---start ethics.lec.02.11.97---

A vet's role regarding suspected abuse:

young man, wife, and 2 y.o kid come with injured 3 mo old puppy weighing 
about 8 kg. husband says puppy fell off the couch. puppy is depressed 
w/head tilt to left, vertical nystagmus. pupillary reflexes are ok 
bilaterally. episcleral hemorrhage is present left lateral surface of 
globe and soft tissue swelling is present on left cranial/temporal 
region. 

rr 40 breaths/min with short, shallow excursions. mm pale pink, sl tacky 
with crt=2 to 3 sec. soft crackles are over the caudal dorsal lung fields 
bilaterally. abdominal palpation is painful in midcranial region. 

husband goes to get checkbook after agreeing on treatment plan. while 
he's gone, wife cries and explains that husband kicked puppy against the 
wall while angry. you speak with her to calm her down, she stops talking 
when husband enters the room.

you discuss finances w/husband and tell him when you'll call w/update. 
husband stops to leave deposit as wife and kid go to car.

Q: is it your job to be concerned w/differentiateing between abuse and 
accidents?

A: (I say yes!)

Q: how do you proceed if animal abuse is suspected and seemingly well 
founded?
A: (i think it varies per case; generally would need to contact 
authorities, IMO)

Q: do you as a vet have a social obligation to assist the wife? if yes 
how so?
A: (again, I think I do. refer for counselling?)

what if:
after a few hrs you call owner w/this update:

chest rads show moderate pulmonary edema in caudal dorsal lung fields, 
likely neurogenic in origin. abdominocentesis yields .5 cc bloody fluid 
w/PCV 10, TS 5.0.

you've put in an IV cath, given steroids, lasix, low volume IV .9%saline 
and O2. puppy has guarded px though sl. improved - you want to monitor 
closely and keep on O2 x 24hrs

husband elects to pick up puppy against your advice. when they arrive, 
wife is wearing dark glasses and says nothing while husband is present . 
you explain puppy is in unstable condition and offer number for emergency 
clinic. husband seems disinterested and is anxious to pay and leave. 
staff proceeds with discharge process.

Q: what if anything would you do in this situation? sociallY? morally? 
professionally?

NOTE: RE EXAM AND COURSE EVAL: course evaluation CAN be anonymous. if one 
person in the group fails to submit an evaluation, the whole group gets 
an incomplete. also re: grading: it's graded with extreme difficulty: not 
on right or wrong, but on how you present your point of view- unless your 
views are completely ludicrous. More important is how you present your 
case, and how you present alternatives. You are not required to cite 
Tannenbaum, but refer to the book if you are having difficulty thinking 
about the problem. What if everyone in the group can't agree? Divide the 
paper up - like a page and a half per person or something. It's due by 
2/26, at noon.

GROUP DISCUSSION:

group one: discussed taking seminars on how to deal with people in these 
situations because we're all socially inept; discussed dogfighting; 
discussed guys brandishing firearms at three am. You're entitled by law 
to inform SPCA about a case such as this. you are not REQUIRED to do it. 
but if you do do it, there are no legal repercussions against you if you 
are wrong. ALso, how to tell if there is abuse or not...if the injuries 
don't match the story, as in this case, that is a strong indicator. 
falling off the couch doesn't cause this kind of damage. Q1: yes it is 
your responsibility to tell difference between abuse and accident - for 
your own records if not to inform. wide variety of opinions in group- 
some would report them, others would not. as a vet, you don't have 
obligation to assist the wife - as a HUMAN BEING, group one says *maybe* 
you have an obligation to assist the wife. boundaries are shifting 
between how a vet is involved w/family issues. 20 yrs ago, not at all. 
Now, there are states involving the vets w/family problems and this may 
become a national issue, so we're going to have to deal with it which is 
weird, because we don't have any classes in it.

group four: Q1: first, make sure animal is treated and that abuser and 
wife don't take puppy away. do whatever needed to treat dog. if you feel 
PERSONAL obligation to do so, call authorities. it's a personal decision, 
not a professional one (NOTE: this is not at all ok with me - hrg). try 
to not jump down client's throat and upset people.

group three: first they decided not to threaten the owner or make any 
interrogation that would upset the owner and make them leave. discussed 
calling authorities, discussed confidentiality issues. decided not to 
assume anything; maybe dog was hit by car and wife was mad at husband so 
falsely accused. all agreed was NOT professional obligation to worry 
about the family (NOTE: WHAT??? Sheesh. this is scary. -hrg). Consider 
followup call to wife. It's our obligation tofocus on animal only, all 
else is personal choice 

group five: this group varied in opinion: from calling cops and trying to 
intimidate the guy to not doing anything. felt that as vets they would 
care for dog and if dog needs critical care would talk to owners and 
offer adoption or payment plan options. also discussed vets should care 
for pet, maybe give wife a card for social services agency and leave it 
up to her to followup (NOTE: finally! -hrg)

group six: reached consensus quickly. one, yes, try to differentiate 
between abuse and injury. recall that criteria are being formed now to 
help. this case seems very clear cut - no couch is that high. try to get 
animal hospitalized - be kind, conciliatory, to keep animal in hospital 
so it doesn't go home. then immediately call the spca, get their advice 
and see what happens. in terms ofthe wife, there's no evidence she's been 
abused. there is a correlation between animal and spouse/child abuse but 
there's no evidence here. Re: them coming to pick up animal, hopefully 
spca would intervene. in PA it is not legal to "fail to provide animal 
care" for you animal, so maybe you could get away with not letting him 
take animal home. about the wife, at that point, you could try to look 
for signs of abuse, if you see them, call social services. morally there 
is an obligation to help wife, but we aren't trained counsellors so 
shouldn't try to counsel her (note: finally someone makes sense-hrg) also 
note that social services won't take third party reports of spousal 
abuse, she has to do it herself.

group two: my group :) we said YES we should differentiate between abuse 
and accident as part of diagnosis and preventive medicine. if you think 
it's abuse, call owner for followup to check puppy status, also call all 
authorities who might be responsible, call local vets, call local VMA for 
guidelines. if puppy died, stillmake a report so it's on record. in 
general, as humans it is our obligation to be liason between wife and 
social services IF SHE ASKS FOR HELP but you can't do it for her. in this 
case, there is no proof of her being abused. but should be supportive to 
her.

FACTS: this was part fact and part fiction. VHUP has had a somewhat 
similar case. one person did try contacting wife later; she apparently 
was not proactive about getting herself help, so no one could do 
anything. SPCA was contacted, husband was spoken to by someone from VHUP 
as well who noted that the injury wasn't consistent w/the story. It was 
decided puppy could stay w/owner as long as it had followup care of three 
exams at VHUP. they did that and puppy never seen again. Guy finally 
admitted abusing puppy.


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