At this point in the decision-making process, the veterinarian's prognosis and advice become crucial. He can advise on the severity of the condition, on its likely causes and on the required treatment and post-operative care and expected quality of life for the puppy. We can assume he is a highly skilled and optimistic individual; he wants to do all he can to help because he likes the family. Furthermore, orthopaedic surgery is something that his clinic is very capable of performing and it will provide a substantial income. If he recommends euthanasia there is a chance that this client will seek a second opinion and if the therapy is then performed successfully elsewhere the client is unlikely to return. Thus, there are matters of business to consider in the decision-making process.

Finally, there are the interests of third parties to consider. A breed's predisposition to abnormal growth in a front limb may easily become exaggerated when there is a practical solution to the problem, such as surgery. However, this is not something the individual practitioner can influence. Once a form of therapy has been developed, it is only a matter of time before it is made available to the public. The practitioner must decide whether to provide the therapy, to refer the customer to another clinic, or to refrain from recommending the treatment altogether. In these situations, the veterinary profession can only hope that the breed society tries to prevent the problem from arising by the implementation of selective breeding. Nevertheless, there remain some professional responsibilities to consider. Could or should the breeder of this puppy be informed of the defect? Are the present owners the best people to do this, given their lack of professional knowledge and the inevitable disappointment felt after purchasing the puppy? Should the veterinarian contact the puppy's breeder? Whichever, the practitioner should certainly recommend that the new owners of the puppy never use it for breeding and he might even propose that immediate castration/vasectomy or ovaryhysterectomy be performed.

Analysis of this case, with a view to developing a model for decision-making and identifying the relevant professional responsibilities, might lead to the following scheme, which summarises the interests of all parties concerned:

• Animals' interests: the availability of therapy, the chance of therapy being successful, the quality of life after recovery from therapy and the amount and duration of pain and distress during the period of treatment and healing.

• Owners' interests: consideration for the health and well being of the animal, the emotional bond with the animal, the costs of treatment - monetary and labour, the chances of successful treatment and the suitability of the animal for its intended use after healing.

• Veterinarians' interests: consideration for the health and well being of the animal, his relationship with the client and the professional challenge and commercial interest the case offers.

• Interest of the population to which the animal belongs: the absence of inheritable problems that cause serious defects.

This scheme may be applied to conditions observed and treated routinely in veterinary practice, such as entropion in dogs and cryptorchidism in horses. It is rewarding to find that many interventions become quite acceptable from a veterinary point of view. The scheme reveals how important the intended use of an animal is when choosing a form of therapy and also how the specific interests of the animal can be included. It is useful to the veterinarian for the analysis of situations that are ethically complicated and helps him to include all the relevant issues needed for making decisions. By using such a scheme, veterinarians improve their communication with clients and colleagues.

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