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, ‘“Off colour” alpaca?’, was submitted and is discussed by Andrea Turner. 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 ‘Billy the kid’, which was published in the July/August issue of In Practice, appears on page 431.
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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Andrea Turner graduated from the University of Cambridge in 2011 and went on to complete an internship in production animal medicine at the RVC. She then spent some time doing voluntary work in Nepal and working in the UK as a locum farm animal practitioner. She is currently a resident at the University of Bristol, working towards the European College of Bovine Health Management diploma.
‘Off colour’ alpaca
You visit one of your long-standing clients to attend some of their sheep. In the next paddock, you notice an alpaca sitting away from the rest of the group. It looks lethargic and you hear it cough. The owner then tells you that the alpaca in question is an eight-year-old female and has lost weight over the winter but has otherwise been well in herself, although she has been a little ‘off colour’ recently. You offer to examine the animal, but the owner declines saying that they would rather just monitor the animal over the next day or two. As you work in an area of high rates of tuberculosis in cattle and are aware of a TB breakdown in a group of alpacas locally, you have been discussing informally within your practice about developing a policy for TB testing of alpacas. How should you proceed in this case?
Issues to consider
The welfare of the animal in question should be the first consideration as it may be compromised if the animal is suffering a systemic disease, be it bovine TB or not. In this case, it must be questioned whether it would be considered that you were ‘attending’ the alpaca when you were on the premises but had been called to examine other animals. Once you have been made aware of the alpaca, it would seem reasonable that you do have a greater moral obligation in the situation than previously. However, this obligation does not extend as fully as if you had ‘attended’ properly to the animal. If the owners continue to refuse the offer of veterinary attention for the alpaca, you have limited options with regard to ensuring the welfare of the animal. Insisting that you examine the alpaca may be of benefit to it in the short term, but will likely harm your relationship with the client in the longer term.
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Given that the holding is in an area of high incidence of bovine TB this must be considered as a differential diagnosis for any alpaca that is presented with a history of weight loss and respiratory signs. Bovine TB is a notifiable disease and is also zoonotic. This being the case, do you have any greater an obligation to insist that you examine the animal than if TB was not a possible differential? Leaving an animal that is showing systemic signs of disease within a group risks the future health and welfare of the other alpacas, as well as that of local wildlife and livestock (particularly in the case of bovine TB). At this stage, without the benefit of even a clinical examination of the affected animal, do you have any further responsibility to act to protect these animals from the potential risk posed by this individual? Given the notifiable status of TB, if infection is strongly suspected, you are obliged to report your suspicions to the APHA under the ‘Tuberculosis (Deer and Camelid) (England) Order 2014′. ‘A person in possession or charge of a camelid carcase, or a veterinary surgeon who examines a camelid carcase, who suspects that the carcase may be affected with tuberculosis must give immediate notice of such suspicion to the Secretary of State’. Therefore, even if you do examine the animal, it is not clear that you need to inform the APHA unless you have suspicion on postmortem examination (eg, visual lesions in the carcase).
In this case, the risk to other parties is a relevant concern, to be taken into account when weighing up the pros and cons of your possible courses of action (a utilitarian approach). However, even these additional considerations may not weigh heavily enough for you to insist on examining the alpaca at this stage. The autonomy of the owner over the health of their own animals must be weighed up against the welfare of the animal in question and the animals in the rest of the group, as well as the potential further affects on local wildlife, livestock and livestock keepers if the animal is infected with bovine TB.⇓
Possible way forward
It may not be necessary or helpful to insist on examining the animal at your initial visit, as the owners may fully intend to call you to see the alpaca if it does not improve or if it deteriorates. Therefore, a phone-call to the owners could be made a couple of days after the initial visit to follow-up on the progress of the alpaca.
If the owner reports no improvement or a decline in the health of the animal but continues to refuse a visit, you should highlight that the welfare of the animal is likely to be compromised if it is systemically unwell and not receiving any treatment. All common differentials for weight loss, lethargy and coughing in alpacas should be discussed but you should point out that bovine TB must also be considered in this case and that this is a zoonotic disease.
A discussion about isolation of the animal, biosecurity and hygiene precautions that the owner can take to minimise risk to the other animals, as well as to themselves, would be essential. Voluntary TB testing of the animal could be offered as a possible option to rule out the disease, although the implications of finding positive reactors (movement restrictions/ further blood tests on animals with a negative test) should be clearly explained.
If you suspect that the welfare of the animal is being compromised and that the owners are preventing such suffering being alleviated then involving another party may be necessary. It may even be that the suggestion of involvement of the RSPCA on welfare grounds, or the APHA due to potential of TB infection, would be enough to persuade the owner to allow you to examine the animal, or perform TB testing if you deemed this appropriate.
Finally, the owners should be informed that if the animal dies or has to be euthanased, a postmortem examination would be highly recommended to attempt to ascertain a diagnosis, particularly due to the potential of the presence of TB.
Readers with views to contribute on ‘“Off colour” alpaca?’ should e-mail them toso that they can be considered for publication in the next issue. The deadline for receipt of comments is Friday, September 18. Please limit contributions to 200 words.
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