(Submitted by Ann Deblois Bissett,. Ajax, Ontario). En tant que praticien generaliste, il vous arrive souvent d'.envoyer vos clients, pour des traitements.
VEIrERINARY MEDICAL ETHICS It
D EONTOLOGIE VETERINAIRE
Ethical question of the month - November 1993 Question de deontologie du mois novembre 1993 A client has come into your clinic in Alberta with his older dog and a vaccination reminder card. Your employer has sent this reminder stating that all dogs should be vaccinated for rabies every year. The client asks you, the employee, if yearly rabies vaccination is necessary for his older dog (Rabies vaccination is not required by law in Alberta. For the import or export of dogs between the United States and Canada, rabies vaccinations are considered to be adequate for three years.) Is it ethical to encourage this practice?
Un client vient vous consulter a votre clinique, en Alberta, au sujet de son vieux chien. II est muni d'une lettre de rappel de vaccins. Votre employe avait envoye cette lettre qui mentionnait que tous les chiens doivent etre vaccines contre la rage chaque annee. Le client vous demande, 'a vous qui etes l'employe, si la vaccination annuelle contre la rage est necessaire meme pour son chien plus age (La vaccination contre la rage n'est pas legalement obligatoire en Alberta. Lors de l'importation et de l'exportation de chiens entre les Etats-Unis et le Canada, elle est consideree comme valable pendant trois annees consecutives.) Pouvez-vous, dans une perspective ethique, encourager cette pratique?
tions, however, vary considerably from locale to locale, with some jurisdictions requiring annual boosters and others, such as Alberta, requiring no vaccination at all. It is possible that a given animal may not meet the general rule of three-year vaccine efficacy because of individual differences; for example, when a dog suffers from an immunosuppressive disease militating against the development of a full immunological response, but statistically such a situation is extremely rare. If a veterinarian had reason to believe that such a condition obtained in a given case, he or she might be justified in annual vaccinations. Such relatively recommending course, yours." rare circumstances do not, however, justify an across-theboard recommendation of annual immunizations. Ken Kilpatrick, Wetaskiwin, Alberta This caveat about annual immunizations is strengthened by some preliminary results reported in cats (1). Due to the serious public health implications of rabies, A of researchers at the University of Pennsylvania group we feel that annual revaccination of pets should be recommended in high risk areas. This is in accordance working in pathology noted that, beginning in 1987, there with the label directions of many of the current rabies was a marked annual increase in the number of cases of vaccines, including "three year" vaccines. It should subcutaneous inflammatory reactions at injection sites most certainly not be considered unethical to recommend reactions in cats, a phenomenon that had previously been rare. This increase coincided with the passage in an annual rabies vaccination in most areas of Canada, where rabies is endemic and where there are many rural 1987 of a state law mandating rabies injections of cats. Further, between 1987 and 1991, they saw a 61 % increase households with pets. in the number of feline fibrosarcomas presented for The article presents epidemiological, histobiopsy. Gail Snyder, Rockglen, Saskatchewan logical, and ultrastructural evidence which suggests that the increase in fibrosarcomas is related to the An ethicists commentary on annual increase in vaccinations. The authors conjecture that rabies vaccination the development of the neoplasms may be related to Current scientific opinion supports the view that rabies aluminum-based adjuvants used for injection. vaccination is efficacious for three years. Indeed, the U.S. If it is the case that rabies vaccination can cause Food and Drug Administration requires of vaccine cellular insult resulting in, as the authors say, "derangemanufacturers that they demonstrate three-year effi- ment of...fibrous connective tissue repair response," cacy in their products. Regulatory and legal considera- in turn leading to neoplasia, it is plausible to guess that
Comments
It is ethical, if presented in the following way: "Rabies vaccine should be given at least every three years. The manufacturers generally recommend annual vaccination if rabies is endemic where the animal is or is going to be. Since the other vaccines (distemper, hepatitis, etc.) should be given annually, we recommend that rabies vaccine should also be given at the same time. It avoids confusion as to when the rabies vaccine was last given, and provides extra assurance if your dog is accused of biting someone. As the pet's owner, the final decision is, of
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similar problems can arise in dogs. In the face of this Reference additional concern, it would seem wrong to suggest 1. Hendrick MJ, Goldschmidt MH, Shafer FS, Wang Y, Somiyo AP. Postvaccinal sarcomas in the cat: Epidemiology and electron probe superfluous vaccination regimens. microanalytical identification of aluminum. Cancer Research 1992; In conclusion, it does not seem to be the practice of 52: 5391-5394. good medicine to suggest annual vaccination for rabies, both because there is reason to believe that a triennial reggrateful to Dr. Greg Ogilvie for dialogue on imen is adequate and because of the suspicions evoked thisI am case. by the report discussed. Thus, I would not encourage the annual vaccination, and would explain my reasons to Bernard E. Rollin, PhD my employer.
Ethical question of the month - February 1994 Question de deontologie du mois- fevrier 1994 Responses to the case presented are welcome. Please limit your reply to approximately 50 words and mail along with your name and address to: Ethicat Choices, c/o Dr. Tim Blackwell, Animal Industry Branch, Ontario Ministry of Agriculture and Food, Wellington Place, R.R. 1, Fergus, Ontario NlM 2W3; telephone: (519) 846-0965; fax: (519) 846-8101. Suggested ethical questions of the month also welcome! Les reponses au cas presente sont les bienvenues. Priere de limiter votre reponse a environ 50 mots et de nous la faire parvenir par la poste avec votre nom et adresse a: Choix deontologiques, a.s. Dr Tim Blackwell, Direction des productions animales, Ministere de I'agriculture et I'alimentation de l'Ontario, R.R. 1, Fergus (Ontario) NlM 2W3; telephone: (519) 846-0965; telecopieur: (519) 846-8101. Les soumissions des questions en ethique sont toujours bienvenue! As a general practitioner, you routinely refer specialty work, such as orthopedic surgery, to a relatively close, larger practice that employs a qualified individual to perform these surgeries. This practice has always represented itself to you as a referral practice for your benefit, but it is also engaged in general medicine and surgery. For the third time this year, you have received complaints from clients whom you who had referred to this specialty clinic for orthopedic care that the receptionist at the referral practice aggressively pursued them to have some type of routine medical procedure performed, while the animal was "there anyway" (once heartworm test, twice annual vaccinations). In these cases the individuals declined, advising the receptionist that they preferred to have these services performed by their regular practitioner. Is it ethical for this referral practice to try and pick up this extra work? (Submitted by Ann Deblois Bissett, Ajax, Ontario).
En tant que praticien generaliste, il vous arrive souvent d'.envoyer vos clients, pour des traitements specialises, par exemple de chirurgie orthopedique, a une plus grande clinique, relativement proche, qui emploie un personnel qualifie pour ce genre d'operations. Cet etablissement s'est toujours presente comme une clinique de specialisation, vous offrant ses services dans ce domaine. Mais cette clinique traite egalement des cas de medecine veterinaire et de chirurgie veterinaire generaux. Pour la troisieme fois en un an, des clients se sont plaints 'a vous apres s'etre adresses, sur votre conseil, a cette clinique, pour des traitements en orthopedie. On les avait pousses 'a soumettre leurs animaux "a des traitements de routine, etant donne que I'animal "etait la de toute maniere" (une fois pour un test de depistage de la dirofilariose cardio-pulmonaire, deux fois pour des vaccinations annuelles). Les clients repondaient qu'ils preferaient avoir recours aux services de leur praticien habituel pour ces traitements. Est-il ethique, de la part de la clinique de specialisation, de proposer des services de soins generaux a vos clients? (Soumis par Ann Deblois Bissett, Ajax, Ontario)
Yes/Oui LI No/Non FIi Comments/Commentaires:
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