Professional ethics

‘The things that will destroy us are: politics without principle; pleasure without conscience; wealth without work; knowledge without character; business without morality; science without humanity, and worship without sacrifice.’

Mahatma Ghandi

The oldest code of medical laws and ethics in the world is the Babylonian Code of Hammurabi that appeared about 2250BC. This ‘eye for an eye’ code makes ‘failure to cure’ the personal responsibility of the physician. This approach, reintroduced in modern courts, assume doctors are responsible for all the outcomes of medical interventions. Unfortunately, by regulating the duties of physicians and punishing failure, physicians become reluctant to treat those cases where outcome is poor[i].

The Hippocratic Oath is the code which members of the public and the medical profession most commonly refer to. It explains the expected and required professional norms. The Hippocratic Oath (written in the fourth century BC) has, however, no direct link with the famous Hippocrates. It obliged doctors always to work for the patient’s benefit, not to give deadly drugs, not to misuse their position, and to keep silent what they may learn during the course of treatment. Hippocrates’ contemporary, Plato challenged this rule. He thought that ‘doctors should not only be concerned with the prolongation of life but should consider the interests of the state[ii].’ However, despite Hippocrates’ assertions, the Hippocratic Oath is a code by which most Australian and American practitioners have never agreed to abide[iii]. Nevertheless, things have recently changed in USA and Canadian medical schools (although not in Australasia) who use the Hippocratic Oath in virtually all commencement exercises[iv]. Although veterinarians abide by a different set of laws/moral codes as prescribed by individual state Acts the moral essence is equivalent to that prescribed by Hippocrates; most notably to respect life, reduce suffering, etc. Aristotle describes ‘goodness’ as a form of virtue and that practise and habituation are necessary to acquire it.

‘Virtue, then, is of two kinds, intellectual and moral. Intellectual virtue owes both its inception and its growth chiefly to instruction, and for this very reason needs time and experience. Moral goodness, on the other hand, is the result of habit. None of the moral virtues is engendered in us by nature, but are instead developed by habit[v].’  

In Plato’s Republic, there is mention of the tale of the shepherd Glaucon, a person reminiscent of Golom, in JRR Tolkien’s Lord of the Rings. Plato’s original story describes how Glaucon was a lowly man who one day discovered a magical ring which gave him powers to become invisible. Using this ring, he was able to seduce the queen, kill the King and become king himself. The story is a symbolic tale of how power corrupts, implying that ultimate power, such as Glaucon’s ring, would lead to the person abandoning all ethical standards. Plato remarks that a man who could under such tempting circumstances refrain from abusing his power would be good, but despised by his fellow man. 

‘No one, it is thought, would be of such adamantine nature as to abide in justice and have the strength to abstain from theft, and to keep his hands from the goods of others, when it would be in his power to steal anything he wished from the marketplace with impunity, to enter men’s houses and have intercourse with whom he would, to kill or to set free whom he pleased; in short, to walk among men as a god… If any man who possessed this power we have described should nevertheless refuse to do anything unjust or to rob his fellows, all who knew of his conduct would think him the most miserable and foolish of men, though they would praise him to each other’s faces, their fear of suffering injustice extorting that deceit from them.’  

What relevance does this notion of goodness have to veterinary practise? Plato tries to convince his readers that until we put to ourselves the questions which faced all philosophers, we have not chosen how to live, but merely why we live, which has already been answered by the fact that we are already alive. The compassionate attitude of relieving suffering in animals does not necessarily conflict with our other professional need to improve animal productivity for consumption. With an inherent consideration of animal welfare, the two can co-exist in a broader framework of animal ethics. Conflict only arises when we ignore the existence of animal emotions, instincts, drives and motivations as clearly described by animal ethologists[vi]^,[vii].  Thus in striving to ensure we act ethically and for the betterment of patients, we are in turn benefiting ourselves emotionally.

Do animals feel pain? There can be little argument that they do, but as to whether there is an intellectual or mental perception of this pain is debateable. But by attempting to diminish an animals suffering by saying they cannot abstract their pain into an art form is wrong. Richard Sarjeant in his book on pain wrote that: 

‘Every particle of factual evidence supports the contention that the higher mammalian vertebrates experience pain sensations at least as acute as our own. To say that they feel less because they are lower animals is an absurdity; it can easily be shown that many of their sense are far more acute than ours – visual acuity in certain birds, hearing in most wild animals, and touch in others; these animals depend more than we do today on the sharpest possible awareness of a hostile environment. Apart from the complexity of the cerebral cortex (which does not directly perceive pain) their nervous systems are almost identical to ours and their reactions to pain remarkably similar, though lacking (so far as we know) the philosophical and moral overtones. The emotional element is all too evident, mainly in the form of fear and anger.’  

The only objection most philosophers, especially Cartesian philosophers, have to this argument is in relation to how animals express this pain, in particular their language skills. As will be discussed later, the evolution of language and its uses are not a direct indicator of intelligence per se, and must be dismissed. Besides, the ability or not to use language by a humans or animals is not relevant to the question of how they should be treated. Though Wittgenstein believed that there is no consciousness without language, this too is disproved by modern research on animal’s ability to abstract, and non-verbal communication. It is also irrelevant to the argument about an animal’s pain state. That human’s need proof that an animal feels pain is more a statement of their empathetic weakness than anything else.

The writer James Joyce once said that the actions of men are the best interpreters of their thoughts. Such a statement is clearly evident when I see veterinarians dedicating their lives to helping animals. Beyond a need for money and meaning in life, such actions by veterinarians convey what their thoughts, intentions and motivations must be - one of altruism. Why else would someone dedicate their time (which is the greatest asset anyone has to give) to such a cause, except for the pleasure of it?

Veterinarians are by nature attracted to the profession for reason of scientific curiosity, animal rapport, providing service to society, etc. One would assume that there is an inherent sense of morality and ethics contained within these motivations. Yet, when we have a mortgage to pay, children to put through school and holiday expenses to meet, are we tempted to over-medicate or over-diagnose a patient’s problem? None of us is immune to such temptations. Yet, there is no restriction on the use of diagnostic and treatment modalities. It is easy to justify doing another diagnostic test when we know there are many bills to pay this month. Does it matter if we over-prescribe in such a situation? Will anyone know if we perform an X-ray and full blood test when it may not necessarily require it, merely to improve the weekly takings for our clinic? A simple answer is that in the short term, no.

When we consider the definition of a successful veterinary practise, what yardstick do we use? Is gross profit alone the sole arbiter of success? For many, the answer is yes. Being a good veterinarian simply means having a financially successful practise. Financial income is equivalent to client activity at the clinic, yet does it infer client satisfaction? How is client satisfaction determined? Total number of clients who use the services of the practise is one measure of satisfaction. Loyalty is another, as determined by number of visits by a client during a specified period of years. Another is referral of clients to the practise from other clients or other veterinary practises.

I remember once being told by a fellow veterinarian that she would rather have half as many clients and charge twice as much. But to extrapolate the logic of this assumes that her motivation for being a veterinarian is not to help others but to minimise her effort to that which gives her an income with the least amount of stress and time wasted. Obviously, the least amount of time spent at work is important, but the down-side of this equation is that the clients she has are only partly satisfied with her performance. It would be the same as saying ‘Give me a spouse who I can satisfy in half the time and I would be twice as happy.’ Such logic in marriage leads to dissatisfaction, stagnation and inevitably divorce. I do not know of any successful marriage where partners hadn’t spent a considerable time, usually late at night, trying to settle a dispute that needed to be resolved. These emotional issues which arise in relationships are no different to relationship conflicts with clients, albeit less intimate ones. To give only half our effort to anything is to leave ourselves feeling as short-changed as our partner or client does.

I remember once working as a locum veterinarian in a small town that had two neighbouring practises. A friendly compassionate vet operated one clinic while a stern business-driven vet operated the other. The latter vet had by far the greater income. He drove a new car and had a well-appointed vet clinic whereas the other vet, who had twice the number of clients as the other seemed satisfied with a basic service which he provided to his more satisfied clients. I cannot judge one vet with the other except to say that I always preferred locums at the friendlier vet’s practise.

Being good as a person is not about wearing a halo. It is about helping patients and dealing with clients as people who are not as separated from us as we think. Having a veterinary degree does not give us the distinction of being above anyone. On the contrary, a veterinary degree requires of us more commitment to others than we normally would accept. Since knowledge brings with it responsibility, we have to accept that it is par for the course for us to be more responsible than if we did not have the qualification in the first place. Bearing this in mind, we should choose the level of our responsibility to veterinary science and live it fully. We may only work part-time or not at all; but to use a vet degree solely as a means of income without commitment to patients and clients is comparable to the hedonist who seeks mere pleasure without commitment. Invariably, they suffer from isolation, despair and moral impoverishment.