, or professional status in connection with the resale of ethical products in a manner which violates those directions or conditions specified by the manufacturer to ensure the safe and efficacious use of the product.




Medical Records


Veterinary medical records are an integral part of veterinary care. The records must comply with the standards established by state and federal law.


Medical Records are the property of the practice and the practice owner. The original records must be retained by the practice for the period required by statute.


Ethically, the information within veterinary medical records is considered privileged and confidential. It must not be released except by court order or consent of the owner of the patient.


Veterinarians are obligated to provide copies or summaries of medical records when requested by the client. Veterinarians should secure a written release to document that request.


Without the express permission of the practice owner, it is unethical for a veterinarian to remove, copy, or use the medical records or any part of any record.




Advertising


Without written permission from the AVMA Executive Board, no member or employee of the American Veterinary Medical Association (AVMA) shall use the AVMA name or logo in connection with the promotion or advertising of any commercial product or service.


Advertising by veterinarians is ethical when there are no false, deceptive, or misleading statements or claims. A false, deceptive, or misleading statement or claim is one which communicates false information or is intended, through a material omission, to leave a false impression.


Testimonials or endorsements are advertising, and they should comply with the guidelines for advertising. In addition, testimonials and endorsements of professional products or services by veterinarians are considered unethical unless they comply with the following:


The endorser must be a bona fide user of the product or service.


There must be adequate substantiation that the results obtained by the endorser are representative of what veterinarians may expect in actual conditions of use.


Any financial, business, or other relationship between the endorser and the seller of a product or service must be fully disclosed.


When reprints of scientific articles are used with advertising, the reprints must remain unchanged, and be presented in their entirety.


The principles that apply to advertising, testimonials, and endorsements also apply to veterinarians’ communications with their clients.


Veterinarians may permit the use of their names by commercial enterprises (e.g. pet shops, kennels, farms, feedlots) so that the enterprises can advertise under veterinary supervision, only if they provide such supervision.

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Oct 1, 2016 | Posted by in EXOTIC, WILD, ZOO | Comments Off on Veterinary Ethics and Legal Issues

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