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, ‘Honesty and euthanasia’, was submitted and is discussed by Peter Fordyce. 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 ‘Being a badger's advocate’, which was published in the June issue of In Practice, appears on page 423.
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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Peter Fordyce qualified from the Royal Veterinary College in 1981 and spent some time working in general practice. He currently teaches first-opinion small animal practice in the Department of Veterinary Medicine at Cambridge. He holds a PhD and the RCVS certificate in animal welfare science, ethics and law.
Honesty and euthanasia
The owner of a dog, which has bitten people in the past and is required by a court order to wear a muzzle in public, comes to you to discuss euthanasia because the dog has now badly bitten her partner. However, the owner's 15-year-old son is absolutely against euthanasia of the dog and has made terrible threats to the family if this happens. During your discussions you notice a lesion on the dog's leg, suggestive of an infected neoplasm. The owner suggests that she brings her son to a scheduled euthanasia appointment so you can tell him the dog has incurable cancer and needs to be euthanased for that reason. What should you do?
Issues to consider
In this situation, at least two interlinked potential ethical dilemmas seem to be posed:
First, given the oath that all members of the Royal College of Veterinary Surgeons must take to ‘ensure the health and welfare of animals committed to my care’, should the clinician euthanase the dog? Secondly, if so, should the clinician conspire with the owner to deceive the 15-year-old son about the primary reason for the euthanasia?
As ‘property’, the dog has no legal right to life and, irrespective of motivation, the owner has the right to kill or have it killed, provided that the killing does not cause ‘unnecessary suffering’.
The RCVS Code of Professional Conduct states that MRCVSs may decline to euthanase an animal (with caveats) on grounds of ‘conscience’, although this guide also points out that, while euthanasia is not an act of veterinary medicine, MRCVSs are in a position to conduct euthanasia in a way to minimise any adverse welfare impact of such killing (RCVS 2013).
While the assertion by Griffith (1979) that ‘I do not believe that the concept of law is a moral concept; laws are merely a statement of a power’ is certainly contestable in many situations, some would argue that the above case, in which animals are regarded as property, exemplifies the point. Fortunately, the RCVS Code recognises the potential moral dilemmas of such situations, arising from the ethical lacuna left by statute law, by introducing the issue of ‘conscience’, allowing the clinician to ask ‘is my involvement in killing this animal one that I find morally acceptable’? However, the Code remains silent on the issue of how such matters of conscience might be framed.
If the clinician feels the decision to euthanase the dog is morally acceptable in the circumstances, the issue of the potential ‘deceit’ of the son must be addressed. While the son has no obvious immediate legal rights in the contract to euthanase his mother's dog, the ethical issue of ‘honesty’ in the clinician's (and profession's) social contract with the family should be considered. Again the RCVS Code of Professional Conduct does provide some general guidance on the issue of honesty, but it is of limited help to the specifics of this situation (ie, where the duty of client confidentiality and the need to treat the client conflicts with the duty to be honest in dealings with the public generally).
Possible way forward
While the dog might be regarded as the clinician's ‘patient’, unlike a human patient it is considered ‘property’ and has no ‘right to life’. Therefore, Beauchamp and Childress's ethical framework used in human medicine, known as ‘Principlism’, is probably not directly applicable in this situation (Beauchamp and Childress 2008). However, Mepham modified and expanded the ‘principled’ approach to ethical dilemmas by including other stakeholders in the ethical framework, as well as the patient, to help highlight and balance areas of ethical concern and conflict that might arise in the tension between ‘individuals worthy of moral consideration’ in a specific situation (Food Ethics Council 2013).
While Mepham's matrix is not an ethical calculus, it may provide a useful framework in which to raise potential areas of ethical conflicts for the parties involved. In the situation above, one could construct a matrix to examine the balance of ethical arguments for refusing to euthanase the dog, or for agreeing to do so with or without deceiving the son. If either the veterinary surgeon or client was not comfortable in reaching a mutually acceptable position about the balance of ethical arguments in the matrix, it might at least highlight the areas of disagreement in which further discussion could suggest a way forward that was more acceptable to both parties.
The most appropriate course of action is likely to be to euthanase the dog, as the likely risk of physical, psychological and legal harm to the family is significant if it were to remain alive in their care for a prolonged period; previous attempts to modify the dog's behaviour did not work and other reasonable options were not available. Additionally, if you refuse euthanasia it is likely the owner would seek the services of another vet who was prepared to do it, causing further psychological trauma for the client and the dog, which does not like being in veterinary practices.
While it seems not quite right to lie directly to the son, it might be considered more acceptable to concur with the construct that the mother would tell the son before the euthanasia (ie, that the suspected infected neoplasm was likely to be difficult to treat because of the dog's temperament, that left untreated it would eventually cause considerable welfare problems for the dog, and that it was kinder to put the dog to sleep before it did). Here, the truth would be told – but not the whole truth. Nevertheless, the active part of the deception would not be conducted by the veterinary surgeon. Condoning the deception is acceptable, based on the view that the utilitarian benefit of greater harmony within the family, as a result of the deception, over-rides the negative consequences of the son being lied to. The justification for this view would be the ‘unfairness’ of the son's behaviour in not fulfilling their duty to the family to behave reasonably and rationally.
Readers with views to contribute on ‘Honesty and euthanasia’ should e-mail them to email@example.com so that they can be considered for publication in the next issue. The deadline for receipt of comments is Friday, August 16. Please limit contributions to 200 words.
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