Principles of veterinary medical ethics of the AVMA

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Introduction

Doctors of veterinary medicine are medical professionals who have earned advanced academic degrees from 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 and earns respect and trust from clients and the public. All veterinarians are expected to adhere to a set of foundational principles that guide a progressive code of ethical conduct collectively known as the Principles of Veterinary Medical Ethics (PVME).

Ethical decision making involves balancing competing interests in a specific situation. The PVME should be used in this context and interpreted in its entirety rather than selectively applying a single section. The PVME is intended to provide ethical guidance for all veterinarians. Ethical dilemmas specific to subgroups within the profession may not be covered in this document and may require referencing Codes of Conduct specific to those groups.

The PVME comprises the Principles, the Code of Conduct, and Definitions. Words that are italicized are defined in the definition section at the end of the document.

The Principles

Three fundamental principles form the foundation of the Principles of Veterinary Medical Ethics: Stewardship, Integrity, and Respect. These are aspirational goals for the veterinary profession, which provide guidance and offer justification for the Code of Conduct.

Stewardship: Veterinarians have an ethical responsibility to alleviate suffering, promote health, and act in the best interests of their patients in balance with the interests of their clients, the environment, and the public.

Integrity: Veterinarians have an ethical responsibility to be honest and truthful in all interactions with clients, patients, and their community.

Respect: Veterinarians have an ethical responsibility to demonstrate respect to all patients, clients, and members of their community, including self and professional colleagues.

The Code of Conduct

The Code of Conduct is an expression of specific types of behaviors that are either expected or required of members of the veterinary profession.

The Code of Conduct comprises 3 sections:

  1. Provide competent medical care
    1. Veterinarian-Client-Patient Relationship
    2. Consultation
    3. Referral
    4. Emergency care
    5. End-of-life considerations
    6. Continuing professional education and client and public education
  2. Prioritize patient welfare in balance with client needs and public safety
    1. Contextual care
    2. Evidence-based medicine
    3. Genetic defects
    4. Conflicts of interest
    5. One Health
  3. Uphold standards of professionalism
    1. Professional image
    2. Honesty and integrity
    3. Respect for others
    4. Autonomy
    5. Supervision
    6. Titles
    7. Confidentiality and record keeping
    8. Fee setting
    9. Impairment
    10. Recognize and respect the law
  1. Provide competent veterinary medical care
    1. Veterinarian-Client-Patient Relationship
      1. A veterinarian shall provide competent veterinary medical care under the terms of a veterinarian-client-patient relationship (VCPR), with compassion and respect for animal welfare and human health. A veterinarian should first consider the needs of the patient to prevent and relieve disease, suffering, or disability while minimizing pain, fear, anxiety, stress, and distress.
      2. Both the veterinarian and the client must agree to the establishment of a VCPR. To assist clients with their decision to accept or decline treatment, veterinarians should share their clinical findings, recommended diagnostic tests and treatment, prognosis, related risks, and estimated cost of services. When a veterinarian has assumed responsibility for making medical judgments regarding the health of the patient and the client has agreed to follow the veterinarian’s instructions, a VCPR is established.
      3. A client may terminate the VCPR at any time.
      4. Once the veterinarian and client have established a VCPR and the veterinarian has begun patient care for an illness or injury, the veterinarian shall not neglect their patient and must continue to provide professional services related to that illness or injury within the previously agreed limits.
        1. As subsequent need and costs for patient care are identified, the veterinarian and client should confer and reach agreement on the approach to continued care and responsibility for fees. If the informed client declines further care or declines to assume responsibility for its cost, the VCPR may be terminated by the veterinarian.
        2. If there is an immediate medical or surgical condition, and the patient is to be referred or transferred to another veterinarian for diagnosis and treatment, the attending veterinarian should continue to oversee care, as practicable, during the transition.
      5. A veterinarian may decline to establish a VCPR or to provide care for an existing patient in certain circumstances.
        1. The client requests care that is beyond the veterinarian’s competence or scope of practice, is known to be scientifically invalid, has no medical indication, or cannot reasonably be expected to achieve the intended clinical benefit.
        2. The veterinarian lacks the resources needed to provide safe and competent care for the patient.
        3. The client is abusive or threatens the veterinarian or staff.
        4. The veterinarian believes the environment, patient, or client threatens the safety of themselves or their staff.
        5. The client has indicated that they have lost trust or confidence in the veterinarian to the degree that the veterinarian no longer feels comfortable providing care.
        6. The client asked the veterinarian to act in an unethical manner.
        7. If there is no immediate medical or surgical condition, a veterinarian may terminate a VCPR by notifying the client that they no longer wish to serve that patient and client.
        8. When a veterinarian is not available, they should provide readily accessible information to assist clients in obtaining needed services.
      6. Multiple VCPRs may exist concurrently.
      7. A veterinarian who in good faith engages in the practice of veterinary medicine by rendering or attempting to render emergency or urgent care, including euthanasia, to an animal when a client cannot be identified and a VCPR is not established should act in the best interest of the animal, irrespective of the veterinarian’s inability to establish a VCPR.
    2. Consultation
      1. Consultations involve the exchange of information between professional colleagues to gain insights and advice on the care of a patient. A veterinarian should seek assistance from veterinary specialists or other qualified experts when indicated.
      2. The attending veterinarian continues to be responsible for the patient and maintains the VCPR when a consultation occurs.
    3. Referral
      1. Referral is the transfer of responsibility of diagnosis and treatment from a referring veterinarian to a receiving veterinarian. A veterinarian who lacks the expertise or resources to manage and treat certain patients in the best manner should advise the client that more qualified or specialized services may be available elsewhere and should recommend referral.
      2. An attending veterinarian should honor a client's request for referral.
        1. A new VCPR must be established with the veterinarian to whom a case is referred.
        2. The referring veterinarian should provide the receiving veterinarian with information pertinent to the case before or at the time of the receiving veterinarian's first contact with the patient or the client.
        3. When the referred patient has been examined, the receiving veterinarian should inform the referring veterinarian of their findings in a timely manner. A report of findings should include a diagnosis, proposed treatment plan, and other recommendations.
        4. Following discharge of the patient, and in a timely manner, the receiving veterinarian should provide the referring veterinarian with a written report advising the referring veterinarian as to the continuing care of the patient or conclusion of the case.
      3. When a client seeks professional services or an opinion from a different veterinarian without a referral, a VCPR must be established with the new veterinarian. Upon client consent, the veterinarian who was formerly involved in the diagnosis and treatment of the patient should provide the medical record to the new attending veterinarian.
    4. Emergency care
      1. When physically presented with an animal affected by a condition that involves extreme pain or suffering and/or poses an immediate risk to the animal’s life as determined by a veterinarian, the veterinarian has an ethical responsibility to provide care for that animal (subsequent to client agreement or until such agreement can be obtained when no client is present) with the goal of preventing and/or relieving animal suffering.  Such care may be limited to stabilization of the patient for transport to another source of veterinary care or euthanasia to relieve suffering.
      2. A veterinarian should make their best effort to ensure that emergency care is available to manage an adverse event related to a treatment or procedure performed on a patient under their care.
      3. When a veterinarian is not available, they should make a good faith effort to provide readily accessible information to assist clients in obtaining emergency services, consistent with available resources.
      4. A veterinarian is not expected to provide emergency care for an animal when the veterinarian does not possess the expertise, or resources needed to manage the emergency. The veterinarian should advise the animal owner of same and make a good faith effort to refer the owner to an appropriate provider.
      5. Veterinarians who provide emergency services should offer to send patients and records back to the veterinarian of record and/or the veterinarian of the clients’ choice as soon as practical to support continuity of care.
    5. End of life considerations
      1. Euthanasia of animals is an ethical veterinary procedure when the “AVMA Guidelines for the Euthanasia of Animals” is followed, including when euthanasia is necessary to relieve intractable pain and suffering  and it is not possible to identify or contact the owner.
      2. Slaughter of animals is an ethical procedure when the “AVMA Guidelines for the Humane Slaughter of Animals” is followed.
      3. Depopulation of animals is an ethical veterinary procedure when the “AVMA Guidelines for the Depopulation of Animals” is followed.
    6. Continuing professional education and client and public education
      1. A veterinarian should continue to study, apply, and advance scientific knowledge, and remain committed to veterinary medical education. Veterinarians are encouraged to collaborate with other professionals in their quest for knowledge and professional development.
      2. Veterinarians are encouraged to make their knowledge available to their communities to enhance their colleagues’, clients’, and the public’s understanding of animal health and welfare, and to offer their services for activities that protect public health.
  2. Prioritize patient welfare in balance with client needs and public safety
    1. Contextual care
      1. A veterinarian should be prepared to offer a range of diagnostic, treatment, and when deemed appropriate, referral options that meet the needs of both the patient and the client.
      2. Contextual considerations include those related to the patient, client, veterinarian, and practice, and are often unique to each case.
      3. If less advanced diagnostic or treatment options are chosen by a client, procedures should be carried out in such a way that an acceptable standard of care for those options is met.
      4. A veterinarian does not have an ethical obligation to deliver care or perform procedures requested by a client that they believe would cause unnecessary pain and suffering for the patient and that is unlikely to be beneficial.
    2. Evidence-based medicine
      A veterinarian should prioritize the delivery of evidence-based medicine and should inform the client when there is a lack of scientific evidence for a recommended therapy.
    3. Genetic defects
      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 misleading to the public and is unethical. However, should the health or welfare of the individual patient require correction of such genetic defects, a veterinarian should recommend that the patient not be used for reproduction.
    4. Conflict of interest
      1. A veterinarian should balance the welfare of the patient, the communicated needs of the client, the safety of the public, and the need to uphold the public trust vested in the veterinary profession; and should avoid conflict of interest or the appearance thereof. A veterinarian should not allow any interests, other than those mentioned above, to influence their choice of treatment for their patient.
      2. A veterinarian should consider the potential for creating a conflict of interest (or the appearance thereof) when deciding whether to participate in vendor incentive programs or other arrangements where the veterinarian receives a benefit for using or prescribing a particular product or service.
      3. A veterinarian who provides an endorsement or testimonial for a commercial product should publicly disclose if they are being compensated for their support, including when the veterinarian has ownership interest in the product.
      4. A veterinarian should not allow their medical judgement to be unduly influenced by personal financial interests or employer expectations regarding production quotas.
      5. The medical judgment of a veterinarian should not be influenced solely by contracts or agreements made by their associations or societies.
      6. A veterinarian should not offer or receive any financial incentive solely for the referral of a patient (fee-splitting).
      7. A veterinarian should disclose potential conflicts of interest to clients.
    5. One Health
      1. Humans, animals, and the environment are inextricably linked, and veterinarians should support collaborative efforts to attain optimal health for all three.
      2. A veterinarian should support efforts and actions that mitigate undesirable environmental impacts related to the practice of veterinary medicine.
  3. Uphold standards of professionalism
    1. Professional image

      A veterinarian should conduct themselves in a professional manner with respect to their veterinary colleagues, clients, other healthcare professionals, and the public.

    2. Honesty and integrity
      1. A veterinarian should be honest in all interactions, and report veterinarians or other veterinary professionals who endanger the health or safety of patients, or are deficient in character or competence, to the appropriate entities.
      2. A veterinarian has an ethical responsibility to report suspected animal cruelty and/or abuse.
      3. A veterinarian should not make false or misleading statements that would defame or injure the professional standing or reputation of other veterinarians. A veterinarian must be honest and fair in their relations with others, and they should not engage in fraud, misrepresentation, or deceit.
      4. Advertising by a veterinarian 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.
        1. Testimonials or endorsements are advertising. A veterinarian should limit their use and only permit representations that are readily subject to verification.
        2. A veterinarian should comply with applicable law and guidelines, such as those issued by the Federal Trade Commission on the use of endorsements and testimonials in advertising.
    3. Respect for others
      1. A veterinarian should treat everyone with respect and dignity and should support an inclusive and welcoming atmosphere that facilitates access to quality veterinary services for all patients.
      2. A veterinarian should model professional behavior and assess individuals solely on their abilities and qualifications without bias, prejudice, and/or discrimination.
      3. A veterinarian and their team should seek to foster understanding and sensitivity toward diverse cultures and backgrounds.
    4. Autonomy
      1. In keeping with applicable law and any employment agreement, a veterinarian should, in the provision of patient care, be free to choose whom to serve, with whom to associate, and the environment in which to provide veterinary medical care.
      2. All decisions that affect the diagnosis and treatment of patients are made by the veterinarian within the context of a VCPR, regardless of practice ownership.
    5. Supervision
      1. A veterinarian having supervisory authority over others should make reasonable efforts to ensure that their conduct conforms to the Principles.
      2. It is unethical for a supervising veterinarian to support or condone conduct that violates the Principles.
    6. Titles
      1. A veterinarian 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.
      2. It is unethical for a veterinarian to identify themselves as certified by an AVMA-recognized specialty organization if such certification has not been awarded and maintained. Use of the term ‘specialist’ should be reserved for a veterinarian who is currently board-certified by an AVMA American Board of Veterinary Specialties-recognized veterinary specialty organization or other veterinary specialty organization that maintains comparable certification requirements.
      3. Veterinarians who focus their practice on a specific species or area of veterinary medicine may use the phrase “practice limited to” but should not use the terms “specialist” or “specializing in”.
      4. The terms “board eligible” or “board qualified” are misleading and should not be used by veterinarians.
      5. A veterinarian should only represent those who are credentialed as a veterinary technician in their state as a “credentialed veterinary technician”.
    7. Confidentiality and record keeping
      1. A veterinarian shall respect the privacy rights of clients, colleagues, and other health professionals and should safeguard medical information within the confines of the law.
      2. A veterinarian must protect the personal privacy of clients and must not reveal confidences unless required to do so by law or it becomes necessary to protect the health and welfare of other individuals or animals.
      3. 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 client consent.
        3. A veterinarian is obligated to provide copies or summaries of medical records when requested by the client.
        4. Without the express permission of the client and the practice owner, it is unethical for a veterinarian to remove, copy, or use the medical record or any part of any record for personal or professional gain.
      4. A veterinarian who is requested to validates the health of an animal for the purpose of ownership transfer should request that the potential new owner obtain records of previous diagnoses and treatments for the veterinarian’s review.
      5. A veterinarian taking over the care of a patient from another veterinarian should request that the owner obtain prior medical records that reflect diagnoses and treatments affecting that animal for the new veterinarian’s review.
    8. Fee setting
      1. A veterinarian (to include those attending, consulting, receiving, and referring) is entitled to charge fees for their professional services.
      2. Regardless of the fees that are charged or received, the quality of services must be maintained at the usual professional standard.
      3. A veterinarian may charge a fee for the services the veterinarian provides in conjunction with the use of third-party providers, including, but not limited to, laboratories, pharmacies, and consultants.
      4. A veterinarian shall honor a client’s request for a prescription or veterinary feed directive in lieu of dispensing, but may charge a fee, pursuant to state regulations, for this service.
      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.
    9. Impairment
      1. A veterinarian owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.
      2. A veterinarian should refrain from offering professional services when their physical, mental, or emotional state could endanger themselves, a patient, or others.
      3. A veterinarian who is impaired must not act in the capacity of a veterinarian and should seek assistance from qualified organizations or individuals.
      4. Veterinarians should encourage impaired colleagues to seek assistance and to overcome their impairment.
    10. Recognize and respect the law
      1. A veterinarian shall obey all laws of the jurisdictions in which they reside and practice veterinary medicine.
      2. A veterinarian should recognize a responsibility to seek changes to laws and regulations that are contrary to the best interests of the patient and public health.
      3. It is unethical to place professional knowledge, credentials, services, or pharmaceuticals at the disposal of any organization, group, or individual to promote or lend credibility to the illegal practice of veterinary medicine.

Definitions

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.

Client: The patient's owner, owner's agent, or other person presenting the patient for care.

Conflict of interest: A situation where personal interests could compromise judgement, decisions or actions made on behalf of a patient or client.

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

Deceit: Concealing or distorting the truth for the purpose of misleading.

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

Endorsement: Approval or sanctioning of an individual, product, or procedure.

Evidence-based medicine: Evidence-based veterinary medicine integrates the best research available with clinical expertise and considers the unique needs of each client.

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.

Fraud: Wrongful deception intended to result in personal or financial gain or to deprive another of a right.

Impairment: The inability to perform duties 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.

Misrepresentation: The act or state of being represented incorrectly, improperly, falsely, or unsatisfactorily.

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.

Professional: An individual person who does a job that requires special training and a high level of education.

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.

Resources: Facilities, equipment, medication and supplies, staff and time needed to effectively perform veterinary services required for a specific case.

Specialist: A veterinarian who has been board-certified in a medical specialty by an AVMA American Board of Veterinary Specialties‐recognized veterinary specialty organization or other veterinary specialty organization that maintains comparable certification requirements.

Testimonial: Statement intended to influence attitudes regarding the purchase or use of products or services.

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

  1. The veterinarian has assumed responsibility for making medical judgments regarding the health of a patient(s) and the need for medical treatment, and the client has agreed to follow the veterinarian’s instructions.
  2. The veterinarian has sufficient knowledge of the patient(s) to initiate at least a general or preliminary diagnosis of the medical condition(s) of the patient(s). This means that the veterinarian is personally acquainted with the keeping and care of the patient by virtue of:
    1. a timely in-person physical examination of the patient(s) by the veterinarian, or
    2. medically appropriate and timely visits by the veterinarian to the operation where the patient(s) is(are) kept, or
    3. both
  3. The veterinarian is readily available for follow-up evaluation or has arranged for the following:
    1. emergency or urgent care coverage, or
    2. continuing care and treatment have been designated by the veterinarian with the prior relationship to a licensed veterinarian who has access to the patient’s medical records and/or who can provide reasonable and appropriate medical care.
    3. The veterinarian provides oversight of treatment.
  4. Patient records are maintained