Sep 21, 2018 - reveals that the regular veterinarian for this farm ... majority of practising veterinarians, but it is not quack- ery. .... B.C. SALES OFFICE:.
\ VETERINARY MEDICAL ETHICS DEONTOLOGIE VETERINAIRE
Ethical question of the month - January 1995 Question de deontdlogie du mois janvier 1995 You are called to a new client's farm to examine a steer with severe bronchopneumonia. The steer is breathing open-mouthed and staggering around the pen. Its rectal temperature is 101.2°F. Pulmonary auscultation reveals near complete consolidation of the lobes of both lungs. You inform the owner that you do not believe, at this advanced stage of the disease, that treatment will be successful. The owner elects to have the animal euthanized. Further history reveals that the regular veterinarian for this farm has recently taken an interest in homeopathic veterinary medicine and has been treating this steer with some unconventional therapies. You call your colleague to inform him of your involvement in the case and question him on his treatment regime. Although his therapy for the steer is totally foreign to you, he claims it is well documented in the science of homeopathy and has worked better than conventional antibiotic therapy in similar cases. Do you report this colleague to your local veterinary licensing body?
Vous etes appele a la ferme d'un nouveau client afin d'examiner un bouvillon qui souffre d'une bronchopneumonie grave. Le bouvillon respire par la bouche et titube dans son enclos. Sa temperature rectale est de 101,2 'F. L'auscultation pulmonaire permet de constater l'affermissement des lobes des deux poumons. Vous informez le proprietaire que vous ne croyez pas, vue le stade avanc6 de la maladie, qu'un traitement sera efficace. Le proprietaire decide d'euthanasier l'animal. L'examen plus approfondi de l'historique medical demontre que le v6terinaire habituel de la ferme a recemment developpe un interet pour la medecine veterinaire homeopathique et qu'il soignait le bouvillon a l'aide de therapies non conventionnelles. Vous telephonez a votre collegue pour l'informer de votre intervention dans le cas et lui posez des questions sur le traitement qu'il a administre. Meme si la therapie utilis6e pour soigner le bouvillon vous est tout a fait inconnue, il souligne qu'elle est tres bien documentee dans la science de l'homeopathie et qu'elle a ete, dans des cas semblables, plus efficace qu'une antibiotherapie conventionnelle. Devez-vous rapporter votre collegue 'a l'organisme d'autorisation veterinaire
approprie'?
Comments You should report your colleague if you feel that the treatment provided was not appropriate for the condition, or that it was administered in breach of ethical conduct. This may mean that you should discuss the case with your colleague and attempt to find out if the treatment was a proper homeopathic approach to the problem. Following that, it may be necessary to ascertain if the producer was informed of the alternatives available prior to his choosing homeopathy. Homeopathy is a branch of medicine foreign to the majority of practising veterinarians, but it is not quackery. Alternative medicine is a valuable approach or adjunct in many cases. The public desire for these methods makes it imperative that practising veterinarians be willing to accept this form of treatment and refer clients seeking it to their colleagues with an interest in it. This will ensure that the choices a producer makes will include the best scientific homeopathic or combined treatments, supervised by animal health professionals, not by "alternative" therapists filling a void left by the veterinary profession. Randall Ulrich, Victoria, British Columbia 268
An ethicist's commentary of the case of a veterinarian utilizing homeopathic
therapy In discussing the issue of alternative approaches to diagnosis and treatment in veterinary medicine - in this case, a homeopathic approach - we may take as our point of departure the American Veterinary Medical Association's (AVMA) Guidelines on Alternate Therapies (1), approved by the House of Delegates in 1988. Regarding homeopathy, the guidelines state that "homeopathy is a historic therapeutic modality currently used by some veterinarians. No scientific evidence presently exists to demonstrate safety or efficacy, although favorable anecdotal testimony has been recorded. It is recommended that judgement be withheld until suitable research has been conducted on animals. Veterinary homeopathy should be practiced only by a licensed veterinarian. The public should be informed in advance by the practitioner that homeopathy is currently considered an unconventional form of veterinary practice." Obviously, the first question that arises is whether the client was informed that the therapeutic regimen employed Can Vet J Volume 36, May 1995
by the veterinarian in question was unorthodox, not typically prescribed, and not buttressed by "mainstream" scientific literature. As the AVMA's guidelines suggest, it is reasonable to make communicating such information to the client a nonnegotiable presupposition of alternative therapeutic modalities. There are 2 related reasons to insist on this condition. First, since the therapy in question is, in essence, experimental in the eyes of the larger veterinary community, common social morality demands informed consent from the client. Second, the use of an unproven therapeutic modality in cases where an accepted and effective regimen already exists, as in this case, runs the risk of occasioning greater suffering in the patient, which also demands that the client confront the implications of taking the alternative route. Were I the veterinarian in this case, I would approach my colleague and ask if he had indeed informed the client of the nonstandard nature of the therapy. If he had, I would take no further action, except perhaps to stress to him the marked lack of efficacy of his regimen in this case and urge him to reexamine his approach. If he had not informed the client, I would call his attention to the logic of the AVMA's guidelines and insist that he do so in the future. If he demurred, or failed in the future to discuss the nonstandard nature of the therapy with and garner informed consent from clients, one would have no choice but to approach the licensing board.
On the other hand, one should not dismiss alternative therapies a priori, a common reaction among traditionally trained and traditionally oriented veterinary and human medical practitioners. Oftentimes, alternative regimens do have data buttressing their efficacy, data no more nor less extensive than similar clinical research data one can find supporting more mainstream approaches, the difference lying largely in which journal the data have appeared in. Even more important, as is vividly demonstrated by acupuncture, today's "fringe" therapy can become tomorrow's mainstream approach. As is well known, acupuncture was in essence ignored by western medicine until an article by the eminent journalist James Reston, who happened to undergo acupuncture while accompanying the late former President Nixon to China, appeared in the New York Times extolling this remarkable anesthetic efficacy. Empirical medicine, such as one finds among Chinese herbalists, has a long history, and it is wildly implausible to suggest that all of its approaches should be categorically ignored. Indeed, pharmaceutical companies consistently employ ethnopharmacologists to seek out putatively effective medicaments among "primitive" cultures. One needs to walk a fine line between excessive conservatism, which can blind medical professionals to new therapeutic approaches, and an uncritical embracing of alternatives, however implausible they may be. Bernard E. Rollin, PhD
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published in the CVMA Directory and reads, "In order for any homeopathic, natural, herbal, biologic, or 'parabiologic' product to be approved as a veterinary drug or biologic, the manufacturer must provide substantive Editorial comment data proving efficacy of action, freedom from adverse The Canadian Veterinary Medical Association has a side-effects on the animal, and freedom from residues or position statement on homeopathic products, which is potentially harmful contaminants." Reference
1. AVMA Policy Statements and Guidelines: Guidelines on Alternate Therapies. AVMA Directory and Resource Manual, 44th ed. American Veterinary Medical Association, 1995: 52.
Ethical question of the month - May 1995 Question de deontologie du mois - mai 1995 Responses to the case presented are welcome. Please limit your reply to approximately 50 words and mail along with your name and address to: Ethical Choices, c/o Dr. Tim Blackwell, Health Management, Ontario Ministry of Agriculture, Food, and Rural Affairs, Wellington Place, R.R. #1, Fergus, Ontario NlM 2W3; tel.: (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. Docteur Tim Blackwell, Groupe de la sante des animaux, Ministere de l'Agriculture, de l'Alimentation et des Affaires rurales de l'Ontario, R.R. #1, Fergus (Ontario) NlM 2W3; tel. : (519) 846-0965; telec.: (519) 846-8101. Les soumissions des questions deontologiques sont toujours bienvenues! An 8-year-old, neutered, male, domestic shorthaired Un chat domestique castre, age de 8 ans et au poil cat is admitted to your clinic with a complaint of court est admis 'a votre clinique souffrant de lethargie lethargy and anorexia. The cat was last examined et d'anorexie. II y a deux mois, le chat avait fait 2 months previously with a urinary tract infection and l'objet d'un examen car il souffrait d'une infection severe cellulitis at the site of a ventral abdominal ure- du tractus urinaire et de cellulite grave oiu avait ete throstomy. The urethrostomy was performed several pratiquee une uretrostomie abdominale ventrale. years ago at another clinic. Euthanasia was recom- L'uretrostomie avait ete effectuee plusieurs annees mended during your first examination, but the owner auparavant dans une autre clinique. L'euthanasie insisted on treatment. The cat improved after receiv- avait ete recommandee lors de votre premier examen, ing fluids and systemic and topical antibiotics. The mais le proprietaire avait insiste pour que vous cat's condition suddenly deteriorated 2 days ago. soigniez l'animal. La condition du chat s'etait amePhysical examination reveals severe dehydration, lioree apres l'administration de liquides et d'antibiobradycardia, hypothermia, and an infected and fly- tiques systemiques et topiques. Il y a deux jours, sa blown urethrostomy opening. Euthanasia is again condition s'est soudainement deterioree. recommended. The owner refuses and leaves the clinic, L'examen physique revele une deshydratation, apparently intending to seek a second opinion. Should une bradycardie et une hypothermie graves ainsi you have: qu'une ouverture infectee de l'uretrostomie et infestee 1. attempted treatment again as requested by the de mouches a viande. L'euthanasie est de nouveau owner? recommandee. Le proprietaire refuse et quitte la cli2. euthanized the cat on humane grounds against nique apparemment pour obtenir une deuxieme opithe owner's wishes? nion. Qu'auriez-vous dfu faire? 3. notified all nearby clinics of the situation and 1. tenter de soigner l'animal tel que le demandait the likelihood that the owner may be seeking le proprietaire? treatment elsewhere? (Submitted by Lea 2. euthanasier le chat sans le consentement du Stogdale, Winnipeg, Manitoba) proprietaire pour des raisons humanitaires? 3. aviser toutes les cliniques environnantes de la situation et de la possibilite que le proprietaire cherchera peut-etre un traitement ailleurs? (Soumis par Lea Stogdale de Winnipeg, au
Manitoba)
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