Ethical Basis for the Safari Knowledge Systems Business Process

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Safari Knowledge Systems Professional Veterinary Ethics

Professional Associations

Traditional professional associations have been around for a long time for example the Hippocratic Oath is over two centuries old. Yet, there has been an explosion of professions of all kinds in the past 100 years that first began in England then moved to the United States. Professional organizations are a by product of the technological, epistemological and socioeconomic changes that have helped create the information age. To practice medicine as a veterinarian in the United States you must be licensed by the American Veterinary Medical Association which is a national association that regulates our profession. The existence of a national organization shows that veterinary professionals are a part of a broad institution that includes a partnership with society.

Ascension of Pet Importance

We are witnesses to one of the most significant societal shifts in human history. Human civilization has undergone four ages. First came the Hunter and Gatherer Age. This was followed by the Agricultural Age, then the Industrial Age and fourth and finally the Information/Knowledge Worker Age. This is the age in which we now exist. Each of these ages represents a different way of life, a different method for creating wealth and a different social structure.

The primary difference between the three previous ages and the current one is the dispersion of the family unit. In all previous ages the family stayed together, either on the farm or near the factory. Now, however, children leave home to gain knowledge and become Knowledge Workers, seldom returning home. This “empty nest” at home and the stress of the child away from home creates a social vacuum that is unprecedented in human history.

Pets are being sucked into this social vacuum, assuming the position of family members, climbing the social ladder and ascending from the back yard to the bedroom and from the kennel to the couch. In today’s society, where the number one prescription drug treats anxiety, people are learning to prescribe a pet instead of a pill. They form bonds that generate the need for a new level of veterinary healthcare. This new level of care appreciates and attends to the new needs of the emerging human-animal bond. It is in this environment that Safari Knowledge Systems exists.

The veterinary industry, however, is struggling to adapt to the demand created by the new social position of pets. This is because it does not have the capacity to cope with the range of ethical issues arising from the different value basis of clients in today’s pluralistic society. SKS, on the other hand, understands that the veterinary profession is in a transition from reactive medicine and surgery on ill or injured pets to proactive care of healthy pets involving wellness plans and client education. By changing the emphasis from reactive to proactive veterinary medicine the system increases capacity through involvement of all members of the team, not just the veterinarian, in communicating ethical considerations with the client.

The business model is evolving from the single file doctor-centered approach to the multi-tasking, client-centered, team based approach. The business process is changing from prescribing pills based on clinical impression to prescribing information based on advanced diagnostics and technology. The roles of the healthcare team are changing from serving the doctor to serving the client.

Pluralistic Society and Veterinary Medicine

Under these conditions veterinarians must understand how to apply their professional knowledge to accommodate traditional ethical norms and applying their professional discretion to provide for the new needs of the pet and the client in this rapidly evolving pluralistic society. Pluralism is where numerous worldviews occupy the same public sphere. In other words, there are people who share the traditional agrarian viewpoint with pets seen in the utilitarian focus in the same community as other people who treat their pets as a part of the family. The demands of the pluralistic society require veterinarians to have the ethical and moral capacity to advise clients who consult them in this highly complex environment. The environment is complex because the social norms for agrarian society are different with regard to pet care than the norms for an information age pet owner. The agrarian pet owner may feel social pressure to put a pet to sleep when it is ill and the information age pet owner may have already researched the need for an MRI for their pet. The complexity exists when there is conflicting messages from the different worldviews causing the pet owner to be confused about what they should do. It is in this realm that veterinarians must exercise their judgement to work with the client to determine the best course of action for the situation. This requires communicative discourse or communication between the veterinarian and the client so that a complete understanding of the context can be used to reach a consensus about future action.

To develop an understanding of the structure of our profession I will offer these four criteria that define a traditional profession. Then I will discuss how the elements of these criteria are used or abused in the deployment of veterinary professional services and how the demands of the highly pluralistic veterinary clientele require discretion on the part of the veterinarian to match our professional offering with their needs.

Esoteric Knowledge and the Veterinary Profession

First, to become a member of the veterinary profession a person must master the esoteric knowledge of the profession. This information is so theoretical that the general public cannot easily acquire it. This is not something a person can do on the Internet in their spare time. Since the first examination focuses on diagnosing the nature of the pet’s problem, a professional has to have a theoretical understanding of all the possible causes of the problem and how the various problems can be resolved. Theoretical understanding provides a broad background that makes it possible to diagnose the nature of the problem even when the pet has an unusual or rare disease. People come to veterinarians not only because they want the disease and treatment identified but because they want to understand what they should do next. Should they treat, should they confirm the diagnosis, should they consult a specialist, should they start treatment now, should they start it later, should this vet do the surgery and so on are possible questions. Veterinarians must develop the cognitive skill and moral sensitivity needed to function as a consultant in this pluralistic milieu.

Social Responsibility and the Veterinary Profession

Second, the veterinary profession has explicitly dedicated itself to serving the social values that are tied to the essential human needs hence the veterinary oath:

“Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health, the relief of animal suffering, the conservation of livestock resources, the promotion of public health and the advancement of medical knowledge.

I will practice my profession conscientiously, with dignity and in keeping with the principles of veterinary medical ethics.

I accept as a lifelong obligation the continual improvement of my professional knowledge and competence.”

These values are so important to the members of society that society does not want to risk allowing incompetent people to offer services and society is willing to spend tax dollars to protect these values. Tax dollars are used to build and fund veterinary schools, pay for tuition, fund research, police malpractice, and prosecute those who practice without a license.

Morality and the Veterinary Profession

Third, to exercise moral control over veterinary professionals the profession needs a way to standardize practice, communicate new techniques to each other, and to ensure that only people of integrity and competence become members of the profession. The AVMA along with state chapters set standards for education and entry into the profession, create a code of ethics, investigate malpractice charges, and encourage research to enhance the profession’s ability to serve pets, sponsor educational programs and in general police the profession. Self-policing is essential, since it is difficult for members of the public to judge incompetence when they lack the esoteric knowledge.

Veterinary Values and the Veterinary Professionals

Fourth, veterinarians, like other professionals, have an extra strong moral commitment to serve the values to which the profession is dedicated. There is certainly something embarrassing and almost repugnant about a veterinarian who does not care when the delivery of care is compromised. One reason people feel it is an honour to be called a professional is the implication that the person has an uncommonly strong commitment to the quality of his or her work. In fact, veterinarians are so committed to the values the profession serves it seems inappropriate for them to think they joined a profession for anything resembling financial reasons. Veterinarians are not as concerned with their own financial well-being as with the delivery of their services. Veterinarian’s have an extra strong moral commitment to professional values which takes priority over personal financial interests because of a broader obligation to the public good.

Codes of Ethics and the Veterinary Profession

All professional codes of ethics including the veterinary codes of ethics are justified by higher-level moral theories. Codes of ethics are not separate moral systems; they are part of a general strategy for specifying how universal moral values ought to be implemented in the veterinary context. The codes specify how a group of people who have accepted professional duties of station are supposed to help implement some of the major values of the broader society (which ought to be governed by universal principles of morality). Thus, as a part of a general theory about how to apply universal moral values, it is useful to give professionals extra strong duties and privileges with regard to serving certain values only because it is a necessary step for helping the profession protect the broader social value it has promised to safeguard. For instance, a stronger obligation to maintain confidentiality applies to veterinarians than to ordinary citizens because extra strong confidentiality is needed to help the veterinary profession meet its responsibility to the community’s broader moral values. So, veterinarians do not have a special duty of confidentiality for its own sake, as though confidentiality were an independent value from a separate sphere of professional morality. They have the duty to maintain confidence because it is a necessary secondary duty for carrying out the first priority of the profession: to promote a higher value for the good of society. Maintaining confidences is one of the ways for veterinarians to help promote universal moral values such as justice, equal opportunity, due process, etc., while helping clients meet their pet care needs.

Confidentiality and the Veterinary Profession

These codes of ethics such as the duty of confidentiality can complicate the lives of veterinarians by creating conflict between universal obligations and professional obligations. For example, what if a client were to communicate the fact that they make it a practice of abusing animals? This would create a moral dilemma which would require the veterinarian to choose between the applied ethics of the profession and the higher universal values of the society. In these circumstances, the professional ethic of keeping client confidentiality would be superseded by the duty of care to society in reporting such a crime. Other things being equal, keeping the confidence of an animal abuser does not seem to carry much weight when compared to the public interest in convicting such a person. Because codes of ethics promise that the veterinary profession is more than an economic association out to further the financial interests of veterinarians a fairly explicit “contract” between society and the profession is stated in the code. Thus, the code gives members of society some reason to trust the profession to look out for society’s interests. This is the basis for asking society to give the profession autonomy in setting standards and policing its own members.

Economization of the Veterinary Relationship

To protect the integrity of the veterinary profession, veterinarians need to resist the economization of the client relationship. Economization converts all relationships into ones based purely on financial incentives, in effect allowing market forces to determine the quality of the interaction between the client and the veterinarian. Human HMO’s are a good example. Clients have a different status than customers who are buying goods from a salesperson. A customer buying goods will be able to make their own value judgement on the quality of the goods they are buying, they can see it, touch it, test it out and can compare it to other similar items they own. The judgement is based on tangible qualities of the goods they purchase. The customer will be able to judge if the asking price is fair.

When purchasing services this type of value judgment becomes more complicated. A customer with limited understanding of how a car works is unable to judge if the cost of the repair matches the quality of the work done. Because there are fewer tangible aspects for the customer to base the judgement on they place more emphasis on customer care and how must they trust the mechanic involved. Where there is limited trust, the customer feels vulnerable and fears the garage will cheat them.

With veterinary services the ability to judge quality becomes even more difficult for the client. Unable to judge the technical ability of the veterinarian the client judges the quality of care given to their pet on several criteria; the appearance of staff and premises, how sympathetic and understanding staff act towards the client and the pet, do staff deliver promises when they say they will, how trustworthy the veterinarian appears.

The client has no choice but to implicitly trust the recommendations they are given regarding their pet’s treatment. In other words the client and veterinarian are not equal economic traders in the marketplace.

Paternalism and the Veterinary Profession

For instance a veterinarian, with the esoteric knowledge would have unfair advantage over a client with a dying pet if the relationship were based only on economic self-interest. There has to be a different model that can characterize the proper role of a veterinarian with their client. It is this reason that SKS prefers to not pay veterinarians based on individual production of charges to clients. In addition, because the relationships with clients are based on the client’s dependency, many might expect the veterinarian to solve the client’s problems by making decisions for them.

But this paternalistic model of professional practice takes too much control away from the client. It assumes the veterinarian always knows best how to serve the client’s values or the client’s worldview.

On the other hand, if we reverse the relationship of dependency by focusing on the fact that the client is hiring the veterinarian, we might assume the veterinarian is simply the agent of the client and should blindly perform their wishes. But this model takes away too much control from the veterinarian. It implies that the vet should just follow orders of the consumer of his or her talents. A professional should never blindly follow orders, since a veterinary professional recognizes that other social obligations (such as animal welfare or public health) exist in addition to the obligation to please the client. Professionals should think of themselves as working with clients, not just for clients. Professionals and clients are supposed to work as partners to solve the pet’s problems within the boundaries set by the professional code of ethics. This requires a fiduciary relationship, which means a relationship based on mutual trust. This model reinforces the traditional view that veterinary practice has a moral dimension that requires more of the professional veterinarian that is demanded by a narrower concept of market relationships in business settings.

Ethical Veterinarians

The ethical veterinarian must learn to communicate in a way that does not force clients into using a language that mutes the client’s own voice to such a degree that she disappears. Veterinary professional codes ought to explain in detail the moral necessity for dialogue between clients and veterinarians, so that all veterinarians will take this seriously. Of course in practice all clients are dependent on the esoteric knowledge of the veterinarian, and in light of this, they may show little inclination to act as equals in specific interactions with veterinarians. But veterinarians should not make this reality worse than it is by using their position of expertise and power to hinder the development of interactive dialogue. Instead, they should use their esoteric skills to further such dialogue even if it takes special effort to learn to communicate across differences.

Different veterinarians have different communication skills and different motivations in this regard and therefore get different results. Consider a discussion between two veterinarians where one vet bragged said that client consent forms were a farce. They bragged that “I can get any client to consent to anything I want.” He is right on a concrete level, especially in paternalistic doctor-client interactions. However, the ideals behind informed consent point to what ought-to-be not what-is in some clinical situations. In the same conversation another veterinarian pointed out, “If you approach the issue of consent properly, clients will not consent to just anything. The idea of informed consent involves the values of honesty, client autonomy, veterinary autonomy, standards of practice and mutual dialog that should be educational for both the veterinarian and the clients. Which doctor is being more sensitive to the moral norms that ought to regulate the dialogue between a veterinarian and a client? The first doctor focuses too much on the empirical fact that doctors can easily sabotage the abstract ideal of informed consent if they refuse to cooperate with the ideal. In a literal sense, he is blinded by the power and influence that comes with his professional perspective and the dependency clients with sick pets feel in his presence. The voice with which he speaks will interfere with attempts to seriously consider the tentative voice of the client because he is using power-over to control the relationship. This can be seen in many veterinarians who not only treat their clients in this unethical manner but also treat their staff with the same power over communication.

Does the structure in the practice encourage participation of all people (clients and other staff) in ways that show universal respect for different voices or is the voice of the veterinarian the only one that is heard? Does our profession use and develop the kind of professional jargon that makes the esoteric knowledge of the profession hopelessly obscure to those who are not members of the profession including lay staff members? Professional jargon forces clients to adopt a position of dependency and mystifies the power over nature of such a relationship. This hinders clients’ ability to express their version of their needs and supports the stance of paternalism taken by some veterinarians. Only when we demystify the jargon and make the communications client friendly and staff friendly do we encourage productive communication on more even footing.

Given that unique cases always involve special circumstances, codes of ethics cannot possibly cover every contingency that might arise in professional practice. Thus, professionals must exercise professional discretion, which means they need leeway to use their esoteric knowledge to figure out the best means to carrying out the goals of the veterinarian, the client and the pet in specific cases. Because there are often several different options that might satisfy the needs of the pet or client the veterinarian has to be given the opportunity to help the client choose in each case which option is best; for example should we use surgery, radiation, chemotherapy, or should we wait and see? As this in itself can cause problems when outcomes are unexpected and decisions have been made that may be judged as arbitrary it is necessary to have a way to deal with the outcomes of discretionary judgements. Thus, veterinarians should be able to explain to others the reasons or rationale behind their use of discretion. If they cannot give a responsible account to other members of the profession, that justifies how they used their power to make discretionary decisions then perhaps they were not making discretionary decisions at all. That is, although there is room for autonomous use of individual initiative in the veterinary profession, the initiative must still make sense to others in the profession. In this context corruption occurs when someone uses professional powers for personal gain at the expense of the values the veterinary profession is supposed to serve.

Value diversity does exist however and shifting technological developments have complicated the application of veterinary practice to such a degree that the option of simple obedience is no longer sufficient. The recent advances in genetics and diagnostic tests in combination with the perceived value of the pet to the family create a situation where proactive veterinary care must be a justified initiative for the future. The rationale for advancing practice into the predictive, proactive realm exists today but may not be supported by the mainstream of the profession. Therefore, professionals cannot always rely on the traditional codes in all cases, because the codes may not be up to date or may be written from a different worldview than the client or vet is experiencing.