SVME ONLINE ETHICS COURSE John B. McCarthy, DVM, MBA, Jose Peralta, DVM, Ph.D., Diane Levitan, VMD, ACVIM, Alice Villalobos, DVM, DPNAP CLASS ONE BASIC ETHICS AND VETERINARY MEDICINE John B. McCarthy, DVM, MBA, et al THE VETERINARIAN’S OATH Upon graduation, new veterinarians are asked to take the Veterinarian’s Oath. Many students are “introduced” to the Oath in their ethics class or classes before graduation. It which was originally adopted by the American Veterinary Medical Association (AVMA) in 1959, amended and re-adopted in 1999 and re-affirmed by the AVMA in 2004. In the following, the underlined words were added by the AVMA Executive Board in November 2010. The Oath states the following: Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health and welfare, the prevention and relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge. I will practice my profession conscientiously, with dignity, and in keeping with the principles of veterinary ethics, I accept as a lifelong obligation the continual improvement of my professional knowledge and competence. A major direction and premise of the Oath, given to the new veterinarian, is to practice my profession…. in keeping with the principles of veterinary ethics. The document “The AVMA Principles of Veterinary Medical Ethics” published by the AVMA, is meant to be a helpful guideline, however, to fully understand what the oath implies we should consider some ethical principles and definitions of ethics. 1 DEFINITIONS ETHICS according to Webster's International Dictionary, Unabridged is: The discipline dealing with what is good and bad or right and wrong or with moral duty and obligation. a. A group of moral principles or set of values b. A particular theory or system of moral values c. The principles of conduct governing an individual or a profession. ETHICS according to Albert Schweitzer Nobel Peace Prize recipient and philosopher Albert Schweitzer’s definition of ethics is widely accepted. He stated, "In a general sense, ethics is the name we give to our concern for good behavior. We feel an obligation to consider not only our own personal well-being, but also that of others and of human society as a whole." ETHICS 1 AND ETHICS 2 according to Dr. Bernard Rollin In a guest editorial in the November/December 2000 Journal of the American Animal Hospital Association, Vol 36 pgs 477 to 479, Dr. Bernard Rollin wrote the following descriptions of ethics: Ethics1 is the beliefs about right and wrong, good and bad, justice and injustice we all hold socially, personally and professionally. We are taught Ethics1 by parents, teachers, peers, society literature etc. Ethics2, on the other hand, is the philosophical examination, critique, justification of ethics1 COMMON ETHICAL PRINCIPLES THE GOLDEN RULE - Do unto others as you would have them do unto you. THE PROFESSIONAL ETHIC - You should only do that which can be explained before a committee of your peers such as a review by an area ethics committee or a board of directors. A UTILITARIAN PRINCIPLE - The greatest good for the greatest number. As expressed by Jeremy Bentham – British Philosopher 1748-1832 – There are a number of other acceptable definitions of Utilitarian Principle THE DISCLOSURE RULE - Ask yourself: if the full glare of examination by associates, friends, and even family were to focus on your decision, would you remain comfortable with it? - IBM’s Business Conduct Guidelines ANIMAL ETHICS AND VETERINARY ETHICS To understand the meaning of Ethics in veterinary medicine we must consider Animal Ethics and Veterinary Ethics. Jerrold Tannenbaum in his book, Veterinary Ethics Animal Welfare, Client Relations, Competition and Collegiality, considers the following concepts with relation to these two subjects: 2 ANIMAL ETHICS - The field of ethics that concerns the moral obligations that people have regarding animals. For the purposes of this discussion, animal ethics will mean the well being and care of all animals by all people and will be considered in a future class under the subject of Animal Welfare VETERINARY ETHICS – The field of ethics as it relates to veterinarians and others directly involved in the provision of veterinary care. It will be this definition and these individuals who this class, and much of this course, will be most directly addressed to. THE FOUR BRANCHES OF VETERINARY ETHICS Tannenbaum in his book, Veterinary Ethics, Animal Welfare, Client Relations, Competition and Collegiality further defines Veterinary Ethics as having “Four Branches”. He describes these as follows: 1. Descriptive – Values or standards of a profession – What is acceptable behavior as determined by your peers? An example would be The Veterinarians Oath. The Oath is a document of official ethics with defined terms. Descriptive veterinary ethics is the study of the actual values and ethical attitudes of members of the profession and those training to become veterinarians. 2. Official – Values formally adopted by organizations composed of members of that profession. An example is the AVMA Principles of Veterinary Medical Ethics, which will be discussed in a future class. 3. Administrative – Rules and regulations of governmental bodies that regulate veterinary medicine. An example would be the requirement to be licensed to practice or to be registered with the proper governmental agency in order to prescribe and use controlled drugs. Not all rules and regulations of governmental bodies are ethical in nature. Some are technical in nature. Only standards of governmental bodies that articulate and enforce ethical rules for veterinarians would be classified as standards of administrative veterinary ethics. Provisions in practice acts or regulations of licensing boards that prohibit false, deceptive, or misleading advertising, or that prohibit fraud in the practice of veterinary medicine are examples. These and other examples of Administrative Ethics will also be discussed in later classes. 4. Normative – Tannenbaum describes normative ethics as the activity of looking for correct norms for veterinary professional behavior and attitudes. For the purpose of this class, the author will consider normative ethics as the branch of veterinary ethics whereby the individual seeks correct answers to ethical questions. An example is the individual’s willingness to agree or not to agree to euthanize a healthy animal for the convenience of the owner. Another example would be whether or not a veterinarian should encourage lengthy, expensive radiation or chemotherapy for an aged animal or whether or not the veterinarian is obliged to suggest palliative, end of life care for animals with terminal conditions. Normative ethics will be an ongoing subject as we proceed in this course 3 ETHICS OR THE LAW? There is often a fine line between violations of ethical codes or violations of the law. For example: Violations of “Official” values, codes or principles as determined by members of a profession, such as the AVMA would generally not be enforced by a court of law and could bring penalties such as dismissal from the Association. This would rarely cause the individual so penalized to lose their right to practice veterinary medicine or to work in a veterinary practice. . Violations of “Administrative” rules and regulations determined by governmental bodies would be enforced by a regulatory body or by a court and could result in the loss of licensure or other criminal punishment causing the individual to be forced to cease practice. This would include loss or suspension of licensure for being found guilty of repeated drug abuse, drunk driving arrests or other criminal or misdemeanors charges. ETHICAL CONFLICTS There are many instances facing our society and our personal lives where a given situation may be considered unethical but legal and vice versa. Perhaps the most common conflicts facing the new veterinarian or veterinary practice employee will be between their “Normative” ethics and the applied standards of the society in which they find themselves. For example the “AVMA Principles of Veterinary Ethics”, an example of “Official” Ethics, states simply Humane euthanasia of animals is an ethical veterinary procedure. The “AVMA Animal Welfare Position Statements”, another example of “Official” ethics, states The AVMA is not opposed to the euthanasia of unwanted animals, when appropriate, by properly trained personnel, using acceptable humane methods. There are many veterinarians or others employed in a veterinary practice who would not necessarily agree with these statements. How and when should these conflicts be addressed? Another conflict occurs when society or an individual appears to have higher regard for some species of animals than for others, i.e. places different moral relevance on different animal species. For example, there is often a difference in public opinion over the use of mice versus dogs in a laboratory setting. Another example would be society or an individual accepting consumption of beef and lamb at the dinner table versus consuming horse meat. A vivid example is branding of cattle. Using a hot-iron brand to identify cattle is legal and commonplace and would not result in an animal cruelty charges, however, intentionally burning a companion animal’s skin for any reason is regarded as animal cruelty and would never be accepted today. Adherence to one’s normative standards will be a personal matter between an individual’s conscience, their clients, their patients and their employers. Newly employed veterinarians or other employees should not expect their employer, or even the practice’s clients, to hold to the same standards as they do. For example, when working in a veterinary practice where euthanasia of “unwanted animals” is an accepted procedure, the new employee will be expected by their employer to comply with the animal’s owner’s request to either do so or assist in the procedure. Therefore, during the pre-employment interview period, the 4 prospective employee should bring forth their normative ethical standards and be sure that the employer will accept them. If your normative ethical standards are not negotiable, you should not accept a position in a veterinary practice that does not share your view. You should not expect the practice to change for you. Some examples of other ethical issues and questions that should be addressed by a prospective employee before a position is accepted: Are cosmetic surgeries such as ear cropping, ear trimming, tail docking and dew claw removal routinely done? Are procedures such as declawing cats or debarking dogs performed when asked for? Are individual surgery packs used for all surgeries? Are animals routinely hospitalized overnight without nursing supervision? Are animals given chemical restraint for radiographs to lessen human exposure? NEXT CLASS Our next class will give examples of many situations commonly found in today’s veterinary medicine that have ethical questions and consequences involved in them. References: Tannenbaum, Jerold - Veterinary Ethics Animal Welfare, Client Relations, Competition and Collegiality – Second Edition (Mosby Year Book Inc. 1995) Rollin, Bernard E, - An Introduction to Veterinary Medical Ethics, Theory and Cases, Second Edition (Blackwell Publishing 2006) STUDY SUBJECTS The Veterinarians Oath – Where does it come from? What was the 2010 revision? Who must take the oath? When does a veterinary student take the Veterinarians Oath? Definitions – Ethics1 and Ethics 2, Ethics, Animal Ethics, Veterinary Ethics Four Branches of Veterinary Ethics – What are they? - Examples of Each? Consequences of violations Ethical conflicts – How can they influence your choice of a position? 5