QUALITY PRACTICE
ETHICAL DILEMMA
DIFFERING OPINIONS ON HANDLING AN ERROR
Veterinarians and their teams use their knowledge , experiences , and values to make ethical decisions daily in practice . Occasionally , the decision on the appropriate course of action may not seem as clear or there may be differing opinions amongst the team members on how best to proceed . Let ’ s look at an ethical dilemma relating to a medical error to see how a veterinary team could handle such a situation .
A patient has been admitted to a veterinary facility for a procedure . A medication that the patient is known to have a severe allergy to is given in error . This is caught immediately , and the appropriate treatment is administered . The patient remains stable , and the procedure is performed . The patient recovers well with no evidence of any adverse effects of receiving a medication in error . Dr . A who is overseeing the case , has told all staff members that the client is not to be informed of what happened as the patient is fine and the clinic does not need to “ get in trouble ” for no reason . Dr . B does not agree with this plan and can see that some of the staff members appear uncomfortable with this decision too . Dr . B feels that being honest with the client , regardless of what the client ’ s reaction could be , is a veterinarian ’ s obligation both morally and professionally .
So , if a medical error does not result in harming a patient , should the client be told what happened ?
Some , like Dr . A , would say that if the patient is not harmed , why tell the client , and risk the potential for the veterinarian to receive a complaint or be involved in a civil action ? The stress of going through either process when the patient is fine seems unnecessary . Others , like Dr . B , would argue that this is lying by omission and the client has the right to know what happened to their animal . If the client were to find out that the veterinarian had withheld this information , the consequences may be worse . To come up with a consensus on the appropriate action to take , this veterinary team can take a structured approach to discuss the ethical issues raised . The College has resources to help guide these discussions .
To start , there is the Code of Ethics document which outlines the profession ’ s values and provides the foundation for ethical principles . The Code provides a framework to guide veterinarians in ethical decision making and how to act as morally responsible members of the veterinary profession . An ethical decision tree is provided to help work through ethical dilemmas using a series of questions . These questions take into consideration options for courses of action , such as :
– The parties affected by the decision – generally this is the animal ( s ), the client and the veterinarian but can also include the veterinary team , the profession , future clients and patients , society , and the environment
– The interests of each party
– Prioritizing the interests of each party
– The potential impacts of a decision and how these can be managed
Animal welfare , regulatory obligations and professional expectations should be kept in mind while working through the decision tree .
It may not be possible to create opportunities for team dialogue when a decision needs to be made quickly . However , when there is time , discussion with others regarding ethical dilemmas is suggested . Having proactive discussions of different ethical scenarios that may occur , will help the veterinary team to enhance their ethical reasoning skills and can help to develop clinic policy to promote consistency in decision making among veterinary teams .
Other resources available include an Ethical Decision Making video ; Guidance on Professionalism for Veterinarians document ; and a communication module “ Breaking the Silence : Discussing Medical Errors with Clients ”. This spring , the College will be launching its Ethics Resource Hub to provide further guidance and support .
Going back to the medical error dilemma : after going through the ethical decision tree with the team , Dr . A decided to discuss what had occurred to the patient with the client as being transparent and honest are core principles of the Code of Ethics . Demonstrating professionalism and ethical conduct in the practice of veterinary medicine contributes to veterinarians earning and maintaining trustworthiness .
Resource References : 1 . Code of Ethics
2 . Guide to the Code of Ethics -includes the ethical decision tree
3 . Ethical Decision Making Video
4 . Guidance on Professionalism for Veterinarians
5 . Communication Module : Breaking the Silence : Discussing Medical Errors with Clients
4 College Connection Spring 2021 cvo . org