You have a client with a difficult decision to make about the treatment of their pet dog. They turn to you and ask: ‘What would you do if it was your dog?’ Some practitioners believe this question can help move the management of the case forwards. Others, for various reasons, are reluctant to answer it directly. What is the best way to respond?
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graduated from the University of Bristol in 2002. Since then, he has worked in small animal practices in the UK and Hong Kong. He holds a BA in philosophy from the University of London and is currently working towards a PhD in veterinary and agricultural ethics at the Royal Veterinary College.
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Issues to consider
In the consultation room it is relatively common to be asked the question ‘What would you do if it was your dog?’ The question can be posed when the client is unsure as to which course of treatment to pursue. This could be due to moral issues or constraining financial means for treatment. The first task is to ‘unpack’ the question, since it can be interpreted in different ways.
Perhaps the truest and most literal interpretation translates to a thought experiment whereby the dog in question becomes the clinician's dog. The question then becomes ‘What would you do if it was your dog (with your moral values, and your practical resource base)?’ – Q1. ‘Practical resource base’ in this context means both financial capacity and the practical aspect of being a veterinary surgeon, with the technical ability to manage the dog's condition on a daily basis. Alternatively, taking the question less literally, it could mean ‘What would you do if it was your dog (with your moral values and my practical resource base)? – Q2. It could also mean ‘What would you do if it was your dog (with my moral values and my practical resource base)? – Q3.
In moving through these interpretations, we are moving from the notion that the client seeks your judgement based on the dog being existentially owned by you as a veterinary surgeon (Q1), through the dog being owned by the client as if they had your judgement based on your moral values and their resource base (Q2), to your judgement based on their moral values and their resource base (Q3).
Other issues to consider are:
That the overriding duty of veterinary surgeons is to ensure the welfare of animals under their care;
That trust is an important element in the practitioner-client relationship, and this question can be interpreted as indication of trust in the practitioner;
That a practitioner ought to attempt to answer any reasonable question posed by a client;
That context should also inform decision-making.
Possible way forward
A possible way forward is to assume one of the interpretations of the question and answer it. Although the truest interpretation may be Q1, this literal understanding, in effect, assumes that the client is a veterinary surgeon and can manage the dog's condition in the same way a veterinary surgeon could. It is therefore reasonable not to answer based on this interpretation.
Whether to answer Q2 or Q3 is more problematic. Approaching the question in the way described above divides decision-making criteria into three classes. The first implicit criterion is simply the veterinary surgeon's empirical knowledge of health, disease and welfare. The second is moral values, determining for instance the value placed on quality versus quantity of life. The third is practical constraints, in particular financial capacity to pay for treatment. A possible way forward is first to answer the question based on a Q2 interpretation. Indeed, based on the broader context of the situation, it seems reasonable to believe that this is what the client is asking. You could then explain that your professional judgment is based on empirical medical knowledge and moral values, for instance the relative importance of quality versus quantity of life. In particularly difficult cases, answering the client's question in this sense could form the basis of further discussion about the next steps in the dog's treatment.
From the perspective of medical ethics, the fact that clients are motivated to ask this question is revealing. It is only relatively recently that the paternalism model of clinical practice has been replaced by the autonomy model. In the autonomy model the patient makes an informed decision about treatment from a range of reasonable alternatives (in veterinary practice the patient is represented by its owner). In the paternalism model the patient is treated solely on the basis of the practitioner's judgement. When the client asks ‘What would you do if it was your dog?’ it appears to shift the practitioner-client relationship back towards the paternalism model. This is despite the client not being committed to any course of treatment by asking the question. In conclusion, the question appears to represent a role-play which allows the client to explore more deeply the practitioner's judgement of treatment and justification for it.
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, ‘What if it was your dog?’, is presented and discussed by Steve McCulloch. 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 ‘Homeopathic vaccine’, which was published in the June issue of In Practice, appears on page 495.
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.