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, ‘Follow-up fiasco’, was submitted and is discussed by Richard Green. 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 ‘A stitch in time . . .’, which was published in the June issue of In Practice, appears on page 375.
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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Richard Green qualified in 1989 from the University of Bristol and went on to work in companion animal practice in the UK and abroad. He is currently chief veterinary surgeon at the Blue Cross animal hospital in Hammersmith, which provides care for animals whose owners are unable to afford private veterinary services. He holds the RCVS Certificate in Animal Welfare Science, Ethics and Law.
You are presented with an eight-year-old dog with a chronic non-healing deep ulcer over the carpus. It is infected and the dog is significantly lame on the leg. It transpires that the dog was once seen approximately a year ago for a lesion over the carpus and the owners was advised to come back for a follow-up appointment but never returned. Although the owners don't give any reason for the failure in seeking the additional recommended veterinary care, they do add that the dog has been managed on self-prescribed paracetamol since that time. It is unclear why they have re-presented for the problem at this point, although the dog is in moderately poor condition otherwise. You feel they have not done as much as they should to treat the dog. How do you approach this?
Issues to consider
There are a number of competing issues in this scenario. First, there is the poor welfare of the dog, as indicated by its chronic non-healing ulcer and condition, which is probably a reflection of a poor quality of life over a longer period of time. There is also the owners' failure to obtain help in a timely fashion (and their lack of an excuse) to consider, as well as the owners' inappropriate use of a human drug to treat their pet (although this could indicate that there has been an appreciation of the pet's discomfort and attempts made to alleviate it, even if misguided). It is also important to be self-aware about your own frustration at the behaviour of the owners and the situation.
Additionally, it is possible that a court could find that the owner had been derelict in their duty to their pet under the Animal Welfare Act 2006, should the case be prosecuted.
Possible way forward
Most vets would agree that (health and safety notwithstanding) their primary responsibility is to their patients and, in this scenario, despite the frustrating and upsetting manner in which the case has been presented, it is important to keep that knowledge at the centre of any decision-making. It can also be helpful to mentally construct a simple ethical matrix to allow for the interests of the other parties involved in the case – the owners and the vet – and to consider what impact different decisions might have upon them, as well as the dog. This could also help to show that the immediately obvious conclusion (ie, this dog has bad owners), although possibly true, might actually indicate a more complex situation, and that taking a confrontational stance might not actually present the best solution for any of the parties involved, including the dog.
There are a number of potential ways to approach this case. These could range from simply treating the dog and saying nothing, through to working with and educating the owners to improve awareness and compliance, or perhaps to reporting the owners to the RSPCA, which could potentially lead to the confiscation of the animal and prosecution of the owners.
To a large extent, the vet's personal ethics and experiences will have a big impact on which course of action is taken in this situation. For example, a strongly self-interested (hedonistic) vet might consider the first option if they can remain untroubled by their conscience or moral stress. However, a vet with a strong drive to do the right thing (for either deontological or virtuous reasons) might decide to report the owner and let the events play out, regardless of other considerations.
Taking a utilitarian approach, in which the best end-result (ie, the best outcome for the dog) is of utmost importance, is often the cornerstone of welfare decision making. In this case, the possible decisions and consequences might be:
Confiscation and eventual euthanasia or rehoming of the dog; ?
Return of the dog to the original situation with some palliation but probable relapse;?
Palliation, potentially with a little luck and hard work, to effect a permanent improvement in the dog's quality of life within its familiar home environment.
Taking a good history in a case such as this can be more akin to being a social worker than being a vet but this extra effort can pay dividends.
To solve a pet's problems there often has to be an understanding of the owners' situation. This does not mean condoning the owners' behaviour and it does not mean ‘letting them off the hook’ – if things do not improve then a more robust intervention could still be necessary. However, although it is not always the case, approaching a case such as this in a sympathetic fashion can create an opportunity to improve the lives of both pet and owners.
If you have any views to contribute about ‘Follow-up fiasco’, pleases e-mail email@example.com and they will be considered for publication in our next issue. The deadline for new comments is Friday, August 21. Please limit contributions to around 200 words.
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