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, ‘Value and treatment’, 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 ‘Fate of a severely lame cow’, which was published in the November/December issue of In Practice, appears on page 47.
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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Paul Roger worked in practice for 25 years and then left to form a veterinary consultancy, where he deals mainly with farm animal welfare and sheep health. He is an 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 a past-president of the European College of Small Ruminant Health Management.
Value and treatment
Farm animals are already kept for the benefit of people. Would some sick animals be more valuable to society if they were killed rather than treated with antimicrobials? Would that make this practice desirable?
Issues to consider
This dilemma starts with the assumption that a class of animals is kept for the benefit of people, which implies a specific relationship between the animals and people. Moreover, it suggests that society should define in what ways this relationship can offer mutual benefits, depending on the services or products the animals supply. Society should also determine limits on these interactions and supply guidance on how the relationship can be maintained as beneficial to both parties.
The idea that some sick animals are better killed than being treated with antimicrobials is not new, as euthanasia is permitted for domestic species and is used not only to alleviate suffering but also as a tool in disease control (eg, slaughter policy in the control of foot-and-mouth disease, removal of reactor cattle and badgers in the control of TB). This application of the idea of disease control and the alleviation of suffering through selective killing has met with mixed reactions from society.
It can be argued that the animals we use for production deserve a level of care above what we deliver to wild animals, but we also have a duty to preserve and sustain our wildlife and their habitats. The spread of exotic infectious disease has been a feature of northern European livestock agriculture over recent years (eg, Schmallenberg virus, Q fever, foot-and-mouth disease) and our response to these disease incursions has relied heavily on the ability of the government to take action and on innovative leads from the pharmaceutical industry.
Possible way forward
In evidence-based medicine, it is difficult to align the practice of killing the sick rather than opting for treatment where there is a realistic expectation of treatments being successful. For the clinician, this becomes more problematic as clinical diagnosis and treatment selection are not exact sciences. We recognise the cardinal signs of illness and can successfully treat animals when the diagnosis is straightforward (eg, hypocalcaemia, cerebrocortical necrosis), but in instances in which the diagnosis or prognosis is more doubtful (eg, environmental mastitis, coliform septicaemia) this becomes a fraught analysis. The evidence we need to progress may involve laboratory investigation, which will delay defined treatment and may place others at risk (eg, causes of abortion and risk to other animals and perhaps zoonotic implications).⇓
To deal with this dilemma, one could aim to take a stand which roughly reflects the provenance of the Animal Welfare Act 2006. In this Act, the evidence base for how animals should be kept is referred to in the form of the five freedoms and the limitations are clearly set out, but the language remains woolly in that suffering is referred to without clear definition and the descriptor ‘unnecessary’ reflects that there may be an argument for some suffering being necessary (‘what doesn't kill us makes us stronger’).
Even if we accept that it is right to kill some animals rather than treat them, we need to establish the motives for this action and to be certain that we do this in a way that fits in with the principle basis of biomedical ethics – that is, respect for autonomy (an arguable concept when applied to production animals), beneficence, non-maleficence and justice.
Readers with views to contribute on ‘Value and treatment’ should e-mail them toso that they can be considered for publication in the next issue. The deadline for receipt of comments is Friday, January 23. Please limit contributions to 200 words.
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