British veterinarians could elect not to treat a pet away from their hospital, even if an owner insists on a visit, under revised guidelines being considered by the Royal College of Veterinary Surgeons. The updated guidelines would encourage in-clinic visits, clarify when a veterinarian may want to travel to a sick or injured animal, and ensure that clients are better informed about after-hours emergency care and costs. Responsibility for a pet’s welfare ultimately rests with the owner, the organization’s 42-member council decided. The council endorsed the updates Thursday after a three-day hearing and following surveys of veterinarians and animal owners. The draft changes to the Code of Professional Conduct were forwarded to the Standards Committee for refinement and final approval. The current code advises veterinarians to consider all requests for at-home visits and states that practitioners are “not expected to risk life or limb.” The revised language would empower veterinarians to decline a travel request when they deem an out-of-office visit unnecessary or unsafe. The British Veterinary Association contributed to the debate and supports the changes. “The willingness of veterinary surgeons to provide 24/7 emergency care is one of the main reasons that the public places its trust in our profession,” said President Robin Hargreaves, BVSc, MRCVS. “But BVA has argued that the delivery of that obligation has to be realistic and public expectation must be managed. “We therefore welcome the college’s commitment to highlight owners’ responsibilities alongside those of veterinary surgeons,” Dr. Hargreaves said. “We also welcome the recommendation that the college better supports vets by making it clear that out-of-hours costs are generally more expensive and that vets are not obliged to carry out substantive treatment for which the owner cannot pay.” One case that led to the debate involved relief veterinarian Munhuwepasi Chikosi, whose clearance to practice in Britain was revoked after a disciplinary panel found that he unnecessarily delayed going to the home of a dog that had been run over by a car and whose owner was requesting euthanasia. Dr. Chikosi, the lone veterinarian working at an after-hours practice in September 2011, told the owner that clinic policy forbade him from abandoning his post, and he advised placing the dog on a blanket and driving the animal to the hospital. An at-home visit would cost $1,000, the owner was told. Efforts to move the dog failed, and Chikosi, having been replaced by another veterinarian, showed up at the farm about two hours after the initial call and euthanized the dog. Whether the outcome of Chikosi’s case would have been different under the revised guidelines is unclear, but the disciplinary panel criticized his “absence of compassion” during multiple telephone calls with the dog’s owner and daughter and stated that the delay caused “unnecessary pain and suffering.” The recommended guidance contains three major points: In nearly all cases, a sick or injured animal’s needs are best met at a hospital. Veterinarians are not obligated to leave a hospital “unless in their personal judgment there is a set of circumstances which indicate that the welfare needs of the animal could only be served by doing so.” • Pet owners may request but cannot demand that a veterinarian come to them. Neil Smith, president of the Royal College of Veterinary Surgeons, which sets standards for British practitioners, acknowledged that the proposed guidelines aren’t a cure-all. “No doubt the outcome will not please everyone, but these changes are based on robust evidence,” he said. What AVMA Says For U.S. veterinarians, advice on how to handle requests for in-home services is vague. The American Veterinary Medical Association’s Principles of Veterinary Medical Ethics state: In emergencies, veterinarians have an ethical responsibility to provide essential services for animals when necessary to save life or relieve suffering, subsequent to client agreement. Such emergency care may be limited to euthanasia to relieve suffering, or to stabilization of the patient for transport to another source of animal care. 1) When veterinarians cannot be available to provide services, they should provide readily accessible information to assist clients in obtaining emergency services, consistent with the needs of the locality. 2) Veterinarians who believe that they haven’t the experience or equipment to manage and treat certain emergencies in the best manner should advise the client that more qualified or specialized services are available elsewhere and offer to expedite referral to those services. 3) Veterinarians who provide emergency services should send patients and continuation of care information back to the original veterinarians and/or other veterinarians of the owners’ choice as soon as practical.
