1. How should communications between the veterinarian and the client differ when discussing vaccines/vaccination versus other treatments/medications?
The issues related to consent and client discussions relative to risk/benefit profiles do not differ in their essence between vaccines and other medications. That does not mean that every practitioner must have the same level of discussion with every client for every vaccine or other medication. Wherever there are meaningful risk/benefit considerations, it is strongly recommended to include the client in the decision-making process.
2. Is it necessary to explain the risks associated with every individual vaccine during each vaccination appointment?
It is advisable to have an initial vaccine discussion about vaccines with the client that is documented and thorough, followed by periodic and less extensive discussion at subsequent vaccination. If the practitioner believes that the risk/benefit profile for the various antigens administered in a visit is essentially the same, they could be discussed as a group. If an individual antigen is considered to carry a significantly different risk/benefit profile, then it could be addressed individually.
At subsequent vaccination appointments, it is reasonable to briefly remind the client of the clinical approach taken to vaccination and ask if the client has any questions. Additionally, if over time there is a change in the perceived risk/benefit profile, then additional discussion with the client is indicated. Finally, practitioners must be in a position to know their clients and identify those that will benefit from more discussion.
3. Can a veterinarian be held legally liable for withholding a core vaccine from a dog with immune-mediated disease that later succumbs to one of the diseases prevented by the core vaccines?
The risk of legal liability should be low if the client is involved in the process and the discussion is documented in the chart. For example, a notation in the medical record that: (1) a discussion was held with the client regarding the relative risks of exacerbating the patient’s immune-mediated disease or other adverse events versus the potential for disease/death if the patient contracts a disease for which vaccination has been foregone, (2) the client chose not to vaccinate, and (3) the client was given an opportunity to ask questions.
4. What is a reasonable degree of documentation for risk/benefit discussions with clients concerning vaccination?
There is no “one size fits all” answer to this question. The Guidelines purposefully do not say “document consent in this manner.”
Why? In large measure risk/benefit discussions represent opinion. The current level of legal risk relative to small animal vaccination protocols is considered low. However, whenever claims are made against veterinarians, they often include allegations that appropriate consent was not obtained. Different people have different levels of risk tolerance. One veterinarian may be very satisfied with making a note in the chart that the risks and benefits of vaccination were discussed with the opportunity for questions and/or providing a client handout. Others may not be comfortable with anything less than obtaining a client’s written consent. However, given the current risk level, the recommendation is to focus on client communication with a level of documentation that does not disrupt the practice. It is also recommended that practitioners consider use of a specific client handout. If handouts are used, it is important to date or otherwise identify and archive them, such that the specific handout provided to a client can later be retrieved if necessary.