Special Report Rapport spcial

A call for a national guidance document for veterinary professional conduct in Canada
Barbara S. Horney

he Canadian Veterinary Oath, endorsed by the Canadian Veterinary Medical Association (CVMA) in 2004, states: As a member of the veterinary medical profession, I solemnly swear that I will use my scientific knowledge and skills for the benefit of society. I will strive to promote animal health and welfare, relieve animal suffering, protect the health of the public and environment, and advance comparative medical knowledge. I will practise my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics. I will strive continuously to improve my professional knowledge and competence and to maintain the highest professional and ethical standards for myself and the profession. (1)

This oath is typically recited (although not officially required) by graduating veterinarians in white coat ceremonies across Canada and is recognized by most, if not all, practicing veterinarians in this country. It may come as a surprise to know that there is no Canadian document titled the principles of veterinary medical ethics nor is there any other national document outlining general guiding principles, values, and conduct of the profession, apart from the oath. This makes the Canadian veterinary profession unique among other Canadian professions and different from veterinary professional groups in other countries. In this essay, I add my voice to Dr. George Guernseys earlier call for the creation of a national guide for professional ethics (2). A consensus document containing a common vision of ideal professional values, principles, and conduct is important in helping to guide our professions commitment to public service in our area of expertise. Re-examination of the traditional values of veterinary medicine in light of the changes in veterinary medical practice and society would help us retain our relevance Department of Pathology and Microbiology, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island. Address all correspondence to Dr. Barbara Horney; e-mail: horney@upei.ca Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office (hbroughton@cvma-acmv.org) for additional copies or permission to use this material elsewhere.
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and value to society. In medicine, the term professionalism has been described as observable behaviours from which the norms and values of the medical professional can be visualized (3). A clear, collective understanding of those values and principles and a lived, embodiment of professionalism in practice is required to maintain the trust of the public and to help us deal with changes in society and the practice of veterinary medicine. The creation of a public, national document would strengthen the social contract that the veterinary profession has with the Canadian public as well as rejuvenate our individual and collective awareness and commitment to the values and responsibilities of veterinary medicine. The CVMA is the most logical group to undertake the creation of such a document, similar to the Principles of Veterinary Medical Ethics of the American Veterinary Medical Association (AVMA) in the United States or the Guide to Professional Conduct for Veterinary Surgeons of the Royal College of Veterinary Surgeons (RCVS) in the United Kingdom (4,5). The lack of a Canadian national guidance document may have come about as a quirk of veterinary professional history. The Veterinarians Oath approved by the AVMA contains the same reference to the principles of veterinary medical ethics. In the United States this phrase refers directly to an AVMA document of that title, which is the most recent iteration of the original AVMA Code of Ethics initially sanctioned in 1867. Prior to the formation of the CVMA in 1948, Canadian and Mexican veterinarians were members of the AVMA, a North America-wide veterinary association which had changed its name in 1898 from the USVMA to the AVMA to reflect the international membership (6). After the formation of the CVMA, no parallel guidance document was adopted by the Canadian association, although the reference to the principles was retained in the Canadian oath. Professions, including veterinary medicine in Canada, are permitted autonomy and self-regulation in recognition of the complex and specialized knowledge required for professional practice (7). An excellent definition of profession is found in Baillires Comprehensive Veterinary Dictionary: a calling or vocation requiring specialized knowledge, methods and skills, as well as preparation, in an institution of higher learning, in the scholarly, scientific and historical principles underlying such methods and skills. A profession continuously enlarges its body of knowledge, functions autonomously in formulation of policy, and maintains by force of organization or
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concerted opinion high standards of achievement and conduct. Specifically in this regard it maintains and polices a code of ethics and conducts a professional organization of which a majority of the profession are members. Members of a profession are committed to continuing study, placing service above personal gain, and are committed to providing practical services vital to human and social welfare. (8) This definition is similar to those proposed for human medicine (9,10). By definition then, the ultimate goal of a profession is to promote public good through service to society in an area of special knowledge and skill. A code of ethics is required to clearly outline the values and expected conduct of the members and the profession is permitted self-regulation and autonomy in practice. The licensing of veterinarians and the practice of veterinary medicine in Canada are regulated by provincial bodies and rules (or codes) for professional conduct are, indeed, found within the provincial statutes or accompanying legislation (11). The provincial veterinary medical associations in some provinces have created a separate code of professional ethics that sets out expectations of the members beyond the legally enforceable statutory code. The contents of these rules or codes (statutory and other) are not uniform across provinces and public access to these documents is variable. The interaction between the human medical profession and society has been described as a social contract with reciprocal obligations and expectations between society and the profession (12). Although it is not a formal, legal contract, this implicit agreement permits professions considerable autonomy in practice and setting of educational standards, a monopoly over the application of their knowledge, financial and non-financial rewards, and the privilege of self-regulation. These privileges are granted by society in return for the assurance of physician commitment to public good, competence in practice, trustworthiness of the professionals, and the expectation that members of the profession will place the interests of the patient and public above their own (10,12). Self-regulation by the professional group is considered to be the best method of regulating services that fill a societal need but require specialized knowledge (13). This implicit exchange of obligations and expectations between the profession and the public rests on mutual trust. The failure of the profession or individual members to meet (or be seen to meet) the expectations of the public can undermine this trust and threaten the integrity of the contract (10,12). This implicit social contract applies to all professions, including veterinary medicine. The social contract is strengthened if the expectations and obligations are understood and fulfilled by both parties. When legitimate societal expectations are not fulfilled by the members of the veterinary profession, significant changes can result in the way veterinary medicine is viewed by the public and regulated by society. The loss of autonomy in practice, the loss of self-regulation and even the complete loss of professional status may follow the loss of public trust (12,14). There has been considerable discussion on medical professionalism in response to declining public trust and perceived threats to traditional values in human medicine. Several authors
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have urged re-examination and renewal of professionalism in medicine (12,1416). An international statement of values and principles for physicians (the Physicians Charter) followed an extensive study of professionalism called The Medical Professionalism Project in human medicine (17). The importance of teaching professionalism in professional programs has been recognized (7,18). Concern has been expressed over the challenge to the retention of professional values in light of increased business values and methods in medical practice and education (1922). The veterinary profession faces similar challenges (23,24). As in human medicine, the practice of veterinary medicine is increasingly viewed as a commodity delivered in the business of veterinary medicine where professionals are often employees, medical care often involves a team of individuals, and the clients/patients are viewed as consumers. Advances in medicine and technology have increased the expectations held by our clients as well as the cost of care. Companion animals are viewed as family members, animal welfare is a prime societal concern, and lifestyle expectations of younger professionals are different from those of previous generations. These changes challenge the traditional professional values of placing the patient, client, and public good before self interest and the prime goal of service to society. There has been a shift in the interactions between members of the veterinary profession from colleagues to competitors in the marketplace. Decreased inter-practice member communication and limitations on publication of scientific and technological advances may result from undue concentration on market share and intellectual property rights. These forces can negatively affect self-regulation and threaten effective assurance of competence of our members individually and collectively. In order to fulfil the expectations of society, veterinarians must understand what these expectations are, and be seen to act on this knowledge. The process of developing a document giving voice to what we perceive to be our values, guiding principles and ideal professional conduct would help to renew our commitment to the social contract collectively and individually. Publication of a guidance document would strengthen the social contract by clearly communicating our commitment to society, animal health and welfare, and public health. We cannot rely on nostalgic professionalism to ensure that veterinarians will adhere to unwritten, unexamined values and principles (25). A guidance document, developed through consensus, would help us maintain our commitment to these ideal values and principles, outwardly exhibited as professionalism, while negotiating the economic, lifestyle, and other realities of practice. There has been much concern expressed over the inadequacy of the hidden curriculum in transmitting non-technical competencies, including professional ethics and leadership, to veterinary students (2630). A common, national guidance document is integral to the explicit teaching of professionalism in veterinary colleges so that those entering the profession will understand and fulfil the obligations of the implicit social contract between veterinary medicine and society (7). The mission of our national professional association, the CVMA, is to be the national voice for the veterinary professiondedicated to serving and representing the veterinarians
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of Canada committed to excellence within the profession and to the well-being of animals. It shall promote public awareness of the contribution of animals and veterinarians to society (1). The CVMA publishes position statements on specific issues that fall under the area of veterinary expertise following consultation with the membership. These statements comment on important issues, but typically pertain to animal welfare or specific practice issues and do not offer guidance or public comment as to general professional values or conduct. A publicly available consensus document on the ideal values, principles, and conduct of veterinary professionals is important to retain public trust and to keep members striving toward those ideals while dealing with the realities of professional and societal change. This endeavor would fit well with the CVMA mission statement.

Acknowledgments
The author thanks Drs. Richard and Sylvia Cruess at the Centre for Medical Education, McGill University, for their advice and comments on the draft of this manuscript.

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