Dealing With Ethical Dilemmas in Veterinary Medicine
Despite the guidelines that outline how vets should conduct themselves in practice, dealing with tricky issues, like economic euthanasia, can be overwhelming and, at times, draining.
In 2018, researchers found that 77% of vets have experienced moderate to severe levels of stress due to ethical dilemmas. 70% have additionally had little to no training on how to resolve these conflicts of care [1].
In this article, we explore some of the common ethical dilemmas experienced in veterinary medicine and discuss how you can deal with them like a pro.
Examples Of Ethical Dilemmas In Veterinary Medicine
When it comes to ethical dilemmas, common problems tend to spring up time and time again.
These problems include:
Issues surrounding treatment options (whether to try the most advanced treatments available or not, etc.).
Issues related to animal welfare (is it better to euthanize a pet or continue with treatment?).
Conflicts are due to the competing interests between a client and the caregiver (monetary limitations or religious beliefs).
A big problem in veterinary medicine (and a key driver of pet owner/vet conflict) is the lack of universally accepted moral standards assigned to animals.
Unlike humans (who are generally treated with a base level of dignity), views on how animals should be treated vary wildly. This can lead to a lot of tension between owners and vets.
These conflicts often manifest during treatment cost discussions [3]. Owners may not see the value in treatments or not understand the price associated with the diagnostic or therapeutic approaches recommended.
How To Deal With Ethical Conflict As A Vet
Mullan’s framework is a process vets can use when faced with dilemmas. It can be broken down into four steps:
1- Identification of possible outcomes
2- Establishment of party interests
3- Formulation of an ethical decision
4- Minimization of the decision’s impact
In the following section, we will demonstrate each step using a fictional example.
Identify All Possible Outcomes (Options)
Let’s set the scene.
An obese rabbit called ‘Flopsy’ is brought to your practice by Mr and Mrs Smith. It is smelly and seems somewhat lethargic. Upon inspection, you find that the rabbit’s nails are so long that they are causing mobility issues.
Alongside this, you also discover that the rabbit has:
– Overgrown teeth
– Matted fur
– Severe urine scalding of the perineum with secondary infection.
The rabbit is suffering and requires medical intervention. It is in a condition that is likely to deteriorate over time.
After speaking to the owners, you discover that the rabbit belongs to their son, but he is currently away from home at university. They try their best to look after the rabbit but struggle due to their work responsibilities.
When assessing the best course of action, the first thing you should do (according to Mullan’s framework) is to think about all possible outcomes.
In this case, you would most likely want to treat the signs of illness and talk to the clients about appropriate diet and home hygiene.
If the owner refused, you could consider rehoming the rabbit or having it signed over to the practice. This would probably benefit the animal but cause tension with the client (and possibly practice management also).
You could be more aggressive and chastise or threaten the owners with legal action on the premise that the animal is suffering as a result of neglect. But this is a high-risk approach, which may not result in the best outcome.
Euthanasia may also be an option, but it could cause distress to you, the client, and clearly the pet.
Establish The Interests Of All The Affected Parties (Motivating Reasons)
Now we have established several courses of action, considering the interests of the affected parties.
As a vet, your primary interest is likely to be that of the animal. So for you, the best-case scenario is one where the pet leaves healthy and the client leaves happy.
Your client’s interests, on the other hand, may be different. They probably don’t want to harm Flopsy, but they have limited time and money. These resources may fall short of the standard needed to solve the issue. They may also want to pass over the responsibility for decision-making to their son. So a win in their eyes would be that the rabbit is no longer a burden on their resources.
At this stage, you may also want to consider the legal or ethical guidelines surrounding animal welfare or professional conduct. This includes considering factors related to legal ownership and liability.
It is likely in no one’s self-interest that the animal continues to suffer. Avoiding this scenario would be the minimum acceptable outcome- one which every veterinary professional needs to calibrate their coping mechanisms to bear.
Formulate An Ethical Decision
When it comes to making ethical decisions, while there (typically) aren’t any absolute right or wrong answers, there are shades of grey based on competing factors.
In this case, the utmost priority is to ensure Flopsy’s well-being. If you feel that the owners are amenable, discuss the treatment plan with proper follow-up care.
If this option is not available, then a plan B approach would be to discuss the less palatable (but entirely viable) ‘minimization of suffering’ approach. In the short term, this might mean controlling both pain and infection. But it might also mean euthanasia.
A final option might be to sign ownership of the animal over to the care of another willing body.
The decision will be made by making the clients aware that they have choices, and indeed a responsibility to act. When walking through the options, try to arrive at a decision together while being compassionate and open-minded.
Minimize The Decision’s Impact
Try to remain objective at this stage. If your client feels like you are not on their side, they are more likely to shut off, ignore your advice, or feel badly treated. This, in turn, will result in them being less amenable to working with you.
A two-way dialogue (adopting a curious but compassionate inquiry) can help the client feel understood and listened to. This will allow trust to form, making it easier to come to a decision together. Not necessarily the best decision in your eyes, but one everyone can live with [3] [4].
Ways To Reduce Moral Stress
Ethical dilemmas can be tough to deal with. A lot of vets can struggle with the anxieties surrounding ethical judgments. If you struggle with ‘moral stress’ in addition to the framework we’ve described, there are a few things that may help:
Journaling- journaling can be great for processing uncomfortable emotions, and easing moral stress and anxiety.
Talking- if in doubt, chat with a mentor or a licensing board to ascertain where the lines of professional conduct lie. Such guidance can help show a clear way forward.
Getting proper rest- Seven hours of quality sleep can optimize your decision-making abilities and boosts resilience and mental stamina.
Mindfulness-breathing and gratitude exercises can reduce stress related to ethical decision-making.
Networking- seek support from your peers. When it comes to ethical dilemmas, most scenarios are common and well-understood [5].
Some Words Of Advice
Every vet inevitably will have to deal with morally challenging cases – so know that you are not alone.
Use the framework we have outlined as a guide, and work on your communication skills to better handle ethical scenarios in the future.
Doing so may not result in the perfect outcome, but it will help create a situation where you feel happy enough to sleep soundly at night.
References:
1- ‘Ethical conflict and moral distress in veterinary practice – PubMed.’ 15 Oct. 2018, https://pubmed.ncbi.nlm.nih.gov/30320478/. Accessed 6 Sept. 2021.
2- ‘Survey of the frequency and perceived stressfulness of ethical ….’ 7 Jan. 2012, https://pubmed.ncbi.nlm.nih.gov/22084032/. Accessed 6 Jul. 2021.
3- ‘Introduction to Ethics in Practice – Vet Nurse Online.’ https://www.vetnurseonline.co.uk/cms/wp-content/uploads/2011/10/ethics-handout.pdf. Accessed 6 Jul. 2021.
4- ‘What would you do case studies | The Animal Welfare Foundation.’ https://www.animalwelfarefoundation.org.uk/education-and-debate/student-zone/case-studies/. Accessed 6 Jul. 2021.
5- ‘Understanding Moral Stress in Veterinarians – AVMA My Veterinary ….’ https://myvetlife.avma.org/new-veterinarian/your-wellbeing/understanding-moral-stress-in-veterinarians. Accessed 6 Jul. 2021.