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, ‘A stitch in time . . . ’, was submitted and is discussed by Paul Roger. 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 ‘Financial incentives’, which was published in the May issue of In Practice, appears on page 311.
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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David Main worked in practice for 25 years and the left to form a veterinary consultancy, where he deals mainly with farm animal welfare and sheep health. He is a RCVS and European recognised specialist in sheep health and production, and a diplomate of the European College of Animal Welfare and Behavioural Medicine. He is the current president of the European College of Small Ruminant Health Management.
A stitch in time . . .
You have been called to a client with a large sheep farm. He rarely calls you for lambing difficulties as he doesn't think it's worth his while, but has done so this time as he has several difficult lambings for you to deal with at once. While you are there you notice a number of ewes with inexpertly stitched vulvas; in some cases the sutures have ripped through the tissue. How should you proceed?
Issues to consider
After the lambings have been dealt with, the other problems need to be addressed in their order of importance to the animals concerned. In such a situation, one might assume that unnecessary suffering might have been inflicted on these ewes and that that could have been compounded by pain and distress.
First of all, one should ask, is the problem avoidable? If it is avoidable, what and when could the farmer have done something to prevent this happening? Is it a problem due to lamb numbers, to over-fat ewes or to some other confounding issue, as prepartum prolapses have a multifactorial provenance? Are there factors involved that could lead to more similar presentations or has this been a blip in an otherwise normal season?
This would not be reasonable if it was accepted as a normal event. Non-surgical interventions might have been a possible course of action, and one would need to investigate whether such options were considered.
Secondly, was the corrective action taken adequate and in the best interests of the ewes on which the procedure was performed? The question implies that the stitching is not neat and that, as in some cases the stitches have ripped through the tissue, it is likely that poor technique and/or incorrect use of materials has occurred. Under these circumstances, in which postsurgical trauma has caused swelling to already traumatised tissues and the sutures have ripped through the tissue, the ewes have undoubtedly been made more susceptible to infection or to further damage of the prolapsed structure. The ewe might continue or restart the straining that has contributed to the initial prolapse and this could then lead to a prolapse of the intestines, through the ruptured viscus, as well as the death or destruction of the ewe, along with the loss of the lambs being carried.
Possible way forward
If the Bühner method has not been used, if there is no evidence of the use of local anaesthetic and analgesia, and of concomitant treatment with an anti-inflammatory and of antibiotics, where necessary – these records can be found in the farm medicines book – then education is needed and an explanation of the potential benefits of epidural anaesthesia and analgesia are necessary.
As the stitching was not done intentionally to cause harm to the ewes, the farmer needs to be warned that his actions could be construed as inflicting unnecessary suffering on his own livestock. It should also be explained that that would be considered an offence under the Animal Welfare Act 2006, since there are better and accepted alternatives to those he used.
The farmer might be concerned at the potential economic loss and of the difficulty he faces in managing these ewes at parturition. For these concerns, he should be reassured and trained to use his veterinary team more regularly, so that he can plan and develop good strategies to prevent these incidents and to deal effectively with such problems as soon as they arise. It should be communicated clearly that having these steps in place is much better than dealing with difficulties inexpertly and then waiting for add-on comments when the veterinary surgeon is on farm for some other reason.
The farmer must also realise that client confidentiality can only be maintained if it does not put animals at risk and that he must comply or risk being reported to an outside agency or regulator.
The veterinary surgeon must also examine his duty to uphold the interests of all animals under his care, and to not be swayed by economic conflicts of interest with the client.
Readers with views to contribute on ‘A stitch in time . .’should e-mailso that they can be considered for publication in the next issue. The deadline for receipt of comments is Friday, June 27. Please limit contributions to 200 words.
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