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The Veterinarian-Client Relationship
When you take your pet to your veterinarian to be examined, you become the veterinarian’s client. As the client, you are bound by any conditions in your agreement with the veterinarian. But, what about the veterinarian? The veterinarian is already bound by the rules of practice issued by the veterinary accrediting agency for the state where he or she practices (usually called rules of professional conduct). These rules outline the requirements for licensure as well as what encompasses the veterinarian-client relationship.
The Principles of the American Veterinary Medical Association: A Model for State Practice Requirements
For each state, the rules regarding veterinarians are a little different. However, the Principles of Veterinary Medical Ethics of the AVMA (“Principles”) provide general guidance for state laws and regulations, and most states follow these general guidelines in drafting their veterinary practice rules. It should be noted that every state has its own licensing requirements (see these on the Map of State Veterinary Codes).
Although the Principles are very important to understanding the veterinarian-client relationship, they are simply guidelines and policies that are suggested for the veterinarian to follow. While disregarding or disobeying these guidelines and policies may indicate that the veterinarian is in violation of his or her ethical duties, they do not create a cause for a legal action. A veterinarian who disregards these guidelines and policies may be subject to disciplinary proceedings by the veterinary board in his or her state; however there is not a cause for legal action just because there is a violation of the Principles.
An examination of the Principles does give some insight into the ethical underpinnings for the various state practice codes. For example, the Principles make it unethical for veterinarians to identify themselves as members of an AVMA specialty organization when they are not members of that organization. The Principles also make it unethical to assist non-veterinarians with the practice of veterinary medicine. This particular Principle protects veterinarians, clients, and patients from the unauthorized and dangerous practice of veterinary medicine by persons without a veterinary license. The Principles also recommend that veterinarians continue their veterinary education after they receive their licenses. In some states, veterinarians are required to continue their veterinary education in order to renew their license. Additional protection can be found in the provision that recommends that veterinarians impaired by alcohol or other substances should seek help from qualified organizations or individuals.
In discussing professional behavior, the Principles state, “Veterinarians should first consider the needs of the patient: to relieve disease, suffering, or disability while minimizing pain or fear.” Additionally, the Principles require veterinarians to obey the laws of the jurisdiction where they reside and practice veterinary medicine. Veterinarians are also prompted to be honest and fair when they relate to others. These requirements and recommendations are also designed to protect the clients and patients of veterinarians.
State veterinary accreditation requirements also serve to protect clients who seeks the expertise of a trained veterinarian. Licensing requirements typically include submitting an application for licensing, passing a state licensing exam, and providing the board of examiners with transcripts from the applicant’s veterinary school. State accrediting agencies may also require licensed veterinarians to renew their licenses through a process which includes an application, payment of fees, and continued veterinary education.
In addition to licensing and license renewal, state veterinary accrediting agencies (e.g., state boards of veterinary medicine) are also involved in disciplinary proceedings against veterinarians and in determining which actions taken by veterinarians are acceptable, and which are not. The definitions of acceptable and unacceptable actions vary from state to state. However in general, the actions of a veterinarian are considered unacceptable if the veterinarian engages in false or misleading advertising, misrepresents the services rendered, or is convicted of a crime.
State veterinary accrediting agencies may also regulate where the veterinarian displays his or her license and when the veterinarian can disclose information on which animals they have treated.
One of the most vital portions of state ethics rules as well as the Principles is the discussion of the veterinarian-client-patient relationship. The importance of defining this relationship is also underscored by the fact that many states now define this phrase in their veterinary practice codes (see New Mexico and Florida, for example).
Veterinarian-Client-Patient Relationship and Informed Consent
A veterinarian-client-patient relationship (“VCPR”) begins when the veterinarian takes responsibility for the animal. The Principles state that a VCPR exists when all three of the listed conditions are met. The first condition basically requires the client to allow the veterinarian to see and treat the animal. The second condition is the basic requirement of informed consent. The third condition is to have back-up measures set in place, in case the treatment fails or in case the patient has a bad reaction to the treatment.
The Principles require veterinarians to form a VCPR before prescriptions are written or given out, and to keep medical records. The Principles require “informed consent” from the client before the patient is treated. Getting this “informed consent” typically means the veterinarian explains both the risks and benefits associated with a particular treatment method. Then the client signs a document which states the client understands the risks and benefits. By giving informed consent to a procedure or treatment, it is assumed that the client both read and understood all of the terms in the statement. Once informed consent has been given, the patient- animal may be treated according to the conditions listed within the statement.
According to the Journal of the AVMA, part of informed consent means that client information sheets provided to the veterinarian must be handed out with the drug(s) they pertain to. These client information sheets have information on risks associated with that particular drug.
Under the Principles, veterinarians must write a prescription for medications that can not be obtained over the counter. This includes Veterinary Feed Directive medicated feeds for food producing animals (e.g., poultry and livestock). These medicated feeds must not be prescribed for use that does not meet the terms of the label. In food producing animals “extra-label” use of prescription drugs by veterinarians or non-veterinarians is strictly prohibited. In non-food producing animals, the extra-label use of drugs is recognized as necessary. Veterinarians may prescribe drugs to non-food producing patients for extra-label use as long as they follow the guidelines for the use of prescription drugs.
Termination of a VCPR, under the Principles can and should be done by the veterinarian under certain circumstances. One circumstance is that the patient no longer requires medical care. The other circumstance is that there is an ongoing condition for which the patient should be referred to a different veterinarian for diagnosis, care, and treatment. Clients, on the other hand, may terminate a VCPR at any time.
State veterinary practice codes also define "veterinary-client relationship" in a similar manner as the Principles. For instance, Florida defines a "veterinarian/client/patient relationship" as one "where the veterinarian has assumed the responsibility for making medical judgments regarding the health of the animal and its need for medical treatment." Oklahoma also defines the term similarly, but adds that there is "sufficient knowledge of the animal or animals by the licensed veterinarian to initiate at least a general or preliminary diagnosis of the medical condition of the animal." Both the Principles and state practice codes reflect the idea that the veterinarian has assumed the ethical responsibility for care of an animal.
Under the Principles, a veterinarian needs to follow certain guidelines to avoid undergoing disciplinary proceedings. Disciplinary proceedings can be filed for any number of reasons, including failure to follow state and local regulations regarding medical records, failure to adhere to the ethical requirements of the Principles, and for knowingly using false or misleading advertising.
Most ethical requirements under the Principles allow for self-regulation and self-discipline of veterinarians. Some requirements, like the one on medical records, defer to the state and local standards for regulation and discipline of their rules. In most states a separate disciplinary committee or board is set up to deal with problems. The process of taking a case through the disciplinary proceedings committee or board involves several steps. Typically, these steps involve filing a complaint and at least one hearing with a board subcommittee dedicated to issues of veterinary liability and punishment.
To determine if a veterinarian is criminally liable, one must look to the laws of the state where the veterinarian practices. While approximately 28 states have laws that either mandate or allow veterinarians to report cases of suspected animal abuse, very few make veterinarians criminally liable for the failure to do so (California and Colorado, for example). These jurisdictions then usually limit both criminal and civil liability when the report of suspected abuse is made in good faith. Veterinarians are not generally required to cross-report potentially criminal situations to other state agencies. Other laws may make veterinarians responsible for reporting suspected cases of spousal or child abuse.
In most instances, the failure to follow the laws or regulations set forth by the state accrediting agency results in fines and other similar penalties. In severe circumstances, a veterinarian may face license revocation or restrictions.
In general, veterinarians are supposed to help both the clients and their patients. While the patient is the animal receiving care, the duty of care is extended to his or her human caretaker. The relationships of veterinarians and their clients and patients are governed by state rules and regulations as well as any voluntary ethical organizations to which veterinarians might be members, like the American Veterinary Medical Association (AVMA) or the American Animal Hospital Association (AAHA).
These governing rules and laws generally require the veterinarian to behave professionally with regard to his or her patients and clients. The rules also require the veterinarian to be honest and forthcoming in all of their dealings with both their clients and the public at large. Failure to follow these rules means that a veterinarian may be punished or professionally disciplined. Ethical principles, like those developed by the AVMA, also protect the important veterinarian-client relationship. This ensures the proper care of patient and client alike.
For more, see the Detailed Discussion.
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