THE Everyday Ethics series in In Practice gives readers an 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 this final contribution for 2016, Steven McCulloch, who coordinates the series, summarises contributions made during the year, and responses to online polls.
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Steven McCulloch graduated from the University of Bristol in 2002. Since then, he has worked in small animal practice in the UK and Hong Kong. He holds a BA in philosophy from the University of London and a PhD on the ethics of veterinary policy from the Royal Veterinary College. He is a diplomate of the European College of Animal Welfare and Behavioural Medicine.
NINE excellent Everyday Ethics articles have been published in 2016. They have been written by veterinarians working in practice and in academia, not only in the UK but also in Ireland, Norway and Hong Kong. All of them concerned small animal practice, with the exception of a contribution on tendon firing in horses. There was good participation in online polls, with over 100 responses in some cases. The Everyday Ethics section gives readers the opportunity to respond to articles, and a number of readers used this to contest the analysis in the preceding issue. This article summarises contributions in 2016, including the results of online polls.
In ‘When in Rome’ (January issue) Richard Brown discussed being asked to perform cosmetic surgery on a Doberman while working in a developing country. If the vet did not perform the surgery, the dog's owner - a farmer - would. The context of practising outside the UK with less stringent professional regulation meant the vet had greater autonomy of action. Should the vet act in a more utilitarian (greatest good) or deontological (according to rules/principles) way in this context? Brown did not support a firm position but outlined the moral features of the case. Interestingly, respondents seemed less utilitarian and more deontological in their responses, with 58 per cent saying they would refuse to perform the surgery and 42 per cent that they would ask the RCVS for advice.
In ‘Changing established protocols’ (February issue) Hanne Stabursvik discussed vaccination protocols in small animals. A client suggested antibody testing instead of blanket annual vaccination. Despite the desirability of this policy, which was supported by the WSAVA, there was a lack of antibody tests at reasonable prices. There was also the question of centralised policy on vaccination versus individual practice/vet autonomy. In the online poll, 85 per cent of respondents considered current vaccination regimes to be suboptimal. Of these, 64 per cent believed individual vets should change regimes only when recommended by professional veterinary bodies.
In ‘Questioning morals’ (March issue) Richard Brown discussed certification in horses. In the scenario, a vet was asked by the wife of a large dairy client to backdate an equine flu vaccination certificate. The horse belonged to their severely disabled daughter, and needed to be vaccinated to take part in a summer pony club. Brown argued strongly against false certification, but suggested the possibility of the vet investigating alternative solutions on behalf of the client's family, such as speaking to the pony club about making an exception in this case. In the poll, 98 per cent were opposed to false certification, with 63 per cent of these favouring refusing false certification and leaving the matter at that, and 27 per cent supporting the idea of helping the owner to find a third way. A small minority (2 per cent) opted for false certification, on the basis that the benefits to the child and her family outweighed the potential harms.
In ‘Too feral to save’ (April issue) David Mills discussed the management of a simple tibial fracture in a young stray cat. Based on a critical anthropomorphic approach, Mills ultimately sugges-ted euthanasia as the most justified action. In the online poll, 45 per cent favoured euthanasia, 38 per cent amputation and rehoming or release, and 17 per cent surgical fixation and rest. Responding to the article, Maureen Hutchison argued that the cat would prefer to continue to live and indeed had a right to continued life. She suggested that the scenario was actually about whether the vet was prepared to treat and find a carer for the cat, and whether rescue centres would be able to find a home in such cases.
In ‘Refusing to take part in euthanasia’ (May issue) Manuel Magalhães-Sant'Ana discussed an animal-rights activist nurse who refused to take part in a euthanasia. Magalhães-Sant'Ana described unconditional and conditional/contextual refusal and furthermore outlined Article 9 of the Protection of Human Rights and Fundamental Freedoms on the ‘right to freedom of thought, conscience and religion’. He suggested that the nurse had a right to refuse treatment, but that this could be trumped in some circumstances. In the online poll, most respondents (59 per cent) believed the nurse to have a contextual right to refuse assistance, 20 per cent believed the nurse to have absolute right, and 22 per cent believed the nurse never had such a right. Rose Unsworth subsequently argued against nurses having such a right based on the potential for it to lead to animal welfare consequences, for instance as a result of abandonment or drowning.
In ‘Using the evidence’ (June issue) David Mills discussed the ethics of evidence-based veterinary medicine (EBVM) in the context of surgery options for anterior cruciate rupture in a large dog. Mills argued that self-audited unpublished experience should take precedence over specialist osteotomy procedures based on an epistemological critique of EBVM. In the online poll, 61 per cent supported discussing the merits of both options and letting the owner decide, 37 per cent would refer for osteotomy, and 1 per cent would perform lateral fabellar surgery. In a reply to Mills, Martin Whitehead argued the case for osteotomy, based on the objective nature of EBVM and the unreliable nature of self audit.
In ‘A request for euthanasia: handling the client’ (July issue), Andrew Knight discussed the ethics of a euthanasing Bob, a healthy young cat. The owner was moving to a new flat that didn't allow cats, and couldn't bear someone else looking after Bob. Knight argued that Bob had an interest in a continued good life, and cited the RCVS Code on a vet's right to decline euthanasia. In the online poll, 59 per cent said that they would decline to euthanase Bob, while 40 per cent would euthanase Bob if the client insisted. Responding to the article, Richard Stephenson argued that Knight's approach would add to an already stressful situation for the client. He argued against Knight's opportunities-based account of the harm of death, and claimed that professionals opposed to euthanasia should take full ownership by guaranteeing rehoming.
In ‘Too hot to handle?’ (September issue) Madeleine Campbell discussed tendon firing in horses. She argued that there was no evidence for the beneficial effects of thermocautery, and indeed that the procedure may be harmful. Based on a number of ethical frameworks, she argued that tendon firing is not in the best interests of equine patients. All respondents to the poll agreed, believing there to be no/minimal evidence for thermocautery. Of these, 71 per cent would refuse to perform the procedure, while 29 per cent would perform tendon firing if the client insisted.
Finally, in ‘A request for euthanasia: advising a colleague’ (October issue), Andrew Knight added a twist to the scenario in his earlier article about Bob. A summary of the scenario is set out below, along with the online poll results and a response from Richard Brown.
The articles published this year reflect readers' current concerns about everyday ethical conflicts in veterinary practice. Four of the articles are concerned with the ethics of killing (Mills, Magalhães-Sant'Ana and two from Knight). Two are focused on the issue of evidence in prescribing the best course of treatment (Mills, Campbell). Brown's two articles are concerned with the ethics of practising in a different cultural context and the issue of false certification.
The Everyday Ethics articles and subsequent comments invariably feature highly in the top ten articles downloaded from the In Practice website each month. This shows a healthy interest in the ethical scenarios that arise in the various contexts of everyday veterinary practice. I would like to encourage readers to continue to submit articles, suggest scenarios for analysis, provide written responses and participate in online polls.
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