Vol.1, No.3, 128-134 (2011)
doi:10.4236/ojas.201 1.13017
opyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJAS/
Open J ournal of Animal Science s
Informed consent in veterinary medicine: legal and
medical perspectives in Italy
Annamaria Passantino, Valeria Quartarone, Maria Russo
Department of Veterinary Public Health, Faculty of Veterinary Medicine, University of Messina, Polo Universitario Annunziata,
Messina, Italy; passanna@unime.it
Received 5 July 2011; revised 20 August 2011; accepted 3 September 2011.
During the last four decades the doctrine of in-
formed consent (IC) has become a legal stan-
dard and an essential component of ethical
guidelines in medicine, due to its relevance for
basic human rights such as autonomy and re-
spect of dignity. Over the last few years, this
legal formula has gained importance in veteri-
nary medicine, thereby influencing the everyday
activities of the veterinary practitioners. This
paper briefly describes the ethical and legal
background of IC in Italy and examines how it
relates to the practice of veterinary medicine,
considering the change in social sensibility to-
wards animals. It also outlines the discussion
that should take place between Veterinarian and
client before a planned procedure.
Keywords: Informed Consent; Veterinary Medicine;
Professional Duty; Law; Ethics; Veterinarian-Cli ent
Relationship; Animal
In recent years, patients’ consent to medical treatment
has particularly attracted the attention of legal doctrine
and law, becoming the object of continual research and
various interpretations and becoming so relevant as to
gain independence from medical duty as a whole.
From a paternalistic perspective, when the physician
was the sole depository of medical secrets and therefore
the only one who could make decisions, physicians and
patients have moved on to a new relationship as col-
laborating peers [1].
The principle of informed consent (IC), in fact, re-
flects the concept of autonomy and self-determination [2]
of a person requiring and requesting specific medical
and/or surgical intervention. The theory of autonomy is
defined as self-governance or self-rule, a capacity of
people to reflect and choose, and freedom to express
individual aspirations and preferences [3].
Such a justification of IC also lies with the fact that, in
most of Europe and beyond it [4], physicians’ ethical
codes see the duty to ask for IC as an expression of pro-
fessional correctness itself [5].
Like physicians, veterinarian have concerns about
client confidentiality, and are troubled by ethical con-
flicts that arise when the interests of patients (chil-
dren/animals) and clients (parents/owners) diverge. How-
ever, since animals are typically treated legally as a form
of property, the ethical and practical problems for vet-
erinarian have substantive differences from those faced
by physicians. From a legal perspective, the confidential
relationship presumed between physicians and patients
does not always explicitly apply to veterinarian and their
Nevertheless there are circumstances where confiden-
tiality requirements are explicitly waived to protect pub-
lic or animal health. For example, the Italian Principles
of Veterinary Ethics indicate that a doctor of veterinary
medicine has an obligation to protect the privacy of cli-
ents, but make an exception if a veterinarian is required
by law to reveal confidential information, or if it be-
comes necessary to protect the health and welfare of an
individual, animals, and/or others whose health and
welfare may be endangered.
Relating to IC, veterinarians have a rather unique po-
sition, because the law does not oblige them to have the
patient-owner sign a document like in human medicine
[6]. A veterinarian’s only obligation is of a moral kind.
IC is the process of obtaining the permission of the
patient to have an opportunity to decide about his/her
health care. This definition originates from the legal and
ethical right of the patient to retain autonomy and from
the ethical duty of the physician to involve the patient in
health care decisions.
A professional and his/her client are bound by a con-
A. Passantino et al. / Open Journal of Animal Sciences 1 (2011) 128-134
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJAS/
tract: the latter applies to the first for a professional ser-
vice and, from the time the former accepts, he/she is
obliged to the client as to the use of certain means, not as
to the outcome.
The risk of missing the target will lie with the client.
Along with this main obligation, the professional is
bound to fulfill secondary obligations. Italian law on
contracts (article 1175 of the Civil Code) enforces the
obligation to behave “according to the rules of correct-
ness”: a specific application of this principle is the pro-
fessional’s “duty to inform”.
Actually, clients of nearly all professions, or better
creditors of professional services, must, to a certain ex-
tent, make choices that involve weighing costs and
benefits, which may be complex and hard to understand.
To make decisions, they have to rely on their general
learning and on correct information from the profess-
Especially in the medical profession, IC cannot be
done without, but to this day it is hard to define, stating
its limits and range, pointing out the multifarious situa-
tions in which it becomes relevant [7].
A conscious person, in full possession of his/her men-
tal faculties, will not have to passively undergo any
medical treatment (diagnostic tests, therapy, surgery,
etc.); this concept derives from the constitutional prince-
ple of the inviolability of personal freedom and the right
to health that produce the legal claim to self-determina-
tion and the refusal of all illegitimate interference.
In fact, in according to articles 13 and 32 of our Con-
stitution, the valid consent of the person in question is
necessary, and he/she shall give it only after receiving
appropriate information and sufficient elements to
evaluate the treatment he/she will have to undergo and
the consequent hypothetical risks.
Clearly, IC involves the patient’s participation,
awareness, information, freedom to choose and decide.
Consent is valid after previous complete information:
a physician is obliged to supply the indispensable ele-
ments to inform the patient sufficiently about the kind of
treatment, the therapeutic alternatives, the aims, the
chances of success, the risks and side effects [8].
IC includes not only the important and fundamental
autonomy of the patient to decide, but also the essential
objective element, that is, information. The expression
IC has simply been transposed in Italian and approxi-
mately translated in an ambiguous fashion into “con
senso informato” when really it should be referred to as
“informazione per il consenso” (“information for con-
sensus”) not only to respect the concept but, surely, for a
more correct deciphering and a more precise interpreta-
tion related to the numerous concepts it presupposes and
implies. Information and consent may be viewed as the
two sides of the same coin; in fact Mallardi (2005)
writes that “ […] on the one ha nd, having obtained con-
sent, following correct and sincere information inter-
preted and deciphered as an important phase and an
essential indicator of correct, scrupulous medico-pro-
fessional procedure and, on the other, the consensus
itself conceived as a duty aiming at the maximum respect
of the rights to self-determination, independence and
autonomy of the patient”.
The jurisprudential and doctrinal debate, arising in re-
lation to the IC, must not turn it into just another bu-
reaucratic performance or a conflict in the physic-
cian-patient relationship, or reduce it to a formality, for
the physician to protect himself against a potential law-
suit, but must be seen as a moment in the fundamental
therapeutic alliance between patient and physician,
which alone allows them to face a disease correctly.
The ratio in the request for IC must, therefore, be
identified in the determination to promote autonomous
health decisions, which has been left aside since the time
of Hyppocrate’s philosophy, which acknowledged that
physicians had the duty and right to tell nothing to the
patient about his/her health conditions and the health
treatments he/she was undergoing ([…] reveal nothing to
the patient about any event to come […]), both to avoid
“extreme measures” from the patient and to guarantee
the physician’s prestige and authority [9,10].
IC in a veterinarian-client relationship (VCR) is vastly
different from IC in a medical doctor-adult human pa-
tient relationship; where in a veterinarian-client-patient
relationship (VCPR), the patient is not capable of mak-
ing a decision for him or herself. By contrast, in a rela-
tionship between a medical doctor and an adult human
patient, the patient can make the decision him or herself.
Veterinarian-client IC is not based on the principle of
individual autonomy, since it expresses the subject’s
self-determination, which the animal species is not en-
dowed with.
The IC paradigm for human beings is in fact practi-
cally inseparable from its reference to autonomous moral
subjects [2,11]. Since veterinary practice deals with
non-autonomous moral patients, the reference to consent
has a different meaning. In veterinary medicine, where
no rule of law obliges the veterinarian to obtain IC mak-
ing it a sanitary service (with the exception of Ministe-
rial Circular no. 14 of 25 September 1996 on Good prac-
tices of Clinical Experimentation of veterinary drugs on
animals), and informing the client-owner is a duty con-
nected with Good Practice (Code of Good Veterinary
Practice of the Federation of Veterinarian of Europe,
approved by the Federazione Nazionale degli Ordini
A. Passantino et al. / Open Journal of Animal Sciences 1 (2011) 128-134
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJAS/
Veterinari Italiani [FNOVI], Jan.29, 2005) and the Italian
Ethical Code of rights and responsibilities of veterinary-
ian, and on the other hand—justified by the ever-in-
creasing technicalities and specialization of the veteri-
nary profession—represents a form of certified qualifica-
tion of the performances offered by the Veterinarian.
In fact, article 29 of the Italian Ethical Code (Duty to
inform and informed consent in veterinary practice)
states that “The Vet, on undertaking contractual respon-
sibilities, is bound to inform his client clearly on the
clinical situation and the therapeutic solutions.
The Vet mu st inform exactly o n the risks, the costs and
benefits of the different and alternative diagnostic and
therapeutic routes, as well the predictable consequences
of the eventual decisions. On informing the client, the
Vet will ha ve to consid er h is/her degree of understanding,
in order to allow them to give full approval to the diag-
nostic-therapeutic proposals.
Any additional information required by the customer
must be satisfied.
A Vet must also answer all investigations on preven-
tion matters from the public at large.
The Vet is bound to inform his/her client on the pre-
dictable suffering and pain of their animal and on the
presuma ble du rat i o n of the professional operati on.
It is the Vet’s duty to communica te to a client the need
to perform particular actions, in order to avoid suffering,
pain or prolonged illness in the patient animal”.
It being understood that consent is necessary, we must
say that the choice of the treatment lies with the Veteri-
narian, because, for his/her professional skills, technical
and scientific knowledge of medicine, he/she stands on a
higher level than the owner of the animal. Once the
treatment has been chosen, the veterinarian must propose
it to the client, who might not accept it. In this case, the
veterinarian is free of any professional obligation and is
not obliged to carry out any treatments that the client
may considers suitable, but which are against the physic-
cian’s “science and conscience”.
Conversely, if the veterinarian thinks that more than
one treatment is suitable, the ultimate choice lies with
the client who has ultimate responsibility for the animal
and for decisions about its welfare.
In veterinary medicine, getting this IC typically means
the veterinarian explains both the risks and benefits as-
sociated with a specific medical or surgical intervention.
IC is an important concept in the VCPR because it is
part of what defines the boundaries of that relationship.
In addition to defining how the veterinarian and the cli-
ent together make decisions regarding the care of the
patient, IC also defines how the veterinarian deals with
the client. If the veterinarian does not give the client
enough information to allow the client to give IC, the
veterinarian has failed to uphold one of his or her duties
to the client and to the patient. IC is rooted in the idea of
protecting both the client and the veterinarian.
Obtaining IC from clients is a crucial element of ethi-
cal and professional communication in veterinary medi-
cine. In non-emergencies, obtaining IC requires the vet-
erinarian to discuss with the client the clinical issues, the
alternatives to the proposed diagnostic or therapeutic
intervention (in addition to the benefits and risks of each
option), and the possible adverse effects and long-term
care associated with each option [12]. In addition to the
standard “clinical” elements of this conversation, the
veterinarian should attempt to assess the client’s prefer-
ences for and understanding of the choices before him or
Having first said that the quality and quantity of the
information supplied by the Veterinarian to his/her client
does not depend on its eventually being formalized or
not, it is however highly important, if one thinks that
incorrect information might be cited in a lawsuit.
However, there are different evaluations of the “de-
gree” of information to be offered to the client-owner.
Information must therefore be as complete as possible,
true and objective.
In particular, it must comply with the following prin-
Information must be proportional to the importance
of the procedure or treatment method;
Information, though complete, must be limited to the
elements that a client can understand;
Information, though objective, must leave aside
purely scientific aspects.
More specifically, the entries in a clear and complete
IC form will include diagnosis, therapy (medical and/or
surgical), etc., as shown in Table 1.
Those suggestions, however, do not limit the possibil-
ity to introduce further data that might be necessary in
specific cases.
One aspect, which the veterinarian must take into
consideration before informing his/her client of the
costs-benefits of a treatment or procedure he/she deems
necessary for an animal to undergo is the duty to inquire
about the destination of the animal.
So, for example, when the veterinarian diagnoses
pyometra in a bitch, on advising surgical hysterectomy,
he/she will have to inform the owner that such a treat-
ment, though promising good chances of recovery, will
compromise her reproductive function forever. In the
absence of such information, the owner might report the
veterinarian for its incompleteness, in case he/she could
prove that a different decision would have been taken on
A. Passantino et al. / Open Journal of Animal Sciences 1 (2011) 128-134
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Table 1. Kind of information offered to the client-owner5.
Description of the diagnostic course
Moral and other implications of the course chosen
Diagnostic hypothesis, if any, and differential diagnosis
Therapy (medical or surgical)
Description of the recommended surgery and reasons for its choice
Materials used
Complications and consequences of the therapeutic procedure from
the point of view of both man and animal
Therapeutic alternatives or no operation
Difficulties in dealing with the patient or convalescent
Ethical or other implications of the therapeutic course
Unexpected events taking place during the therapeutic deed, where
it is impossible to communicate with owner
Proposed or alternative anaesthesia
Preliminary tests
Ethical implication
the basis of complete and correct information.
A practical aspect of the IC form relates to the possi-
bility of including the costs of treatment among its en-
tries. Although news about the costs make information
complete, they should be kept separate from the rest,
because, for their purely economic value, they represent
a proforma invoice on the veterinary service; on the con-
trary, the aim of IC is informing the client of the costs
and benefits of a certain service.
As regards the forms the expression of consent can
take, unlike in human medicine, where consent must be
given in writing, in veterinary medicine the written form
is not obligatory, although there is a practical tendency
to identify IC with a written form.
Having said this much, we can distinguish between
various ways to express consent:
1) Tacit or implicit consent, when the subject’s will is
inferred from his/her behavior, not from an explicit
2) Explicit consent, when someone’s will is expressed,
either in writing or orally.
There being freedom as to form, we can usefully con-
sider whether it is advisable for a Veterinarian to use
written forms.
Obtaining an IC form for any service a veterinarian
may perform is surely unthinkable. Transferring what is
the custom in human medicine, we can distinguish be-
a) routine activities (e.g. vaccination), to which im-
plicit or oral consent is sufficient;
b) extra-routine activities, or those which may pro-
voke irreversible consequences (i.e. euthanasia, castra-
tion, caudectomy, horn-abrasion, amputation of a leg) or
a risk (surgery), for which IC in writing is advisable,
though not necessary.
In box 1 we propose a facsimile.
This facsimile consent form includes the name and
address of the client (owner) and the name, species,
breed, sex, and date of birth of the patient.
Additionally, it should include a clause indicating that
the person signing the form is the legal owner of the
patient and has the authority to consent to treatment.
Following that clause, another clause has spaces to iden-
tify the veterinarian, the veterinary hospital or office,
and the treatment(s) being administered to the patient.
Next is a clause indicating that the client has been in-
formed of the possible risks and complications of the
treatment, and indicating that the client is aware that
unforeseen problems may arise which require further
treatment. Then, there is a clause which authorizes the
use of anaesthesia or pain medications as needed before
or after the procedure(s). After that, a sentence indicates
that the client is aware that other personnel may be re-
quired in order to assist the veterinarian. Finally, the
signature lines are provided for the client and/or a person
acting as an agent on behalf of the client.
When the client signs the document, he/she declares
that he/she has understood the risks and benefits. By
giving IC to a procedure or treatment, it is assumed that
the client both read and understood all of the terms in the
statement. Once IC has been given, the patient-animal
may be treated according to the conditions listed within
the statement.
In the case of oral consent veterinary professionals
responsible for communicating with clients must be sen-
sitive to cultural differences for it to be satisfactory.
They should be alert to the possibility that individual
words may carry distinct meanings in different regional
dialects of the same language. Further, there is the po-
tential for two-way prejudice (veterinarian versus client
and client versus veterinarian) based on race, gender,
ethnicity, age, sexual orientation, religious or spiritual
beliefs, social status, economic status, or literacy level.
Conflict in these situations is nearly always communi-
cated nonverbally; thus, veterinarians should be vigilant
in observing any evidence of client discomfort or the
possibility of being misunderstood.
The emergency setting can place several constraints
on the procedure of obtaining IC. In emergency situa-
tions, where there is often insufficient time to establish
rapport with the client and/or easily to explain the com-
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plicated medical condition of the animal, the veterinarian
should be truthful, exercising care and flexibility.
In settings involving the communication of bad news,
especially when there is no appropriate biomedical re-
sponse, the fundamental skill needed is empathy [13,14].
In fact, expression of empathy, if appropriate, can en-
courage the client to maintain realistic hope about the
bad news.
The veterinarian, like the trained medical professional,
provides only the information that is perceived to be
required and asks for the client’s trust and approval of a
medical plan that is outlined as quickly as possible. For
example, the veterinarian may briefly inform the client
on the life-saving therapies, the probable long-term out-
come from the medical condition, the cost associated
with the immediate medical plan, and in extreme cases
(severe mitral valve endocardiosis, metastatic mammary
carcinoma, etc.) the option of euthanasia.
Fallowfield & Jenkins (2004) [15] suggest that the
way in which bad news is delivered can have a signifi-
cant impact on the VCPR, decrease the stress for the
deliverer of bad news, and improve several important
outcomes from the receiver’s perspective.
A Veterinarian’s duty regarding IC is two-fold. A Vet-
erinarian has a duty to inform the client and obtain the
client’s consent. The legal approach to establishing this
duty is pragmatic. Although the client has the right to
refuse, it is recognized that the Veterinarian possesses
more information and, as a consequence, more power to
control the circumstances under which the two parties
meet. In addition, the Veterinarian has a duty to respect
and promote the animal-patient’s best interest. As such,
it is the Veterinarian who is held to a higher standard and
thus a greater duty. On the basis of this consideration,
professional practice standards should encourage a Vet-
erinarian to bring up the issues outlined in Table 2.
Among veterinarians, it is widely held that acquiring
IC means protecting themselves from a legal point of
view. Written consent does not guarantee this. A signed
consent form may supply evidence that consent was
given, but not that counselling was necessarily sufficient,
appropriate and not negligent.
Some IC forms that are used in the veterinary field
contain clauses that exempt them from responsibility for
surgery carried out without any previous diagnostic tests.
In truth, such a form, though signed by the client, can
never protect a Veterinarian from non-voluntary respon-
sibilities, caused by negligence (culpa in omittendo),
imprudence (culpa in agendo), inexperience (culpa in
adempiendo), or breach of laws, regulations, orders and
disciplines [16].
Table 2. Information to be Disclosed During Discussion of
1. Results of pertinent diagnostic studies
2. Probable outcome of surgery
3. Likely benefits of surgery
4. Explanation of what surgery will entail
5. Probable complications
6. Temporary complications (e.g. pain, infection) and therapeutic
steps to correct them
7. Permanent results and complications (e.g. paralysis, plegia)
8. Other risks that are reasonably foreseeable
9. Reasonable alternatives to the proposed procedure
An IC form can be used as evidence when a lawsuit is
brought on the charge of missing, incomplete, incorrect
or untrue information. However, such a form could eas-
ily prove that the veterinarian has unexceptionably in-
formed the owner, both from a qualitative and a quanti-
tative point of view, but it could also become ruinous, if
it proved the veterinarian has rashly omitted some in-
So, IC acquires a legal value only if it can prove that a
veterinarian, though using diligence, caution and skill,
and complying with laws, regulations, orders and disci-
plines, has not hit the expected target for other reasons
(either because the ordinary risks and dangers the client
had been informed of have actually come about, or be-
cause the fortuitous or unforeseen events inherent in any
medical activity have taken place).
The ever-growing importance attributed to IC is proof
of a desire for quality in the physician-patient relation-
ship, because it puts the patient's rights first, and then the
physician’s duties.
We must remember, however, that drawing up a form
and having it signed does not in itself exempt a physic-
cian from legal and/or disciplinary responsibilities, while
real and concrete information given to the patient and
the consequent concession of the necessary IC can.
In the VCPR, the veterinarian’s role is crucial: al-
though in the case of surgical treatment to be carried out
on the animal, he/she is not the only one who can decide
in the process that leads to a shared and responsible
choice, he/she is the one charged with the greatest re-
sponsibilities, on account of his/her scientific knowledge
and skills [17].
All this must be connected with a precise duty to in-
form clients of the negative consequences of some of
A. Passantino et al. / Open Journal of Animal Sciences 1 (2011) 128-134
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their behavior to animals.
Openly accessible at
Although there are no specific norms on the matter,
the Italian veterinarians could keep pace with the new
European ethical principles. This is the trend of the Code
of Good Veterinary Practice with the purpose of setting
European standards for veterinarians’ ethical and be-
haveioral principles “vets must gain their clients’ trust by
providing exhaustive communication and supplying ap-
propriate information”.
In overview, information takes over the main role, as a
way to solve problems or, at least, make all the people
involved feel responsible, and consequently mitigate
possible conflicts between Veterinarian and their clients.
On the basis of the aforesaid considerations, we hope
legislators will take the initiative to regulate the matter
throughout the country with specific norms, which re-
quire veterinarian to apply for IC not only by the Italian
Ethical Code, but by a special law. At present there are
no such laws.
This would give a greater dignity to patient-animals
and, in line with the national and European rules con-
cerning well-being and protection of animals, would
confirm their status as “sentient beings” [18,19] and
confer moral rights [20].
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A. Passantino et al. / Open Journal of Animal Sciences 1 (2011) 128-134
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/OJAS/
Box 1. Consent to medical treatment and the related diagnostic tests.
Owner/Owner’s Agent:.................................................. Mr/Mrs. Surname: .......................................................
Name: .................................................................
Address: ........................................................................Town: .......................................................................
Contact Telephone Number(s): .................................... Mobile: ....................................................
Animal/Herd/Flock ID(*): …………………………. Animal Name: ………………...…………………….
Species: …………………………………………… Sex: Male/Female Breed: .....................................................
Colour: ...................................Age: ............................ Reason for the medical examination:................................................................................................
Authorizes Doctor .......................................................... and his/her staff to examine and/or treat and/or carry out the diagnostic tests they deem
necessary on the basis of the examination and the related tests.
Allows them to administer sedatives and/or anesthetics to carry out the necessary instrumental tests, declaring he/she has been informed of the
fact that such tests are not exempt from general complications, even if made with skill, diligence and prudence.
Reaffirms his/her IC to Doctor........................................, who has clearly explained the reasons for which the aforesaid treatments and/or tests are
necessary, also illustrating the risks of the potential contraindications, complications and/or reactions.
Confirms having read and perfectly understood this authorization form, for carrying out medical treatments and diagnostic tests on the above
identified animal, according to the current norms.
At the time of the release of the animal from the veterinarian’s consulting rooms, the owner will take on the job of scrupulously watching it and
immediately communicating to the responsible Veterinarian any complications or accidents that may have arisen or that can negatively affect the
outcome of the surgery or treatment done.
The undersigned also declares he/she will fully pay the costs of the veterinary service that is to be done on his/her animal, presumably between a
minimum of .................... Euros and a maximum of ............................ Euros, if no events, not foreseen in the estimate, take place.
Gives permission for the possible after-death inspection, in case of death of his/her animal.
(*) If the dog is not microchipped, the owner/holder of the animal is informed of his/her obligation to have the animal electronically microchipped,
according to the Law no.281/91.
Date .............................................................
Full signature of the owner/holder to testify information and acceptance .........................................................