When you become a veterinarian, no one ever stops to enumerate all the ways in which your professional behavior can prove corrosive to your personal values. While you may have taken a medical ethics course in college or veterinary school, 10 to one its contents tended toward the theoretical and addressed only the specific ethical standards we should abide by in our roles as medical or veterinary professionals.
The traditional classroom cannot offer much practical insight into how we are likely to react when a client, colleague, case, or coworker presents us with a moral or ethical quandary in real time. Even a case-based classroom's hypotheticals cannot possibly prepare us for real-life scenarios in which we are challenged—ethically or morally—much less how to handle conflicts between our personal morals and the ethical standards of our profession.
Some things we have to just learn by doing. After all, how we practice when no one is looking serves as both ultimate medical ethics exam and test of our moral fiber. None of us really knows the strength of our moral backbone until it is stress-tested.
Morals vs. ethics
Before I launch into some common veterinary scenarios, indulge me as I refresh our collective memory: Morals refer to our conception of the global "right" and "wrong" of things—our personal values, if you will. Ethics comes down to these principles as generally accepted by a specific community—in our case, a moral "standard of care" veterinarians have collectively agreed to adhere to.
So why does this distinction matter? Pardon the digression as I explain:
In practical terms, it is possible to be ethical and not moral. For example, if you refuse to declaw a cat because you believe it is inhumane to do so, you would be abiding by your own personal moral code. Nevertheless, it is considered ethical to declaw a cat given veterinary medicine's reigning code explicitly allows veterinarians to perform this procedure. But if your boss requires you to perform the procedure and you comply despite your moral misgivings, you would be abiding by veterinary ethical standards but violating your own moral code.
Now, let's say your boss requires you to extract the same cat's canines for the owner's "comfort." In this case, it would be both immoral and unethical to do so. That is because our profession's guiding principles do not support this procedure; and since you vowed to abide by the profession's rules when you joined it, performing it would be immoral as well, regardless of where you stand on de-fanging cats.
To summarize: It is possible to be ethical and not moral, but the opposite is not possible in the context of a profession you have joined of your own free will and to which you have explicitly pledged ethical compliance. Hence, to violate our ethical code would be immoral.
Interestingly, not all veterinary professionals agree, arguing anything the law allows is fair game, ethically speaking. Not so! Ethics can be more restrictive and vice versa, which is why I choose to belabor the point. (Confusingly, perhaps.) Sure, it has been tedious and more than a little pedantic to run through this but, trust me, we can all use a little refresher—myself included, of course.
Moral hazards defined
"Moral hazard" is a term coined more than 350 years ago by the insurance industry to describe how an individual or entity might elect to assume a greater risk on behalf of an insurance company simply because they know they won't be on the hook should the insurance company be forced to make a big payout. For example, it is what happens when we tell our clients we won't make a note of their puppy's wiggly patellas, sharky overbite, or undescended testicle on our medical records but—wink-wink—urge them to get pet health insurance ASAP.
More broadly, however, I tend to think of moral hazards as they apply to veterinary medicine as those uniquely veterinary pitfalls we all tend to stumble into at one point or another in the course of our careers. Regardless of your role in the profession, unexpected moral and ethical risks abound. No receptionist, kennel worker, vet tech, associate, medical director, practice manager, or owner is immune.
While the ways in which we can morally and ethically stray can look vastly different depending on our role, it is undoubtedly true those with the most responsibility experience the greatest exposure to veterinary moral hazards, some of which I've outlined below:
1) Insurance decisions
It is not just the standard moral hazard veterinarians confront when it comes to insurance. In addition to pushing policies for the congenitally challenged and the otherwise impaired (which we are all tempted to do at our own moral peril). There is also the looking the other way that happens with rescue pets, co-worker's pets, and—gasp!—even our own. This is why many policies now prohibit veterinarians from treating their own pets.
2) Insurance-based bill-padding
This is a common pitfall. Knowing patients have an active policy in their name has a way of enticing us to sway our recommendations. Instead of approaching a problem deliberately and stepwise, we are more likely to throw diagnostics at the wall to see what sticks. We are also more likely to be more aggressive with our pricier treatment options.
3) The luxury tax
If at any point we find ourselves changing how we practice because we know a client is inherently less price-sensitive, that is a red flag for sure. After all, bill-padding also becomes an issue when dealing with the client who just pulled up in a Maybach or the one you know lives in a $10-million home. However, that is not quite as common as a 90 percent reimbursement policy with a $10,000 annual cap, is it?
4) Production-based bill-padding
Thankfully, I've only seen this happen with one person in all the years I've paid employees on a production basis (this includes techs, managers, and associates). But it was a depressing day I realized we had a bona fide bill-padder in the house. It can be hard to spot but once you do you cannot unsee it.
For many of us who are paid this way, it can become a tricky daily exercise to remain aware of our motivations in this regard. Few of us want to fall into the trap of changing how we practice—either over- or under-charging—because we fear leaning too far or not far enough into the production pay of it all.
