PRINCIPLES OF VETERINARY MEDICAL ETHICS

American Veterinary Medical Association (AVMA)

revised 1993

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Whereas animal research guidelines focus on the treatment of animals being used primarily for human purposes, veterinary medicine is concerned with balancing the interests and welfare of the patient (animal) and those of the client (owner). As a professionally generated ethics document, the AVMA's Principles of Veterinary Medical Ethics in many ways parallels the structure, content, and function of professional documents in human health care. The following are excerpts from the principles.

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Attitude and Intent

The Principles of Veterinary Medical Ethics are purposely constructed in a general and broad manner, but veterinarians who accept the Golden Rule as a guide for general conduct and make a reasonable effort to abide by the Principles of Veterinary Medical Ethics in professional life will have little difficulty with ethics.

The honor and dignity of our profession rest in our obedience to a just and reasonable code of ethics set forth as a guide to the members. The object of this code, however, is more far-reaching, for exemplary professional conduct not only upholds honor and dignity, but also enlarges our sphere of usefulness, exalts our social standards, and promotes the science we cultivate. Briefly stated, our code of ethics is the foundation of our individual and collective efforts. It is the solemn duty of all members of the Association to deport themselves in accordance with the spirit of this code.

These Principles of Veterinary Medical Ethics are intended as aspirational goals. This code is not intended to cover the entire field of veterinary medical ethics. Professional life is too complex to classify one's duties and obligations to clients, colleagues, and fellow citizens into a set of rules.

General Concepts

The Principles of Veterinary Medical Ethics are intended to aid veterinarians individually and collectively in maintaining a high level of ethical conduct. They are standards by which an individual may determine the propriety of conduct in relationships with clients, colleagues, and the public. A high standard of professional behavior is expected of all members of the profession.

Veterinarians should be good citizens and participate in activities to advance community welfare. They should conduct themselves in a manner that will enhance the worthiness of their profession.

Professional associations of veterinarians should adopt the AVMA Principles of Veterinary Medical Ethics or a similar code, and each should establish an active committee on ethics.

State veterinary associations should include reports or discussions on professional ethics in the programs of their meetings.

Teaching of ethics and professional concepts should be intensified in the educational programs of the colleges of veterinary medicine.

The Principles of Veterinary Medical Ethics should be subjected to review with the object of clarification of any obscure parts and the amendment of any inadequate or inappropriate items. A determined effort should be made to encourage compliance with the Principles in their entirety.

Guidelines for Professional Behavior

1. In their relations with others, veterinarians should speak and act on the basis of honesty and fairness.
2. Veterinarians should consider first the welfare of the patient for the purpose of relieving suffering and disability while causing a minimum of pain or fright. Benefit to the patient should transcend personal advantage or monetary gain in decisions concerning therapy.
3. Veterinarians should not employ professional knowledge and attainments nor render services under terms and conditions which tend to interfere with the free exercise of judgment and skill or tend to cause a deterioration of the quality of veterinary service.
4. Veterinarians should seek for themselves and their profession the respect of their colleagues, their clients, and the public through courteous verbal interchange, considerate treatment, professional appearances, professionally acceptable procedures, and the utilization of current professional and scientific knowledge. Veterinarians should be concerned with the affairs and welfare of their communities, including the public health.
5. Veterinarians should respect the rights of clients, colleagues, and other health professionals. No member shall belittle or injure the professional standing of another member of the profession or unnecessarily condemn the character of that person's professional acts in such a manner as to be false or misleading.
6. Veterinarians may choose whom they will serve. Once they have undertaken care of a patient they must not neglect the patient. In an emergency, however, they should render service to the best of their ability.
7. Veterinarians should strive continually to improve veterinary knowledge and skill, making available to their colleagues the benefit of their professional attainments, and seeking, through consultation, assistance of others when it appears that the quality of veterinary service may be enhanced thereby.
8. Advertising or solicitation of clients by veterinarians should adhere to the Advertising Regulations, and should in no case be false, misleading, or deceptive.
9. The veterinary profession should safeguard the public and itself against veterinarians deficient in moral character or professional competence. Veterinarians should observe all laws, uphold the honor and dignity of the profession, and accept its self-imposed discipline.
10. The responsibilities of the veterinary profession extend not only to the patient but also to society. The health of the community as well as the patient deserves the veterinarian's interest and participation in nonprofessional activities and organizations.

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Referrals, Consultations, and Relationships with Clients

Consultations and referrals should be offered or sought whenever it appears that the quality of veterinary service will be enhanced thereby.

Consultations should be conducted in a spirit of professional cooperation between the consultant and the attending veterinarian to assure the client's confidence in and respect for veterinary medicine.

When a fellow practitioner or a diagnostic laboratory, research, academic, or regulatory veterinarian is called into consultation by an attending veterinarian, findings and discussions with the client shall be handled in such a manner as to avoid criticism of the attending veterinarian by the consultant or the client, if that criticism is false or misleading.

When in the course of authorized official duty it is necessary for a veterinarian to render service in the field of another veterinarian, it will be considered unethical to offer free or compensated service or advice other than that which comes strictly within the scope of the official duty, unless the client and attending veterinarian agree.

Consultants must not revisit the patient or communicate in person with the client without the knowledge of the attending veterinarian.

Diagnostic laboratory, research, academic, or regulatory veterinarians in the role of consultants shall deport themselves in the same manner as fellow practitioners whether they are private, commercial, or public functionaries.

In dealing with referrals, veterinarians acting as consultants should not take charge of a case or problem without the consent of the client and notification of the referring veterinarian.

The first veterinarian to handle a case has an obligation to other veterinarians that the client may choose to consult about the same case. The first veterinarian should readily withdraw from the case, indicating the circumstances on the records, and should be willing to forward copies of the medical records to other veterinarians who request them.

A veterinarian may refuse to accept a client or a patient, but should not do so solely because the client has previously contacted another veterinarian.

If for any reason a client requests referral to another veterinarian or veterinary institution, the attending veterinarian should be willing to honor the request and facilitate the necessary arrangements.

The following suggestions are offered for consideration by veterinarians in dealing with clients with whom they are not acquainted or for whom they have not previously rendered service:

1. Conduct yourself in word and action as if the person had been referred to you by a colleague. Try to determine by careful questioning whether the client has consulted another veterinarian and if so, the veterinarian's name, diagnosis, and treatment. It may be advisable to contact the previous veterinarian to ascertain the original diagnosis and treatment before telling the client how you plan to handle the case.
2. Describe your diagnosis and intended treatment carefully so that the client will be generally satisfied with the professional contact.
3. Consider the advisability of notifying the previous veterinarian(s) of your diagnosis and therapy.
4. If your colleague's actions reflect professional incompetence or neglect or abuse of the patient, call it to your colleague's attention and, if appropriate, to the attention of officers or practice committees of the local or state veterinary associations or the proper regulatory agency. Remember that a client who is abruptly changing veterinarians is often under severe stress and is likely to overstate or mis-state the causes for differences with the other practitioner.

Confidentiality

The ethical ideals of the veterinary profession imply that a doctor of veterinary medicine and the veterinarian's staff will protect the personal privacy of clients, unless the veterinarian is required, by law, to reveal the confidences or unless it becomes necessary in order to protect the health and welfare of the individual, the animals, and/or others whose health and welfare may be endangered.

Emergency Service

Every practitioner has a moral and ethical responsibility to provide service when because of accidents or other emergencies involving animals it is necessary to save life or relieve suffering. Since veterinarians cannot always be available to provide this service, veterinarians should cooperate with colleagues to assure that emergency services are provided consistent with the needs of the locality.

Frauds

Members of the Association shall avoid the impropriety of employing misrepresentations to attract public attention.

When employed by the buyer to examine an animal for purchase, it is unethical to accept a fee from the seller. The acceptance of such a fee is prima facie evidence of fraud. On the other hand, it is deemed unethical to criticize unfairly an animal about to be sold. The veterinarian's duty in this connection is to be a just and honest referee.

When veterinarians know that surgery has been requested with intent to deceive a third party, they will have engaged in an unethical practice if they perform or participate in the operation.

Secret Remedies

It is unethical and unprofessional for veterinarians to promote, sell, prescribe, or use any product the ingredient formula of which has not been revealed to them.

Genetic Defects

Performance of surgical procedures in all species for the purpose of concealing genetic defects in animals to be shown, raced, bred, or sold as breeding animals is unethical. However, should the health or welfare of the individual patient require correction of such genetic defects, it is recommended that the patient be rendered incapable of reproduction.

Alliance with Unqualified Persons

No member shall willfully place professional knowledge, attainments, or services at the disposal of any lay body, organization, group, or individual by whatever name called, or however organized, for the purpose of encouraging unqualified groups and individuals to diagnose and prescribe for the ailments and diseases of animals.

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Therapy, Determination of

Determination of therapy must not be relegated to secondary consideration with remuneration of the veterinarian being the primary interest. The veterinarian's obligation to uphold the dignity and honor of the profession precludes entering into an arrangement whereby, through commission or rebates, judgment on choice of treatment would be influenced by considerations other than needs of the patient, welfare of the client, or safety to the public.

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Vaccination Clinics

Definition: The term vaccination clinics applies to either privately or publicly supported activities in which veterinarians are engaged in mass immunization of pet animals. Usually, animals are brought into points of assembly by their owners or caretakers in response to a notification that immunization services will be available. Characteristically, these clinics do not provide the opportunity for the participating veterinarians to (1) conduct a physical examination of the individual animals to be immunized, (2) obtain a history of past immunization or prior disease, or (3) advise individual owners on follow-up immunization and health care.

Scientific and Technical Considerations—Rabies vaccination for the purpose of protecting the public health may be achieved in a rabies vaccination clinic.

When the primary objective is to protect the animal patient's health, clinical examination of the patient including proper history taking, is an essential and necessary part of a professionally acceptable immunization procedure.

Such a clinical examination is expected to be provided without regard to where the vaccination procedure is performed.

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Drugs, Practitioner's Responsibility in the Choice of

Practitioners of veterinary medicine, in common with practitioners in other branches of medicine, are fully responsible for their actions with respect to a patient from the time they accept the case until it is released from their care. In the choice of drugs, biologics, or other treatments, they are expected to use their professional judgment in the interests of the patient, based upon their knowledge of the condition, the probable effects of the treatment, and the available scientific evidence which may affect these decisions. If the preponderance of professional judgement is, or seems to be, contrary to theirs, the burden upon the practitioners to sustain their judgment becomes heavier. Nevertheless, the judgment is theirs and theirs alone.

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Dispensing, Marketing, and Merchandising

Dispensing is the direct distribution of veterinary products to clients for their use on the supposition that the veterinarian has knowledge of the particular case or general conditions relating to the current health status of the animals involved and has established a veterinarian client patient relationship. A veterinarian client patient relationship is characterized by these attributes:

1. The veterinarian has assumed the responsibility for making medical judgments regarding the health of the animal(s) and the need for medical treatment, and the client (owner or other caretaker) has agreed to follow the instructions of the veterinarian; and when
2. There is sufficient knowledge of the animal(s) by the veterinarian 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) and/or by medically appropriate and timely visits to the premises where the animal(s) are kept; and when
3. The practicing veterinarian is readily available for follow-up in case of adverse reactions or failure of the regimen of therapy.

In the veterinarian's office dispensing becomes the distributing of professional veterinary products by virtue of verbal information presented by the owner, as an adjunct to the knowledge gained previously by the practitioner. This is in contrast to a written prescription involving a pharmacist.

Marketing is interpreted to mean those efforts directed at stimulating and encouraging animal owners to make use of veterinary services and products for the purpose of improving animal health and welfare.

Merchandising is buying and selling of professional veterinary products without a veterinarian client patient relationship. Merchandising as defined here is unethical.