ETHICS IN VETERINARY MEDICINE Ethical Responsibilities to the Horse
Ideally, in regard to the care and treatment of horses, the ethical responsibilities of horse owner- ship, societal interests in horse welfare, and veteri- nary medical treatment should mirror each other, all working together for the best interest of the horse. Ethically speaking, the veterinarian’s moral duty is to the patient; the veterinarian is obliged by the nature of the veterinary profession to act in the best interest of the patient; consequently, veterinar- ians must avoid orders or requests from the 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 some- times makes the veterinarian’s goal of ethical practice in the best interest of the horse’s health diffi- cult. In addition, societal concerns—even if they are well-meaning—may not be expressed in ways that are beneficial for the horse. For example, whereas 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 or there is a lack of suf- ficient predators to control their herds.12 Never- theless, by virtue of their special knowledge about horses, ethical veterinarians are in the best position to argue for the welfare of the horse, and it is to the ultimate advantage of both the horse and the veter- inary profession that they do so.
3. Responding to Ethical Challenges
Whereas veterinarians have a special authorityc that helps buttress their legal authority to practice medicine on animals, there are a number of chal- lenges that can confront even the most ethical of veterinarians.13 The way in which veterinarians handle such challenges will ultimately determine the long-term health of the veterinary profession. Such challenges include the following.
(1) The ability of clients to readily obtain their own pharmaceutical products from on-line pharmacies, feed stores, and so forth. Owners can obtain virtually any substance they believe a horse needs.
Veterinarians have typically made a living by selling two things: products and services. The human medical field has traditionally chosen to outsource its products to pharmacies; this has avoided the ethical conflict inherent in selling a product that an individual prescribes.d The only thing that veterinarians have that is
unique is their special knowledge. Individual prod- ucts do not vary among vendors; the only thing that may differ is price. Veterinarians simply can- not compete with large companies offering drugs at discount prices and would probably be wise not to try to do so. Indeed, some states require veterinar- ians to write prescriptions for clients to have filled elsewhere if requested by the client for an animal
being treated by the veterinarian (veterinarian’s do not have to, and should not, respond to requests for blank prescriptions). The AVMA’s Principles of Veterinary Medical Ethics14 recommends that veterinarians comply with their client’s wishes and provide written prescriptions if the client prefers having the prescription filled elsewhere, assuming, of course, the existence of a veterinary-client-patient relationship. The easy availability of prescription medications
to clients does not mean that veterinarians cannot act ethically, nor does it mean that veterinarians cannot sell products (although prescribing products that one sells does carry its own inherent conflict of interest). The AVMA notes several advantages when clients purchase their medications from veter- inarians, all of which are consistent with good med- icine and ethical practice.15
● Veterinarians have medications in stock and can provide medications immediately.
● Veterinarians can answer questions, provide instructions for use, and demonstrate how to give medications.
● Medications controlled by veterinarians have the assurance of having been handled properly.
Clearly, there are many types of businesses that
show little concern for any of the ethical issues as- sociated with selling prescription medications. However, “fighting fire with fire” by offering drugs on demand is unethical; according to the AVMA Principles of Veterinary Medical Ethics, it is uneth- ical, and in most states, unlawful, for a veterinarian to write a prescription or dispense a prescription drug outside a veterinarian-client-patient relation- ship. Rather than compete directly against uneth- ical selling of drugs by engaging in that practice, ethical veterinarians might consider other business models, for example, practicing more along the model of “concierge medicine” in human medical practice, focusing on providing care, as opposed to selling products.16,17
(2) Competing non-veterinarian “experts” (in a variety of areas), many of whom state that they provide services about which veterinarians either do not know or do not care (eg, care of the horse’s teeth), and a seemingly endless array of products and services.
Veterinarians are in the business of providing care; horse owners are generally interested in providing the care that their horses need. However, a variety of factors—including advertising, lobbying, differing ideologies, competitive pressures, and economic in- terests—have led some people to believe that a va- riety of treatments, supplements, or diagnoses are important for the welfare of their horses. Veterinarians are uniquely qualified to help cli-
ents determine which products and services are good for their horses. By virtue of their special
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