CVMA Guidelines on Communicating Risk Assessment
Risk assessment is a cornerstone of modern veterinary practice’s efforts to acquire the owner’s consent before rendering care for animals. In addition to the legal assurances it provides in the veterinarian/client/patient relationship, adequate risk assessment connotes satisfactory communications between veterinarian and owner for the purposes of sharing information, mutually agreeing to the best course of action, and establishing client compliance for appropriate follow-up care. In veterinary medicine the patient care provided and decisions made pertain to a third party, i.e., the animal patient. This means the patient does not have the same legal protections as do human beings and, thus, it is inappropriate to apply the same legal terminology of “informed consent” used in human medicine to issues of consent in the veterinary profession.
Some veterinary legal scholars maintain that the term “informed consent” has gained sufficient foothold in state statutes and veterinary based court opinions that it may be difficult to replace it with a legal principle entitled “risk assessment.” However, the historic origins of “informed consent” are founded in laws governing the practice of human medicine. In this context individuals receive information regarding their health from physicians, make choices about recommended courses of action, and consent to the examination and/or invasion of their bodies. It is this informed consent that prevents them from alleging an assault on their bodies by the health care provider. During these discussions patients make “informed” decisions about courses of treatment, weighing only the relative medical risks and benefits.
Veterinary medicine has generally adopted a pediatric model of “informed consent” wherein owners receive information regarding the health of their animals from veterinarians. As parents do for their minor children, they make “informed” decisions about courses of treatment on behalf of their animals. In both situations, the decision makers weigh the relative medical risks and benefits for the patients under their care. In veterinary medicine, however, the provision of information regarding costs for treatment are an integral part of the informed decision-making process, to the point they are essential to the formation for the contract for the provision of veterinary services. This critical difference hinges on the difference in decision making by the care provider on behalf of human beings vs. the care provider for personal property. Continued use of “informed consent” in veterinary medicine may falsely perpetuate the acceptance of animal guardianship and the additional legal responsibilities intoned by that position. “Risk assessment” addresses the more straightforward issue of care of and payment for that care for animals as is currently engrained in the veterinary profession.
The application of evidence-based medicine and patient advocacy lay the groundwork for fully informed risk assessments. Properly implemented, veterinarians recommend those medical practices for which there is objective evidence of efficacy and from which they may have expectations for successful treatment and mitigation of patient risks. Nonetheless, untested, unconventional treatments for which reasonable mechanisms of action may be hypothesized with some preliminary scientific evidence may sometimes be included in communications with clients regarding alternatives for treatment.
Adequate risk assessment should be conducted before therapy is initiated. Layman’s language should be used whenever appropriate. Clients should be apprised of feasible alternatives and possible adverse effects that might arise from recommended procedures. The following elements should be considered during this process:
Communications sufficient to elucidate the nature of the problem(s).
- Explaining the diagnostic tests used to evaluate those problems and to establish diagnostic priorities.
- Discussing the relative risks and benefits of additional diagnostic procedures or the implementation of specific treatments before they are pursued.
- Describing expected responses to treatment and how they will be assessed.
- Providing a reasonable prognosis for recovery, recurrence, or lack of progress.
- Including information about feeding, aftercare and return visits.
- Providing information about medications, including amount, frequency, method(s) of administration, and risks of adverse effects.
- Warning about security for prescription drugs, including safety of family members and other animals in the household.
- Providing information about potentially communicable diseases.
- Discussing a reasonable cost estimate, payment plan, and protocol to follow if costs will deviate materially from agreed upon approximations.
Misunderstandings may arise when clients’ expectations for treatment effectiveness or risk from side effects differ from those communicated by veterinarians. These become more likely when veterinarians do not communicate the interactive risk of concurrently treating or not treating more than one disease problem.
Risk assessment relies upon cultivation of trust between veterinarians and clients through adequate communications and sustenance of the professional relationship. Evidence of patient advocacy in this relationship sometimes hinges on referrals of clients to specialists who can provide different or more advanced diagnostic or treatment options.
Many commercially available templates for legal consent forms are available, and may be tailored to fit individual veterinary practices. However, the client’s failure to read or communicate misunderstandings of the printed materials does not constitute contributory negligence. Instead, successful risk assessment depends on the completeness of communications underlying the process, and on adequate documentation of those communications.
Approved September 11, 2004 by the CVMA Board of Directors