What Happened To Informed Consent?

This story about a vet who fired her client made my blood boil. 

Not because she fired her client. Vets do have the right to choose whether or not to accept a client. But there are much better ways to refuse a client than this story I recently heard. 

Megan Weir (she asked me to use her real name) … is a loving, conscientious dog owner who wanted to make the best choices for her dog, Moe. 

When Megan and Moe moved to Arizona from Oregon 6 years ago, Moe hadn’t been vaccinated before. But in Arizona, their new vets (not the same one in this story) pressured her to vaccinate him. And that meant Moe got over-vaccinated.

Post-Vaccination Health

After vaccination, Moe developed some health issues. Since then, he’s had two knee surgeries … and he has fatty lipomas.  

Megan’s really good at medical research. She does it for herself, managing her own health issues with diet and supplements.  And she does it for her dog too. So when she started researching fatty tumors, she found canine herbalist Rita Hogan. 

She’s been working with Rita since then. With a change in diet and Rita’s herbal protocols, Moe’s health is hugely improved. And Megan has become much more aware of natural health methods for Moe.

Heartworm Prevention

So, recently, when the conventional vet technician offered heartworm medicine for Moe … she said, “no thank you.”  In fact, she said it 3 times, because the tech didn’t want to drop the subject. 

Megan explained again that she’d prefer to do more frequent heartworm testing … rather than give Moe potentially risky heartworm drugs. 

So … that should be the end of the story, right?

But no … it certainly wasn’t. When the vet heard what happened, she wrote Megan a long email. After blasting her for the huge mistake she was making, she fired her as a client. Before I tell you some of the offensive things the vet said, let me give you a bit of background.

Low Risk

First, I mentioned Megan and Moe live in Arizona. In the desert … not exactly a hotbed of mosquito activity or heartworm cases! In fact, the American Heartworm Society 2019 incidence map shows:

  • About 1/3 of Arizona reports less than one case per clinic! 
  • Most of the state has 1-5 cases per clinic
  • One small area shows 6-25 cases per clinic. 

That last number might sound like a lot. But to put it in perspective … there are many southeastern states that report more than 100 cases per clinic. 

So … Moe lives somewhere doesn’t have much risk of getting heartworm. Neither does Moe’s lifestyle put him at a lot of risk. He lives indoors, and goes for walks, hikes and runs with Megan. Sometimes they play fetch at the park. 

Second, Megan’s well aware of the comparative risks of prevention vs treatment. She’s had a dog who went through conventional heartworm treatment before. So … she knows it’s a risky and difficult process.

And if she ever has another dog with heartworm, she’ll use natural methods like herbs to treat it. In fact, Rita Hogan has successfully treated many heartworm cases. Moe probably won’t get heartworm … but if he does, he’s in good hands. 

Related: 10 natural DIY mosquito repellents for your dog …

The Risks Of Heartworm Drugs

Megan had read about the risks of heartworm preventive drugs. Preventive is the wrong word. They don’t prevent heartworms … they just kill heartworm larvae that are already in your dog. And these drugs that poison the heartworms (by paralyzing them) … can poison your dog too. Common side effects of heartworm medications are problems like … 

  • Vomiting
  • Diarrhea
  • Depression
  • Lethargy
  • Itching
  • Mydriasis (dilated pupils)
  • Anorexia
  • Ataxia (staggering)
  • Hypersalivation (drooling)
  • Convulsions
  • Weakness

RELATED: Why I don’t give my dogs heartworm medicine (and why you shouldn’t either) …

So Megan made a sensible, well-informed decision. She’ll use more frequent heartworm testing … instead of giving Moe these risky drugs. 

The Vet’s Reaction

What Megan didn’t expect was the reaction she got from the vet.  This vet not only fired her as a client for saying no … she wrote her a long, accusatory diatribe! 

And this is a vet whose website claims she uses … “a number of natural remedies to go along with your pet’s traditional treatments.”  So you might expect her to be a little more accepting of a dog owner’s decision not to risk certain drugs!

She practices in the State of Arizona. The Arizona State Veterinary Medical Examining Board  Administrative Rules state … (under section R3-11-501 Ethical Standards):

“A veterinarian shall show respect for the veterinarian’s colleagues, the owner of an animal to whom veterinary medical services are being provided, and the public through courteous verbal or written interchange, considerate treatment, professional appearance, professionally acceptable procedures, and use of current professional and scientific knowledge.”

What do you think? Did Megan receive respect or courteous, considerate treatment from her vet!? Read on and decide! 

What The Vet Said

Here are some of the things the vet said. I’ve quoted directly from her email. 

Laying On The Guilt

“HEARTWORM DISEASE TAKES APPROXIMATELY 6 MONTHS TO SHOW UP ON A TEST.  There is NO SUCH thing as catching heartworm disease “early”.  There are also FALSE NEGATIVES that happen with heartworm tests. Do you really want to roll the dice with Moe’s life like that? 

“There is NO excuse, if you love your dog, to not prevent this awful disease.”

Wow! Nothing like trying to make someone feel bad! This vet all but accused Megan of being a negligent dog owner! 

And it’s nonsensical to say that more frequent testing won’t catch heartworm disease earlier. Logically, if you test more often, you’ll find out sooner if your dog’s infected!

(That’s especially true if you opt for Healthgene’s Heartworm DNA test. It identifies heartworms at the larval stage. The antigen tests most vets run only find adult, female heartworms.)

Overstating Drug Safety

The vet then explained how safe Heartgard is. And how horrible and dangerous conventional heartworm treatment is. (That last part is true … but, as we know, Megan’s well aware of that!). 

“Heartgard – Very safe.  Safe for all dogs, even pregnant and nursing dogs. Safe for Collie breeds, even one with the drug-sensitivity gene.  A dog could eat an entire year’s worth and not have any ill effects.  Very easy and not stressful for the dog (a once a month “cookie”).  It is only in the body for 24-48 hours each month.  Even safe for cats.”

So … let’s look at some of those statements.

 “Very safe.”  Really?  Hundreds of holistic vets and dog owners who’ve witnessed the side effects will tell you otherwise. Even the manufacturer’s prescribing information agrees …

The following adverse reactions have been reported following the use of HEARTGARD: Depression/lethargy, vomiting, anorexia, diarrhea, mydriasis, ataxia, staggering, convulsions and hypersalivation. 

“Safe for Collie breeds.” Moe is a Lab-Pit mix, not a Collie. So this isn’t really relevant. But since the vet brought it up, here’s the prescribing information. 

Studies with ivermectin indicate that certain dogs of the Collie breed are more sensitive to the effects of ivermectin administered at elevated dose levels (more than 16 times the target use level) than dogs of other breeds. At elevated doses, sensitive dogs showed adverse reactions which included mydriasis, depression, ataxia, tremors, drooling, paresis, recumbency, excitability, stupor, coma and death.

They then say that trials show no toxicity in Collies at 10 times the normal dose. But we don’t have any details of those trials … so I can’t really comment on how the company reached that conclusion. There are lots of unknowns. For example … 

  • How long were the trials? 
  • How many dogs? 
  • Did any adverse effects occur? 
  • What happens at 11 times the dose? (Because you know there’s a reason they picked 10 as the safe number. And they admitted studies show 16 times is dangerous!)

“A dog could eat an entire year’s worth and not have any ill effects.” Even for non-Collies …. there’s absolutely no basis for the vet to confidently make this statement.  (So please, don’t give your dog 12 Heartgard chews at once!)

(By the way, most vets aren’t prescribing just plain Heartgard (Ivermectin). They usually give Heartgard Plus. That drug also contains Pyrantel to control worms. So it adds another unnecessary level of risk, to kill a parasite your dog may not even have!) 

You’re A Bad Dog Owner

Next, the vet gives a long and lurid description of how horrible heartworm treatment is. And she continues with more melodrama and accusations … presumably intended to provoke more fear and guilt in Megan. 

“If your dog could pick which route you take, prevention or treatment, which do YOU think they would choose?

“If you would purposely let your pet get heartworm that is easily preventable with a product that is extremely safe, and would rather confine your pet for 8–12 months while simultaneously giving him/her multiple drugs and treatment injections that are highly noxious and unsafe, and subject them to multiple veterinary visits and cross your fingers that they Live through this if your dog contracts this deadly disease, then you are grossly misinformed about the disease, and are Not acting in the best interest of your pet.”

This haranguing by the vet is bad enough. But it gets worse. 

Apparently, You Don’t Get To Choose

This is the part that really made me fume.

“As a licensed doctor for pets, I know what is best for them medically and I give the recommendations that are appropriate.  You can follow them or not follow them, that is up to you.” (Turns out she doesn’t really mean that last part!)

What I do not do is let a lay person tell ME what is best for their pet, and then mindlessly do things that are in direct conflict with the pet’s best interest.

You do not get to pick and choose what I do for your dog, as I will only do what is in your pet’s best interest, and I will never do what endangers your pet or encourages neglect of your pet.”

So let’s see. As a dog owner, I pay you, the vet, to take care of my dog. But you expect me to leave all the decision-making up to you? I don’t get to choose what treatments I want for my dog?

That’s outrageous. And it’s ethically and legally wrong. 

You see, there’s a little concept called Informed Consent

It means that the vet should inform you of the risks, benefits and costs of what she recommends. 

Here’s the policy of the American Veterinary Medical Association (AVMA): 

“Informed consent better protects the public by ensuring that veterinarians provide sufficient information in a manner so that clients may reach appropriate decisions regarding the care of their animals.

“Veterinarians, to the best of their ability, should inform the client or authorized agent, in a manner that would be understood by a reasonable person, of the diagnostic and treatment options, risk assessment, and prognosis, and should provide the client or authorized agent with an estimate of the charges for veterinary services to be rendered. The client or authorized agent should indicate that the information is understood and consents to the recommended treatment or procedure.

“Documentation of verbal or written informed consent and the client’s understanding is recommended.”

But this vet only gave information to the client after the fact. And she did it in a very one-sided manner! She didn’t even give Megan a chance to change her mind … because in the same email, she fired her as a client. 

In legal terms, this concept is even clearer. Here’s an excerpt from a 2004 article on the informed consent doctrine. It was published in a section on Veterinary Medicine and the Law … in the Journal Of American Veterinary Medicine).

“While there is no provision in the law prohibiting assault against animals, a person does have nearly absolute control over his or her own property, and animals are, for most legal purposes, considered property. Thus, animal owners enjoy certain property rights, and the power to consent or deny consent to a medical procedure is one of those rights. From this, it follows that any unconsented harm caused by a veterinarian to an animal owned by another individual would likely violate a property right and therefore be a form of civil wrong. It is on this basis that the informed consent doctrine applies to animals, and, thereby, to veterinarians.”

And by the way, that’s why we recommend you describe yourself as your dog’s owner. Not his guardian, his pet parent or even his mommy! It’s an important legal distinction. Because “ownership” gives you the right to make the decisions for your dog!

RELATED: Pet parents or owners: what’s in a name? …

You’re Fired! 

The vet ended with more insults, saying…

“While I do hope that you realize that believing un-educated things on the internet rather than your licensed veterinarian is negligence to your pet, and while I have enjoyed Moe, Tater and Tott, please consider this a cancellation of your upcoming appointment, and any others in the future.”

So … what did Megan think about this email? 

Megan’s pretty outraged and insulted. Here’s what she told me in a phone conversation today. And yes, she gave me permission to quote her. In fact, she kindly repeated it so I could get it written down!

It’s the most bullshit, asinine, bullying, ignorant email I’ve ever received from anybody in the medical field.”

Megan replied to the vet suggesting that, as two adults … it would have been far preferable to have an adult conversation on this topic. But instead … the vet berated her. She treated Megan like a neglectful, ignorant dog owner … who should obey all the vet’s instructions without question. 

I’ve read that vets get trained in using persuasive skills to achieve “owner compliance.” Apparently, this vet skipped those classes! 

Reasonable vets don’t think this way. They welcome discussions with their clients. In fact, in a recent article for DNM, Karen Rabin DVM said this:

“Becoming a valued part of the decision-making team […] will create a stronger bond and a supportive alliance with your veterinary team. It can mean satisfaction rather than frustration, disappointment and sub-optimal results. It can allow for out-of-the-box thinking. You might even find it’s fun!”

Anybody getting medical care needs an advocate … and for your dog, that’s you! Don’t let bullying vets push you into treatments you don’t want for your dog. 

I’m confident Megan is looking for a new vet right now! You and your vet don’t have to agree about everything. But you do need to find a vet who’ll at least consider and calmly discuss your wishes for your dog. 

RELATED: How to work with your vet: agree to disagree …

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