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, ‘Billy the kid’, was submitted and is discussed by Richard Brown. 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 ‘Possession is nine-tenths of the dog’, 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 Brown qualified from the University of Cambridge in 1981. He gained an MSc in tropical veterinary medicine from the Royal (Dick) School of Veterinary Studies in 1986. He has served as a veterinarian with various overseas governments and has practised for over 20 years in the UK. He is currently an associate director at the School of Veterinary Medicine at City University in Hong Kong.
Billy the kid
At 10 am one of your more experienced and long-standing clients, who runs a croft with milking goats, phoned you urgently to say that one of her 26 goats, Billy, has suddenly become sick. The 15-month-old Toggenburg buck is a bit of a character and from an uncommon line of very hardy goats that are good milkers. The owner suspects he has just contracted enterotoxaemia and asks that you come out immediately.
On arrival, she explains that he is out of date on his clostridial vaccinations as he was only injected at one and two months of age. While he appeared fine earlier in the morning, on examination, he is very sick, passing diarrhoea and blood. Although still standing, he appears slightly shocked. He has a normal temperature, pale mucus membranes, an atonic rumen, reduced intestinal borborygmi, tachycardia, a slightly increased respiratory rate and dysentery. He also cries out when his abdomen is palpated. Although there is no definite test for enterotoxaemia, you agree with the owner. She insists that ‘money is no object’. You consider treatment but have concerns since the risk of death is high and he is in pain. You think euthanasia is one option to be considered on welfare grounds. How do you proceed?
Issues to consider
The phrase ‘money is no object’, except from a long-standing and loyal client, is usually a precursor to a bad debt. If the client has very limited means, euthanasia may well be the only reasonable option.
The owner's possible guilt at not providing boosters, the personal name for the goat, and that fact that the owner has made at least one serious management mistake should not influence your decision. Neither should you feel obliged to treat it because you have been called out or for the short-term financial benefit to the practice. The professional advice given should, as far as possible, be based on clinical history and findings.
As he is a buck and kept for breeding in the hope of benefitting the whole herd in the future, extraordinary treatment and even risk-taking might be justified. Billy's immediate poor welfare, which may be prolonged, needs to be weighed up against the potential future welfare benefits to the herd. The difficulty with this type of utilitarian decision is accurately predicting, and then weighing the moral worth of, the welfare compromises and benefits. Alternatively, you may think, as the owner seems to, that life itself has intrinsic value and that the goat should be treated at any cost.
Although the diagnosis is not certain (he may have eaten a plant toxin such as Rhododendron) he is still standing, was at one point vaccinated and you have good evidence he has been found early (ACGA 2000, Vet Next 2015). It would be reasonable to estimate a 50:50 chance of survival, providing that he receives immediate and thorough therapy.⇓
Possible way forward
While your actions should be practical and clinical, the way you communicate with the owner should show sympathy and empathy. You can reduce the guilt she feels by trying to show that you aren't judging past mistakes.
The risks, approximate costs and possible outcomes should then be explained to the owner as her informed consent is necessary. You must explain that, although she wants treatment, it is a painful condition. Once fully informed, ensure that the owner feels able to change her mind to decide on euthanasia.
You should, of course, give your professional opinion on whether you believe treatment or euthanasia is the better course of action. If you find this difficult, imagine what you would do if it was your goat. There is also some scientific evidence to show that calmly using your gut instinct is often correct, provided it has not been influenced by emotion (Van den Bruel and others 2012, Iqbal and others 2015).
If immediate euthanasia is the chosen option, bear in mind that goats can often be refractory to the full lethal effect of certain barbiturates, so you would be well advised to double check that Billy has actually passed away five minutes or so after the injection.
Alternatively, following initial treatment, it could be useful to take the goat to the surgery to be set up on a drip with more supportive therapy. A definitive decision to either to continue therapy or perform euthanasia should then be made within the next 24 hours depending on the response to treatment. It might also be prudent to ask the owner's permission to act on your clinical judgement without notice, carrying out rapid euthanasia if it is required. You will, of course, as far as it is possible, keep her informed of events.
The matter of why Billy was not vaccinated further should be revisited at an appropriate time with the owner and the rest of the flock shouldn't be forgotten either. They should be moved off the lush pasture and boosted again as well.
Readers with views to contribute on ‘Billy the kid’ should e-mail them to firstname.lastname@example.org so that they can be considered for publication in the next issue. The deadline for receipt of comments is Friday, August 21. Please limit contributions to 200 words.
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