Lecture 5: Veterinary Ethics pt 1
Introduction to Veterinary Ethics
Dr. Siobhan Mullan (RCVS Recognised Specialist in Animal Welfare Science, Ethics and Law) and Dr. Anne Fawcett (MANZCVS(Animal Welfare), DipECAWBM(AWSEL)) instruct this module. The learning outcomes include discussing the scope of veterinary ethics, describing its relevance, understanding utilitarianism, deontology, and virtue ethics, and applying these philosophical approaches and the ethical matrix (though not detailed here) to ethical issues. When teaching animal welfare and ethics, students will encounter controversial issues, instances of poor animal welfare, disagreements with others, and cultural differences. The instructors use an evidence-based approach, encourage respectful discussions, and aim to help students advocate for changes to improve welfare.
The Nature of Ethical Dilemmas
An ethical dilemma is defined as making a moral choice to do the right thing, involving a value judgment that can be reflected in laws or moral conventions. What constitutes a "right" or "most preferred" option can differ among individuals. Case-based discussions are widely used in medical and veterinary ethical teaching to develop reasoning skills. This approach allows for the exploration of different courses of action, alternative ethical viewpoints, and sources of disagreement, facilitating ethical reflection, such as agreeing an animal is in pain but disagreeing on the treatment. The "Grand Bargain," proposed by Susskind & Susskind (2015), states that society grants professions exclusivity over significant services, fair wages, independence, autonomy, and respect. In return, professionals are trusted to apply expertise, experience, and judgment; deliver affordable, accessible, and up-to-date services; curate knowledge; train members; set and enforce standards; admit qualified individuals; and always act honestly, in good faith, prioritizing client interests over their own. Trust is a crucial component in navigating ethical situations.
The Profession's Role and Ethical Demands
Common ethical dilemmas encountered in practice include convenience euthanasia, requests for excessive or futile treatment, and financial limitations to treatment. A study by Batchelor & McKeegan in 2012 found that of veterinarians faced at least one ethical dilemma per week, with years of experience having no impact on this frequency. Rollin's "Fundamental Question" is illustrated by a cartoon depicting a choice between expensive intensive care ( to fix) or getting a new pet, highlighting the monetary value often placed on animal life.
Consequences of Poor Ethical Reasoning
Poor ethical decisions can negatively impact animals and humans, leading to an erosion of trust in both the individual veterinarian and the profession. This can result in moral stress, stemming from acting against professional or personal morals, and contributing to stress, burnout, mental health morbidity, and suicidality. Research by Batchelor et al. in 2015 showed that practicing veterinarians performed no better than the general public in moral reasoning skills, while academic veterinarians scored higher than both other groups, with female academics having the highest scores. The conclusion was that, "despite having a professional degree moral reasoning skills of practicing veterinarians may be insufficient to deal with the demands of their profession." Ethical reasoning often requires stepping out of one's comfort zone, seeking reasons for what is right or wrong, and moving beyond societal or relationship-based morals. Examples of ethical decision scenarios include deciding whether a vet should perform a caesarian section on a Belgian Blue cow, accede to a client's request to euthanase a urinary incontinent bitch, or advise routine neutering of bitches.
Ethical Theories for Decision Making
Three main ethical theories for decision making are utilitarianism, which involves cost-benefit analysis; deontology, which focuses on following rules; and virtue theory, which emphasizes being a good person and character. Other approaches include relational ethics, respect for nature, and contractarianism, which is common in medical ethics.
Utilitarianism
Utilitarianism's core principle is weighing the costs and benefits of different courses of action, considering the consequences of any choice. It is often summarized as "the lesser of two evils" or "the greatest good for the greatest number," where the overall good is sought even if individuals have strong feelings. Common items considered in this cost-benefit analysis include financial cost (), pain, length of life, professional satisfaction, quality of life, and owner satisfaction. For example, considering amputating the leg of a dog with a bone tumour, with a post-op statistical survival rate of after months, the analysis involves stakeholders. For owners, costs include financial expenses () and post-operative care, while benefits include more time with the dog and satisfaction from trying everything. For the dog, costs are reduced post-operative quality of life, pain, and distress of surgery, with the benefit being a chance of increased length of life. For the veterinary team, benefits include income () and professional satisfaction. Revisiting ethical decision scenarios using utilitarianism, for a Belgian Blue Cow C-section, one would consider the age of the sow, welfare, farmer's financial motivations, quality of life for mom/baby (potentially poor if the calf is too large), potential death of mom/baby, and the vet's income. (Notably, one vet was disciplined by RVC for refusing to perform one due to welfare concerns.) For the euthanasia of a urinary incontinent bitch, considerations include the owner's commitment, impact on the owner's quality of life (e.g., in-house incontinence issues), the dog's existing quality of life (minimal pain), cost of treatment, and the dog potentially having many years left; a vet might refuse if it goes against the animal's best interest and pass the case to a colleague. For routine neutering of bitches, one would consider preventing pyometra or cancer (improving quality of life), population control (impacting future welfare of puppies), health risks of any surgery, cost of neutering (could incur more costs later if not done), and the owner's quality of life (heat/pregnancy/spraying).
Problems with utilitarianism arise because people often disagree on what constitutes a harm or a benefit, as subjective experiences like an animal's pain or suffering are difficult to quantify and compare. It is also challenging to weigh items with different "currencies" (e.g., money, pain, emotion) and to accurately estimate consequences due to unforeseen variables. Individual "rights" are barely considered, which can lead to situations where the suffering of a few is deemed acceptable for the greater good of the majority, potentially raising moral objections. In the case of clients who can and cannot afford to pay, many small animal vets in Denmark () frequently encounter clients who cannot pay, with over experiencing this times/month or more. The process for navigating this involves identifying any legal or professional "bottom-line" obligations, identifying all stakeholders (e.g., high-income owners with insurance, lower-income owners without), and identifying different courses of action. It's important to offer all treatment options, from the 'gold standard' to others. A utilitarian 'weighing up' for a fracture might consider a cheaper, riskier fix (higher risk of reduced welfare to the dog, increased stress for the veterinarian, increased chance of culpability), or a less experienced (cheaper) surgeon (similar risks). Other options include reducing costs (e.g., fewer post-op X-rays), offering limb amputation (a drastic but possibly life-saving option), or offering a payment plan (avoiding economic difficulties for owners, though a young couple might perceive it as unfair if a discount is given to others). Reducing overall cost without compromising care through ad hoc discounting raises a distributive justice issue, as it questions fairness if discounts are not universally applied. This practice is very common, often done to provide the best possible care or do everything possible for an animal (Kogan et al, 2015), with benefits including increased chances of best care, owner satisfaction, and vet avoiding stressors, but at the cost or risk of economic impact to the practice.
Deontology
Deontology's core principle dictates that moral choices should be made by following established rules, irrespective of the consequences. The application of rules remains consistent in every similar situation. This theory can incorporate individual "rights," which often form the basis of law. Rules can be derived from professional codes, societal laws, religious beliefs, or universal moral principles. For example, when euthanasing a wild jackdaw with a broken wing that will never be rehabilitated back to the wild, deontological rules might be "We must not kill animals" or "We must only treat wild animals injured by humans." Different rescue centers may have varying rules (e.g., a "no-kill" shelter versus one that specifically treats propeller injuries from boats). The challenge arises when different rules conflict, creating a dilemma about which duty takes precedence. Revisiting ethical decision scenarios through a deontological lens, for a Belgian Blue Cow C-section, a rule might be "always prioritize the welfare of the animal," potentially leading to refusal if the calf is too large and the procedure compromises welfare. Alternatively, a rule could be "a veterinarian must always provide requested medical service within their competence." For the euthanasia of a urinary incontinent bitch, a rule could be "never euthanase a healthy animal" or "a veterinarian must always act to relieve suffering," with the decision depending on which rule is deemed paramount. Regarding routine neutering of bitches, a rule might be "it is always right to prevent animal suffering and disease" (supporting neutering) or "do not perform elective surgery without a compelling medical indication" (potentially arguing against it).
Virtue Theory
Virtue theory's core principle focuses on the character of the moral agent rather than the actions or their consequences, asking, "What would a virtuous person do?" It emphasizes developing moral virtues such as compassion, integrity, honesty, and justice in the veterinarian. Key aspects include a focus on character over action; unlike utilitarianism and deontology which focus on what one should do, virtue ethics centers on who one should be, with right actions flowing naturally from a virtuous character. Virtues are not innate but are cultivated through practice, reflection, and education, meaning a virtuous veterinarian consistently strives to embody these traits. Relevant virtues in veterinary practice include compassion (showing empathy for animals and owners), integrity (acting morally even when difficult), honesty (being truthful about prognoses, costs, and treatments), justice (treating all fairly), courage (making difficult decisions when necessary), and practical wisdom (Phronesis, the ability to discern the right action in complex situations by applying general virtues). In an ethical dilemma, a virtue ethicist would consider what decision a veterinarian embodying these virtues would make; for instance, a compassionate and just vet might find alternative solutions for owners facing financial hardship instead of immediate euthanasia. Challenges to