Veterinary Medical Ethics

Ethical question of the month — January 2019

Even prior to the legalization of recreational marijuana in Canada you received regular queries regarding the use of cannabinoids to treat dogs and cats. You have been careful to explain that there is little research on the use of cannabis-based products to treat dogs and cats. Nevertheless, owners regale you with stories from friends and relatives whose arthritic or epileptic pet became asymptomatic following treatment with a cannabinoid product. Commonly these stories include the fact that until the cannabinoid was used, the family’s veterinarian had been unable to relieve the animal’s suffering. It is apparent some clients believe you will not even provide a dosage because you wish to protect your prescription drug sales. Today you are treating a dog with an apparent cannabis overdose after the owners decided to experiment with products and dosages on their own. The testimonials on the Internet are winning out over your professional conservatism. How should you respond?

An ethicist’s commentary on clients want of marijuana use

The ability of the human mind to perceive in accordance with its expectations is remarkable and well-documented. This is a phenomenon well-known to attorneys who take testimony from witnesses. It was also the subject of an 1841 book by Scottish journalist Charles Mackay titled Extraordinary Popular Delusions and the Madness of Crowds about mass hallucinations in large groups of people precipitated by expectations. The famous story fabricated by then journalist Arthur Machen during a dull period of trench warfare during World War I in Belgium, relating how St. George appeared in the skies wielding a flaming sword to rally British troops was not only attested to by witnesses at the time, but “recalled” many years later.

I experienced this as a college student. One of my roommates could not take finals without ingesting copious amounts of amphetamines to keep him awake, which he acquired from a drug dealer serving the students at Columbia University. One exam week the dealer was not present, and my roommate became virtually hysterical worrying about his inability to study without the usual amphetamines. He was so upset that I went down to a local candy shop selling little blue sugar pills mounted on paper. I bought a dollar’s worth, put them in a pill bottle, and told him that they were extraordinarily powerful amphetamines from Germany. After ingesting the usual number, he came to my room and claimed he was unable to “come down” from the high created by the pills for days after the exams!

Such stories can be endlessly proliferated. Germane to our case are the number of “alternative medical and veterinary medical” treatment modalities that have become extremely popular. In fact, in defense of a science-based approach to treatment, renowned equine veterinarian Dr. David Ramy and I co-authored a book titled Complementary and Alternative Veterinary Medicine Considered, in which we examined a number of alternative veterinary medical modalities that were popular but totally unfounded in terms of scientific evidence. These included colored lights, magnet therapy, Bach flower essences, and other treatments that were wildly popular, but enjoyed no evidential base other than testimony from satisfied clients. Eventually, the veterinary establishment gave up, realizing there was money to be made and many clients were true believers and even began to teach this nonsense in veterinary school!

It should be well-known to all veterinarians that just because a given medicament works in people, that does not mean that it works in animals and is even safe for use in animals. A famous example of this is the use of aspirin in cats, in which a totally benign dose for humans can kill cats because of metabolic differences.

Many clients have resorted to using marijuana for their animals, particularly in cases in which conventional therapies have failed. Despite a wealth of anecdotal evidence, very few controlled studies have been conducted. Furthermore, cannabis contains over 60 biologically active substances, so it is difficult if not impossible to know what has helped the animal, or whether the help is actually a result of the owner expectations.

In the light of the legalization of marijuana by the Canadian government and the ever-increasing legalization of marijuana by States as well as its use in a various of medical contexts for humans, ranging from control of pain to reducing the powerful negative symptoms of Post-Traumatic Stress Disorder (PTSD), it certainly behooves veterinary medicine to undertake carefully designed, well-controlled studies of the effectiveness of marijuana for a variety of veterinary problems. Failure to do this creates perfect conditions for “prescription by Internet, and anecdote,” and, equally importantly, a loss of credibility for veterinary medicine in the mind of the general public.

As imperfect as randomized clinical trials may be (the problems with such trials is the subject of another discussion), they are far superior to totally unfounded claims promulgated by “the grapevine.” At least science provides something of an objective evidential base for acceptance and rejection of therapeutic modalities.

Ethical question of the month — April 2019

Your commercial poultry practice also works with smaller hobby farms. One morning you perform a flock health inspection on a large and well-run commercial duck farm with thousands of ducks on feed. This farm has excellent production and extremely low morbidity and mortality. You notice a couple of birds that are thin and unable to rise but do not discuss them with the producer or require further action since these 2 “poor doers” are outliers in an otherwise extremely healthy flock. Later that day you visit a small farm with 50 ducks where several unexpected deaths have occurred. Two birds are weak and mouth breathing. You discuss possible diagnoses with the owner and explain that the 2 birds should be euthanized on humane grounds. The owner readily agrees. Then you recall your earlier visit where you considered 2 “poor doers” insignificant in your overall flock health assessment. Should you have stopped to address 2 unrepresentative sick birds while you were performing a health inspection on thousands?

Responses to the case presented are welcome. Please limit your reply to approximately 50 words and forward along with your name and address to: Ethical Choices, c/o Dr. Tim Blackwell, 6486 E. Garafraxa, Townline, Belwood, Ontario N0B 1J0; telephone: (519) 846-3413; fax: (519) 846-8178; e-mail: tim.e.blackwell@gmail.com

Suggested ethical questions of the month are also welcome! All ethical questions or scenarios in the ethics column are based on actual events, which are changed, including names, locations, species, etc., to protect the confidentiality of the parties involved.