ETHICS IN VETERINARY MEDICINE


knowledge about horses and their ability to conduct scientific research, they can help determine whether such products and services are not in the best inter- est of the horse or of their client’s pocketbook. It may not be advisable to try to compete against


other “experts” on their own turf. For example, equine veterinary “dentists” do not offer an obvious advantage to lay “tooth floaters” in the eyes of cli- ents. If, by virtue of the ethics and knowledge, veterinarians only perform services that are neces- sary and supported by good science, it will build client trust. Any other attempts to maintain pro- fessional hegemony over the horse’s mouth are likely to be derided as “turf protection.” In that same vein, veterinarians are probably at a disadvantage when competing with chiropractors (who actually have chiropractic degrees), as well as many other non-veterinarian service providers. Similarly, veterinarians who provide special prod- ucts or supplements may have a difficult time in distinguishing themselves from other purveyors of such products. Veterinarians who engage in such competition risk being viewed as, “In it for the money,” by their peers, and when and if such prod- ucts are shown to be a waste of time and money, by the public, to the detriment of both the individual veterinarian(s) and the veterinary profession. The rationale for such products and services is


often presented in terms of client satisfaction, for example, “what the customer wants.” Although providing what the customer wants may be thought of as desirable, in human medicine, studies indicate that it may not be desirable. In 2012, a study of more than 50,000 US adults found that patients who grade their care the highest are more likely to have worse health outcomes and accrue more medical expenses than the least-satisfied patients, even after adjusting for factors such as age, income, illness severity, and insurance coverage.18 Ethical veteri- narians should focus on what is best for the horse and not on competing in areas in which they have no special knowledge or training. They will be re- warded in terms of client loyalty when owners rec- ognize that their veterinarian is interested in the welfare of their horse(s), first and foremost.


(3) “If I don’t do it, somebody else will.”


This is a famous and time-honored rationaliza- tion known as the “futility illusion.” The rationale is clear enough. An action, for example, administer- ing a forbidden substance to a horse, is objection- able. The concern is that if the veterinarian who is present does not undertake the action, someone else will, and the substance will be administered regard- less. Consequently, the conclusion goes, there is no point in not giving the substance, because it will not prevent the action, and business will be lost. The fear is that ethical refusal to do the right thing will only hurt the ethical person without preventing the unethical action. Of course, the rationale is faulty, self-serving, and absurd. If a group of young people


6 2013  Vol. 59  AAEP PROCEEDINGS


were to come across a solitary old person, and one of the group decided that the old person should be robbed and could not be dissuaded, the rest of the group would not be blameless if they decided to participate in the robbery because it was going to happen anyway. In that same vein, it may also be argued that it is


more humane for an unethical procedure (ie, tail blocking, or cutting a tail) to be performed by a veterinarian, with the use of aseptic technique, ad- equate sedation, and post-procedure analgesia, than it is to subject the animal to the risk of such procedures performed by an untrained individual. When considered in a vacuum, that is undoubtedly the case; invasive procedures should be performed by trained individuals with the use of adequate post- operative analgesia. Whereas the “futility illusion” would still apply under such circumstances, the fact is that the procedure being performed would still be unethical, and its performance by veterinarians would only serve to perpetuate the unethical prac- tice and thus could not be condoned. The futility illusion is invoked when someone has something to lose (ie, business) by not doing the dubious action, or something to gain (ie, money) by doing it. In fact, there are times when someone else will not do it. In 1989, months before the Berlin Wall fell, Hungarian border guard Bella Ar- pad refused to obey orders to shoot East Germans crossing to freedom. No one else shot, either, and history changed.19 Furthermore, the impact of a refusal to act unethically can also lead to a good result, even when the action happens. The individ- ual’s determination to do right is always desirable in itself. Under any circumstances, the futility illu- sion is merely an excuse for not acting in the best interest of the horse.


(4) Providing treatments.


When horses need treatment for disease or in- jury, it is in their best interest that they receive the treatments that are most likely to be effective. Of course, some conditions—for example, tendon in- juries or osteoarthritis—lack universally effective treatments. Thus, new treatment opportunities are being constantly advanced to veterinarians. However, because of any number of factors, includ- ing lack of funding, lack of sufficient numbers, and lack of incentive, many such treatments are ad- vanced with little or no evidence of efficacy. There is certainly nothing wrong with providing


new therapies, per se. However, the ethics of in- formed consent mandate that the person selecting a therapy for his or her horse fully understand:


● the nature of the decision/procedure ● reasonable alternatives to the proposed intervention


● the relevant risks, benefits, and uncertainties related to each treatment20


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