Why is it piracy?
Windows Server 2022 and CALs are not a separate product or code base from Windows 11. Windows 11 is a limited use case of Windows 2022 under which you commit to not using the Server 2022 features. The instant you don't do that, you are using a stolen copy of Windows Server and you haven't just started using the server without a license (in production), but also without CALs. So the amount of piracy goes from what seems like a small "misuse of a product under a TOS" to intentional "federal piracy".
One would hope that someone in the veterinary field, having been required to get college educated, would not need a middle school education in following the rules. This isn't hard stuff, at all. Any receptionist could figure this out if they wanted to, that a doctor can't really makes me worried for the poor animals that they don't understand.
Basic ethics, basic English. Nothing technical here. It's a super simple contract that everyone, everywhere is aware of. Lots of people willing to pirate software, but that doesn't mean that they don't understand it.