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Decision making
Comments on the dilemma in the October issue: ‘To treat or not?’
  1. Siobhan Mullan

Abstract

The dilemma in the October issue concerned a vet who had been asked by their client to perform a radical surgical intervention on their pet (In Practice, October 2010, volume 32, pages 458–459). The vet was highly competent at the procedure, but unsure whether it would be overtreatment for that case. If the vet did not perform the treatment, the client had made it clear they would go to another local vet. James Yeates commented that veterinary treatment choices must be based on the interests of the animal. Treatment should first be compared to euthanasia and it should be considered whether the pain of surgery was worth the pleasure of future life. It was not acceptable to perform the surgery simply because another vet would do it otherwise. A possible way forward would be for the vet to advise euthanasia and give their reasons why. If this was unsuccessful, the vet could try to speak to the other vet if possible, as this might reveal that he or she was also not keen to perform the surgery. If both the owner and the other vet were immovable, then performing the operation was legitimate, as it was possible that the other vet was less skilled in the procedure. However, it might be better for the vet to maintain their moral integrity – if the client and the other vet proceeded nonetheless, the stain would be on their consciences.

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Siobhan Mullan works part-time in small animal practice, as well as at the University of Bristol. She holds the RCVS diploma in animal welfare science, ethics and law.

Siobhan Mullan comments: One complicating factor in this case was the expectation that even if the vet concerned did not overtreat the dog, the client would go to another vet who would be prepared to do so. Recent discussions I have had with soft tissue surgeons keen to act ethically in dealing with breed-related conditions highlighted the angst felt by vets who perceive that their moral stance may be undermined by their fellow practitioners.

While considering the expected consequences of your actions is important in many circumstances, James Yeates outlines two major problems with capitulating just because you believe another vet would be willing to do so – the loss of integrity of your decision and the inability to progress the profession's moral standards. The latter issue is likely in itself to have wider welfare and ethical consequences, as the setting of professional norms, whether regulated or otherwise, will have the potential to affect the decisions of all vets about the welfare of their patients. If we are not to contribute to the moral stagnation of our profession (and, importantly, the deleterious effect this could have on the welfare of animals), acting in accordance with our beliefs should have a strong weight in our decision-making process. It would then require a higher threshold of expected harm to enable us to legitimately act against our own moral stance just because another vet would do so.

Have you faced a dilemma that you would like considered in a future instalment of Everyday Ethics? If so, e-mail a brief outline to inpractice{at}bva-edit.co.uk

Notes

THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved. In addition, a possible way forward is suggested; however, there is rarely a cut-and-dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Tethered dog dies’, is presented and discussed by Pippa Swan. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue. Discussion of the dilemma ‘To treat or not?’, which was published in the October issue of In Practice, appears on page 515.

The series is being coordinated by Siobhan Mullan, of the University of Bristol. It is hoped it will provide a framework that will help practices find solutions when facing similar dilemmas.

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