the right to not treat an animal

[zuneski]

Sorry if there has been a thread about this.

So, in preparing for my interviews I've been studying interview questions I've found online. This question stumped me a bit: "Do you have the right not to treat an animal?"

I know the answer is yes (according to the AVMA policy - section E). It says: "Veterinarians may choose whom they will serve...The decision to accept or decline treatment and related cost should be based on adequate discussion of clinical findings, diagnostic techniques, treatment, likely outcome, estimated cost, and reasonable assurance of payment..."

http://www.avma.org/issues/policy/ethics.asp

I know I can't just respond with a "yes" at the interview...I'll need to elaborate. I may have seen a situation like this when an owner didn't pay or stopped making payments and that was kind of a big deal at the hospital w/ the administration and stuff...but I don't know if their pet was refused medical tx b/c of that. Is that a possible scenario?

I'd also like to know about your experiences, if any of you have witnessed a vet refuse tx for an animal and the circumstances surrounding that.

Disclaimer: I'm not trying to start a debate.

Thanks!

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[dyachei]

Sorry if there has been a thread about this.

So, in preparing for my interviews I've been studying interview questions I've found online. This question stumped me a bit: "Do you have the right not to treat an animal?"

I know the answer is yes (according to the AVMA policy - section E). It says: "Veterinarians may choose whom they will serve...The decision to accept or decline treatment and related cost should be based on adequate discussion of clinical findings, diagnostic techniques, treatment, likely outcome, estimated cost, and reasonable assurance of payment..."

http://www.avma.org/issues/policy/ethics.asp

I know I can't just respond with a "yes" at the interview...I'll need to elaborate. I may have seen a situation like this when an owner didn't pay or stopped making payments and that was kind of a big deal at the hospital w/ the administration and stuff...but I don't know if their pet was refused medical tx b/c of that. Is that a possible scenario?

I'd also like to know about your experiences, if any of you have witnessed a vet refuse tx for an animal and the circumstances surrounding that.

Disclaimer: I'm not trying to start a debate.

Thanks!

There's also a no to it - you have the responsibility to treat in emergency situations. Namely to provide essential services. But everything else is dependent on the veterinary-client-patient relationship. You can't stop treating a patient without either referring them or reaching an agreement with the client.

 

[sumstorm]

There are also state laws that affect this sort of thing, but there are lots of reason to not treat a patient:

the treatment the client wants is not appropriate or to your standards(ie convenience euthanasia, pharms without diagnostics, alternative treatments you don't do)

the client is unable to pay for treatment

the client is unable or unwilling to comply with treatments

the patient and/or client presents an unreasonable risk of harm to the staff or other animals (aggressive dogs that can't be handled, possibly animals with infectious zoonotics)

extreme personality confict between staff/vet & patient or client

abuse of staff/facilities by client

need for treatment that is beyond the skill set or ability of the vet (needs a specialist)

Generally the basic thought is that you must stabilize a patient before sending them elsewhere, but I haven't looked into the laws myself. I have seen patients fired or refused for all of the above.

Edit: the above is just a list of examples that I have seen or vets have shared with me. I also have witnessed vets offer only euthanasia or referral, especially with abusive or clients who can't or won't pay for anything else.

 

[THEOSU2012]

Hey There,

So this is a good question, but I think you'll find that you just started a debate. Oh well.

Here's my answer.

You absolutely have the right to refuse service to a client but you also have an ethical responsibility to help animals when they are in need of emergency services. What I think will make the difference is what is your definition of emergency services.

I think most people will agree that the dog who was hit by a car and is bleeding out will say that this is an emergency and you have a responsibility to stabilize the animal, and then offer appropriate options to the owner, such as treating the patient, transfering the patient to another facility once stable or even euthanizing the pet.

However, does an ear infection count as an emergency situation? What about any number of situations? That's really going to depend on your personal ethics, I think.

So really in opinion, the best answer to this question is "It Depends on the Situation". Then be ready to elaborate on the answer. Good luck!!

 

[No Imagination]

... like the others said. But keep in mind, when asked a question during an interview, and especially when you need to elaborate on it, there is no reason to jump right to the most morally ambiguous example (in this case, owners who can't pay). You can bring up an example such as "The owners want to do a treatment that I don't feel comfortable providing, so I refer" or "The owners want me to do something that I ethically have an problem with", such as a cosmetic procedure.

Now, if you feel comfortable jumping right into the meat of the question, such as inability to pay, then by all mean, go for it. Depending on your personality, and your ability to not sound arrogant and confrontational (and your understanding of all the variables in the argument) should really dictate how far you take an ethical dilemma during an interview.

Thats just my opinion on it.

 

[No Imagination]

You absolutely have the right to refuse service to a client but you also have an ethical responsibility to help animals when they are in need of emergency services. What I think will make the difference is what is your definition of emergency services.

How does that work if you run an emergency hospital (or work at one)? Are you ethically responsible to treat all animals that come in for an emergency.

What about when some guy hits a dog, walks in, amd drops it off.

Can treatment of an emergency equate to euthanasia - and everything else is just gravy? <-- Especially if the owner has no real means or intention of paying you

 

[zuneski]

Thank you for all of your helpful comments...and thank you for your list of examples, sumstorm. That totally makes sense that an animal can't be denied of emergency services...I should have known that. I've shadowed an emergency vet before.

No Imagination - that was a good point. My "owners who can't pay" example probably isn't the best for my personality type, and I definitely don't want to give my interviewers the wrong idea about me. Your other examples seem safer to talk about.

 

[DVMDream]

We have some many clients who can not pay, especially in this economy that we have started to allow payment plans for just about anyone. We do require that they leave a check dated for the day they want it submitted or we take a copy of a credit card and we always take a copy of the driver’s license. We require that they usually pay the full amount within 3 months, but for larger estimates we will allow it to go for 6 months. The only time we did not allow a client to do a payment plan was when we received records from another vet and the last page mentioned that the clients file had been closed because of a refusal to pay their bill (it had been an on-going problem with the client). So, I think most people have mentioned the main topics; if it is against your ethical beliefs (convenience euthanasia) or if it requires a specialist and you are not comfortable treating without a specialist.

 

[sumstorm]

How does that work if you run an emergency hospital (or work at one)? Are you ethically responsible to treat all animals that come in for an emergency.

What about when some guy hits a dog, walks in, amd drops it off.

Can treatment of an emergency equate to euthanasia - and everything else is just gravy? <-- Especially if the owner has no real means or intention of paying you

Treatment for an emergency is stabilization so that appropriate decisions can be made; it is not returning the animal to full health.

As sad as it makes many of us, I have witnessed vets say that euthanasia is the only treatment they can provide for the $ the owner is willing or able to pay (and the euth be free) and when the damage is beyond what they can treat but client refuses transfer. So yes, other treatments can be gravy, and euth can be viewed as a treatment.

As for the individual who brings an HBC in, some of that depends. I do know that if you provide treatment without owner permission or another responsible individual (the person who struck the dog) signs for the costs, you rarely have any recourse to obtain payment for any treatment performed.

It is great when clinics and clientele can use payment plans, but in some areas that is disastrous. If the factory has closed down and your 60% of your clientele are laid off, even if they really, really want to pay you for your services, they probably won’t be able to…and if they relocated to find work, or lose their home, etc the likelihood of payment goes down drastically. Wonderful when it works, but not always a viable option.

 

[Marsala]

I find this post very interesting because, last I checked, Purdue's teaching hospital turns away emergencies (even if the animal is on death's doorstep) UNLESS you are already a client. There are a lot of people in the community here who have very negative views of the VTH because of this. If you are not a client, they tell you to drive to the Animal Emergency Clinic (about 4 miles/10-15 min away). No stabilizing the patient, just hope there isn't some sort of traffic. To me, this seems to be ethically questionable, because it is boiling down the entire issue to profit.

 

[sumstorm]

I find this post very interesting because, last I checked, Purdue's teaching hospital turns away emergencies (even if the animal is on death's doorstep) UNLESS you are already a client. There are a lot of people in the community here who have very negative views of the VTH because of this. If you are not a client, they tell you to drive to the Animal Emergency Clinic (about 4 miles/10-15 min away). No stabilizing the patient, just hope there isn't some sort of traffic. To me, this seems to be ethically questionable, because it is boiling down the entire issue to profit.

That is why I said that laws and such vary. I think, unless you are in the meetings over the policy, it is hard to determine if it boils down to profit,partilarly since treatment there may generate more $$$. It may also boil down to space constraints, staff constraints, liability issues (my recall was issues dealing with what must occur once 'through the door', but I haven’t lived in Indiana in a long time.) It may have to do with continuity of care, specializations of treatment, or SOPs for that hospital. Not every hospital/clinic/vet school operates an open admissions emergency clinic. I don’t even know the policy for ours, because I always call my vet for a referral/consult first due to the $$$ of going to emergency/vet school. I have also had the experience of turning away clients (with a relationship) because all hands were already dealing with multiple emergencies. Better to turn away than have an animal die because there literally isn’t the staff to provide adequate treatment. It helps to call ahead, even while on your way, whether it is to a human hospital or a vet hospital.

 

[No Imagination]

I find this post very interesting because, last I checked, Purdue's teaching hospital turns away emergencies (even if the animal is on death's doorstep) UNLESS you are already a client. There are a lot of people in the community here who have very negative views of the VTH because of this. If you are not a client, they tell you to drive to the Animal Emergency Clinic (about 4 miles/10-15 min away). No stabilizing the patient, just hope there isn't some sort of traffic. To me, this seems to be ethically questionable, because it is boiling down the entire issue to profit.

That CAN be due to the fault of vets in the area. A lot of times, teaching hospitals HAVE to p'ay by different rules because they are government subsidized entities, and are therefore seen as unfair competition. I do NOT KNOW if that is the case in Purdue, but I can imagine a situation where another vet or hospital complained that Purdue was stealing clients, and they could not compete due to subsidies by the government (like vet students who tuition is sub. (you all realize that IS vs OS tuition difference comes from somewhere)). That in turn could have caused Purdue to make up some wierd rules to protect both the other vets, as well as itself.

That is pretty much what happened as MS-STATE Dairy (Not the vet school to my knowledge) - but the Dairy industry got annoyed by some of MS-States Dairy practices, so now they cannot operate at any profit, and have to due weird things to not make a profit.

 

[Marsala]

That CAN be due to the fault of vets in the area. A lot of times, teaching hospitals HAVE to p'ay by different rules because they are government subsidized entities, and are therefore seen as unfair competition. I do NOT KNOW if that is the case in Purdue, but I can imagine a situation where another vet or hospital complained that Purdue was stealing clients, and they could not compete due to subsidies by the government (like vet students who tuition is sub. (you all realize that IS vs OS tuition difference comes from somewhere)). That in turn could have caused Purdue to make up some wierd rules to protect both the other vets, as well as itself.

That is pretty much what happened as MS-STATE Dairy (Not the vet school to my knowledge) - but the Dairy industry got annoyed by some of MS-States Dairy practices, so now they cannot operate at any profit, and have to due weird things to not make a profit.

Sumstorm and No Imagination, you both present valid points. I am not sure of why this set up exists. I have heard, though, that it is $ (from a tech who works at the clinic, so whether or not that is valid is up in the air). It is rumored that the Animal Emergency Clinic was created so that emergency care would be available to residents of about 4-5 counties. It is staffed by vets who have day jobs at other clinics.

So, I don't know the truth. Just going on appearances and what I do know. I hope that it is due to laws or something else. But if it is $, that really sucks.

 

[katryn]

On the issue of "dropped of by a stranger, who then left" emergencies, I love the way my current clinic functions. We have a portion of the clinic's revenue that goes into a stray fund. If an unknown animal gets dropped off, it is stabilized using money out of this fund while we attempt to find an owner. If no owner is found within 24 hours, the animal gets added to the stray file and we treat it fully. Should an owner come forward after full treatment we don't require payment, but highly encourage any monetary donation to the stray fund that the owner feels comfortable giving. We did have to set a cap on the number of plain old strays we take in at any point, but it seems to be a good system that gets very little true abuse, especially since most of our clients don't even know that the stray fund/file exists.

 

[Jochebed]

As Dr. Rand Paul has pointed out -
The "right" to health care (of any sort...) implies the "right" to another person's labor.

My labor is my own. I do have an obligation to provide emergency stabilization for an animal in need, but neither the animal nor the client has an absolute right to my services.