Principles of Veterinary Medical Ethics of the AVMA

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Introduction

Veterinarians are members of a scholarly profession who have earned academic degrees from comprehensive universities or similar educational institutions. Veterinarians practice veterinary medicine in a variety of situations and circumstances. Exemplary professional conduct upholds the dignity of the veterinary profession. All veterinarians are expected to adhere to a progressive code of ethical conduct known as the Principles of Veterinary Medical Ethics (PVME). The PVME comprises the following Principles, the Supporting Annotations, and Useful Terms.

The AVMA Judicial Council is charged to advise on all questions relating to veterinary medical ethics and to review the Principles periodically to ensure that they remain current and appropriate.

The Principles

  1. A veterinarian shall be dedicated to providing competent veterinary medical care, with compassion and respect for animal welfare and human health.
  2. A veterinarian shall provide veterinary medical clinical care under the terms of a veterinarian-client-patient relationship (VCPR).
  3. A veterinarian shall uphold the standards of professionalism, be honest in all professional interactions, and report veterinarians who are deficient in character or competence to the appropriate entities.
  4. A veterinarian shall respect the law and also recognize a responsibility to seek changes to laws and regulations which are contrary to the best interests of the patient and public health.
  5. A veterinarian shall respect the rights of clients, colleagues, and other health professionals, and shall safeguard medical information within the confines of the law.
  6. A veterinarian shall continue to study, apply, and advance scientific knowledge, maintain a commitment to veterinary medical education, make relevant information available to clients, colleagues, the public, and obtain consultation or referral when indicated.
  7. A veterinarian shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide veterinary medical care.
  8. A veterinarian shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

The Principles with Supporting Annotations

  1. A veterinarian shall be dedicated to providing competent veterinary medical care with compassion and respect for animal welfare and public health.
    1. Veterinarians should first consider the needs of the patient: to prevent and relieve disease, suffering, or disability while minimizing pain or fear.
    2. Regardless of practice ownership, the interests of the patient, client, and public require that all decisions that affect diagnosis and treatment of patients are made by veterinarians.
    3. The choice of treatments or animal care shall not be influenced by considerations other than the welfare of the patient, the needs of the client, and the safety of the public.
    4. The medical judgments of veterinarians should not be influenced by contracts or agreements made by their associations or societies.
    5. Performance of surgical or other procedures in any species for the purpose of concealing genetic defects in animals to be shown, raced, bred, or sold as breeding animals is unethical. However, should the health or welfare of the individual patient require correction of such genetic defects, it is recommended that the patient be rendered incapable of reproduction.
    6. Attending veterinarians are responsible for choosing the treatment regimens for their patients. It is the attending veterinarian’s responsibility to inform the client of the expected results and costs, and the related risks of each treatment regimen.
    7. Veterinarians may not promote, sell, prescribe, dispense, or use secret remedies or any other product for which they do not know the ingredients.
    8. Humane euthanasia of animals is an ethical veterinary procedure.
  2. A veterinarian shall provide veterinary medical care under the terms of a veterinarian-client-patient relationship (VCPR).
    1. It is unethical to engage in the practice of veterinary medicine without a VCPR.
    2. Veterinarians shall honor a client’s request for a prescription in lieu of dispensing.
    3. Veterinarians may terminate a VCPR under certain conditions, and they have an ethical obligation to use courtesy and tact in doing so.
      1. If there is no ongoing medical or surgical condition, veterinarians may terminate a VCPR by notifying the client that they no longer wish to serve that patient and client.
      2. If there is an ongoing medical or surgical condition, the patient shall be referred to another veterinarian for diagnosis, care, and treatment. The former attending veterinarian shall continue to provide care, as needed, during the transition.
    4. When an attending veterinarian assumes responsibility for primary care of a patient, a VCPR is established with the attending veterinarian.
    5. Clients may terminate the VCPR at any time.
  3. A veterinarian shall uphold the standards of professionalism, be honest in all professional interactions, and report veterinarians who are deficient in character or competence to the appropriate entities.
    1. Complaints about behavior that may violate the Principles should be addressed in an appropriate and timely manner.
    2. All veterinarians in local or state associations have a responsibility to monitor and guide the professional conduct of their members. Members of local and state committees are familiar with local customs and circumstances, and those committees are in the best position to confer with all parties involved. Local and state veterinary associations should consider adopting the Principles or a similar code as a guide for their activities and include discussions of ethical issues in their continuing education programs. The AVMA Judicial Council may address complaints prior to, concurrent with, or subsequent to review at the state or local level, as it deems appropriate.
    3. Veterinary Medical educators should stress the teaching of ethical issues as part of the professional veterinary curriculum for all veterinary students. Concomitantly, veterinary medical examiners are encouraged to prepare and include questions regarding professional ethics on examinations.
    4. Veterinarians must not defame or injure the professional standing or reputation of other veterinarians in a false or misleading manner. Veterinariansmust be honest and fair in their relations with others, and they shall not engage in fraud, misrepresentation, or deceit.
    5. Veterinarians should use only the title of the professional degree that was awarded by the school of veterinary medicine where the degree was earned. All veterinarians may use the courtesy titles Doctor or Veterinarian.
    6. It is unethical for veterinarians to identify themselves as members of an AVMA-recognized specialty organization if such certification has not been awarded and maintained. Only those veterinarians who have been certified by an AVMA-recognized veterinary specialty organization should refer to themselves as specialists.
    7. A veterinarian having supervisory authority over another veterinarian should make reasonable efforts to ensure that the other veterinarian conforms to the Principles.
    8. A veterinarian may be responsible for another veterinarian’s violation of the Principles if the veterinarian orders or, with knowledge of the specific conduct, approves the conduct involved; or if the veterinarian has supervisory authority over another veterinarian and knows of the conduct at a time when its consequences can be avoided or mitigated, but fails to take reasonable remedial action.
    9. Veterinarians who are impaired must not act in the capacity of a veterinarian and shall seek assistance from qualified organizations or individuals. Colleagues of impaired veterinarians should encourage those individuals to seek assistance and to overcome their impairment.
    10. Veterinarians shall disclose to clients potential conflicts of interest.
    11. Advertising by veterinarians is ethical when there are no false, deceptive, or misleading statements or claims. A false, deceptive, or misleading statement or claim is one which communicates false information or is intended, through a material omission, to leave a false impression.
    12. Testimonials or endorsements are advertising, and they should comply with the guidelines for advertising. In addition, testimonials and endorsements of professional products or services by veterinarians are considered unethical unless they comply with the following:
      1. The endorser must be a bonafide user of the product or service.
      2. There must be adequate substantiation that the results obtained by the endorser are representative of what veterinarians may expect in actual conditions of use.
      3. Any financial, business, or other relationship between the endorser and the seller of a product or service must be fully disclosed.
      4. When reprints of scientific articles are used with advertising, the reprints must remain unchanged, and be presented in their entirety.
    13. The principles that apply to advertising, testimonials, and endorsements also apply to veterinarians’ communications with their clients.
  4. A veterinarian shall respect the law and also recognize a responsibility to seek changes to laws and regulations which are contrary to the best interests of the patient and public health.
    1. Veterinarians should obey all laws of the jurisdictions in which they reside and practice veterinary medicine.
    2. Veterinarians should report illegal practices and activities to the proper authorities.
    3. The AVMA Judicial Council may choose to report alleged infractions by members and nonmembers of the AVMA to the appropriate agencies.
    4. It is unethical to place professional knowledge, credentials, or services at the disposal of any nonprofessional organization, group, or individual to promote or lend credibility to the illegal practice of veterinary medicine.
  5. A veterinarian shall respect the privacy rights of clients, colleagues, and other health professionals and shall safeguard medical information within the confines of the law.
    1. Veterinarians and their associates must protect the personal privacy of clients, and veterinarians must not reveal confidences unless required to by law or unless it becomes necessary to protect the health and welfare of other individuals or animals.
    2. Veterinary medical records are an integral part of veterinary care. The records must comply with the standards established by state and federal law.
      1. Medical records are the property of the practice and the practice owner. The original records must be retained by the practice for the period required by law.
      2. The information within veterinary medical records is confidential. It must not be released except as required or allowed by law, or by consent of the owner of the patient.
      3. Veterinarians are obligated to provide copies or summaries of medical records when requested by the client. Veterinarians should secure a written consent to document that provision.
      4. Without the express permission of the practice owner, it is unethical for a veterinarian to remove, copy, or use the medical records or any part of any record for personal or professional gain.
  6. A veterinarian shall continue to study, apply, and advance scientific knowledge; maintain a commitment to veterinary medical education; make relevant information available to clients, colleagues, and the public; and obtain consultation or referral when indicated.
    1. Veterinarians should strive to enhance their image with respect to their colleagues, clients, other health professionals, and the general public. Veterinarians should present a professional appearance and follow acceptable professional procedures using current professional and scientific knowledge.
    2. Veterinarians should strive to improve their veterinary knowledge and skills, and they are encouraged to collaborate with other professionals in the quest for knowledge and professional development.
    3. When appropriate, attending veterinarians are encouraged to seek assistance in the form of consultations and/or referrals. A decision to consult or refer is made jointly by the attending veterinarian and the client. Attending veterinarians must honor a client’s request for referral.
      1. When a private clinical consultation occurs, the attending veterinarian continues to be primarily responsible for the case and maintaining the VCPR.
      2. Consultations usually involve the exchange of information or interpretation of test results. However, it may be appropriate or necessary for consultants to examine patients. When advanced or invasive techniques are required to gather information or substantiate diagnoses, attending veterinarians may refer the patients. A new VCPR is established with the veterinarian to whom a case is referred.
    4. Referral is the transfer of responsibility of diagnosis and treatment from a referring veterinarian to a receiving veterinarian. The referring and receiving veterinarians should communicate.
      1. The referring veterinarian should provide the receiving veterinarian with all the appropriate information pertinent to the case before or at the time of the receiving veterinarian’s first contact with the patient or the client.
      2. When the referred patient has been examined, the receiving veterinarian should promptly inform the referring veterinarian. Information provided should include diagnosis, proposed treatment, and other recommendations.
      3. The receiving veterinarian should provide only those services or treatments necessary to address the condition for which the patient was referred and should consult the referring veterinarian if other services or treatments are indicated.
      4. Upon discharge of the patient, the receiving veterinarian should give the referring veterinarian a written report advising the referring veterinarian as to continuing care of the patient or termination of the case. A detailed and complete written report should follow as soon as possible.
      5. The receiving veterinarian should advise the client to contact the referring veterinarian for the continuing care of the patient. If the client chooses continuing patient care of a veterinarian other than the referring veterinarian, the receiving veterinarian should release a copy of the medical records to the veterinarian of the client’s choice.
    5. When a client seeks professional services or opinions from a different veterinarian without a referral, a new VCPR is established with the new attending veterinarian.When contacted, the veterinarian who was formerly involved in the diagnosis, care, and treatment of the patient should communicate with the new attending veterinarian as if the patient and client had been referred.
      1. With the client’s consent, the new attending veterinarian should contact the former veterinarian to learn the original diagnosis, care, and treatment and clarify any issues before proceeding with a new treatment plan.
      2. If there is evidence that the actions of the former attending veterinarian have clearly and significantly endangered the health or safety of the patient, the new attending veterinarian has a responsibility to report the matter to the appropriate authorities of the local and state association or professional regulatory agency.
  7. A veterinarian shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide veterinary medical care.
    1. Veterinarians may choose whom they will serve. Both the veterinarian and the client have the right to establish or decline a Veterinarian-Client-Patient Relationship and to decide on treatment. The decision to accept or decline treatment and related cost should be based on adequate discussion of clinical findings, diagnostic techniques, treatment, likely outcome, estimated cost, and reasonable assurance of payment. Once the veterinarian and the client have agreed, and the veterinarian has begun patient care, they may not neglect their patient and must continue to provide professional services related to that injury or illness within the previously agreed limits. As subsequent needs and costs for patient care are identified, the veterinarian and client must confer and reach agreement on the continued care and responsibility for fees. If the informed client declines further care or declines to assume responsibility for the fees, the VCPR may be terminated by either party.
    2. 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 (or until such agreement can be obtained when no client is present). 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.
    3. 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.
    4. 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.
    5. 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.
    6. Veterinarians (to include those attending, consulting, receiving and referring) are entitled to charge fees for their professional services.
      1. Regardless of the fees that are charged or received, the quality of service must be maintained at the usual professional standard.
      2. A veterinarian may charge a fee for the services the veterinarian provides in conjunction with the use of third-party providers such as laboratories, pharmacies, and consulting veterinarians.
      3. Payment by or to a veterinarian solely for the referral of a patient is fee-splitting and is unethical.
      4. A veterinarian may not accept payment of any kind, in any form, from any source, such as a pharmaceutical company or pharmacist, manufacturer of medical appliances and devices, for prescribing or referring a patient to said source.

        In each case, the payment violates the requirement to deal honestly with clients and colleagues. The client relies upon the advice of the veterinarian on matters of referral and prescribing. All referrals and prescriptions must be based on the skill and quality of the veterinarian to whom the patient has been referred or the quality and efficacy of the drug or product prescribed.
      5. It is unethical for a group or association of veterinarians to take any action which coerces, pressures, or achieves agreement among veterinarians to conform to a fee schedule or fixed fees.
  8. A veterinarian shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
    1. The responsibilities of the veterinary profession extend beyond individual patients and clients to society in general. Veterinarians are encouraged to make their knowledge available to their communities and to provide their services for activities that protect public health.

Useful Terms

Advertising. Communication that is designed to inform the public about the availability, nature, or price of products or services or to influence clients to use certain products or services.

Attending veterinarian. A veterinarian (or a group of veterinarians) who assumes responsibility for primary care of a patient.

Consulting veterinarian. A veterinarian (or group of veterinarians) who agrees to advise an attending veterinarian, government or industry, on the care and management of a case or issue.

Dispensing. The direct distribution of products by veterinarians to clients for use on their animals.

Ethical product. A product for which the manufacturer has voluntarily limited the sale to veterinarians as a marketing decision. Such products are often given a different product name and are packaged differently than products that are sold directly to consumers. “Ethical products” are sold only to veterinarians as a condition of sale that is specified in a sales agreement or on the product label.

Fee-splitting. Payment by a receiving veterinarian of part of their fee to the referring veterinarian who has not rendered professional services. Under this definition, the use of consultants, laboratory services, and online pharmacies does not constitute fee-splitting.

Impaired veterinarian. A veterinarian who is unable to perform his or her duties in veterinarymedicine with reasonable skill and safety because of a physical or mental disability including deterioration of mental capacity, loss of motor skills, or abuse of drugs or alcohol.

Legend drug. A synonymous term for a veterinary prescription drug. The name refers to the statement (legend) that is required on the label (see veterinary prescription drug).

Marketing. Promoting and encouraging animal owners to improve animal health and welfare by using veterinary care, services, and products.

Merchandising. The buying and selling of products or services.

Over the counter (OTC) drug. Any drug that can be labeled with adequate direction to enable it to be used safely and properly by a consumer who is not a medical professional.

Practice of veterinary medicine. To diagnose, prognose, treat, correct, change, alleviate, or prevent animal disease, illness, pain, deformity, defect, injury, or other physical, dental, or mental conditions by any method or mode; including the:

  • Performance of any medical or surgical procedure, or
  • Prescription, dispensing, administration, or application of any drug, medicine, biologic, apparatus, anesthetic, or other therapeutic or diagnostic substance, or
  • Use of complementary, alternative, and integrative therapies, or
  • Use of any procedure for reproductive management, including but not limited to the diagnosis or treatment of pregnancy, fertility, sterility, or infertility, or
  • Determination of the health, fitness, or soundness of an animal, or
  • Rendering of advice or recommendation by any means including telephonic and other electronic communications with regard to any of the above.
  • Representation of, directly or indirectly, publicly and privately, an ability and willingness to do an act described above.
  • Use of any title, words, abbreviation, or letters in a manner or under circumstances that induce the belief that the person using them is qualified to do any act described above.

Prescribing. The transmitting of an order authorizing a licensed pharmacist or equivalent to prepare and dispense specified pharmaceuticals to be used in or on animals in the dosage and in the manner directed by a veterinarian.

Prescription drug. A drug that cannot be labeled with adequate direction to enable its safe and proper use by non-professionals.

Receiving veterinarian. A veterinarian (or group of veterinarians) to whom a patient is referred and who agrees to provide requested veterinary services. A new VCPR is established with the receiving veterinarian.

Referring veterinarian. A veterinarian (or group of veterinarians) who is the attending veterinarian at the time of referral.

Testimonials (or endorsements). Statements intended to influence attitudes regarding the purchase or use of products or services.

Veterinarian-Client-Patient relationship (VCPR). A VCPR means that all of the following are required:

  1. The veterinarian has assumed the responsibility for making medical judgments regarding the health of the patient and the client has agreed to follow the veterinarian’s instructions.
  2. The veterinarian has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of the medical condition of the patient. This means that the veterinarian is personally acquainted with the keeping and care of the patient by virtue of:
    1. a timely examination of the patient by the veterinarian, or
    2. medically appropriate and timely visits by the veterinarian to the operation where the patient is managed.
  3. The veterinarian is readily available for follow-up evaluation or has arranged for the following:
    1. veterinary emergency coverage, and
    2. continuing care and treatment.
  4. The veterinarian provides oversight of treatment, compliance and outcome.
  5. Patient records are maintained.

Veterinary prescription drug. A drug that is restricted by federal law to use by or on the order of a licensed veterinarian, according to section 503(f) of the federal Food, Drug, and Cosmetic Act. The law requires that such drugs be labeled with the statement: “Caution, federal law restricts this drug to use by or on the order of a licensed veterinarian.”

HOD – January 2015