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, ‘Too feral to save?’, was submitted and is discussed by David Mills. 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 ‘Questioning morals’, which was published in the March issue of In Practice, appears on page 199.
The series is being coordinated by Steven McCulloch, a practising vet with a PhD in the ethics of veterinary policy. It is hoped it will provide a framework that will help practitioners find solutions when facing similar dilemmas.
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David Mills qualified from the University of Cambridge in 2008. After a period in mixed practice, he has worked at RSPCA hospitals for the last three years. He is nearing completion of the CertAVP in welfare, ethics and law. He is currently studying part time for a PhD in the ethics of veterinary interventions and evidence-based medicine.
Too feral to save?
A young stray cat it brought to your charity hospital with a simple fracture of tibia which is eminently fixable. However, the cat is feral to the point of being almost unhandleable. What is the best course of action?
Issues to consider
In this not uncommon scenario, while the condition may be straightforward to ‘fix’, its presence in an animal of this nature creates several potential problems for the welfare of the cat, the veterinary surgeon, the charity and members of staff. These are best considered against the background of possible options:
▪ Perform surgical internal stabilisation followed by a suitable rest period of six to eight weeks, then rehome or release;
▪ Amputation followed by rehoming or release;
The cat's welfare should take precedent: on a cost-benefit calculation, any intervention should have a predictable overall benefit to the animal. With competent technique, and suitable aftercare, surgery would be expected to lead to successful fracture repair (full return to pain-free function) in 95 to 100 per cent of cases, which represents an optimal resolution of the condition (Denney and Butterworth 2000). However, the cat is feral, and so hospitalisation for six to eight weeks is likely to be a great source of mental distress; this may also lead to further pathologies. The cat's unhandleable nature may also result in inadequate pharmacological control of pain. Although the cat's reaction to people may improve over this time, it is in no way guaranteed. The cat may be unsuitable for rehoming, and release may mean any issues with implants are not dealt with, leading to chronic morbidity. Fracture repair may be unsuccessful, returning the animal somewhat to square one.
Amputation offers rapid resolution of pain and far shorter hospitalisation, which entails improved welfare through pain reduction and decreased mental distress. However, the cat may remain unable to be rehomed – there will be less time for desensitisation to occur – and release with the disability of three legs may negatively impact on its ability to live a free-roaming life, including impacting on mobility, territory defence and food acquisition; this may engender unseen welfare issues in a feral cat.
Euthanasia represents a welfare neutral option, although it precludes future pleasurable experiences and the potential for a good life. However, this may be preferable to previous options where there are several welfare ‘unknowns’.
The veterinary surgeon, while divested of an owner and their wishes, nevertheless will bear greater responsibility for the cat's treatment and future welfare. The lack of an owner to ‘check’ any treatment plans leaves the situation open to exploitation, eg, using the cat as a ‘test case’ for fracture repair techniques; this may be compounded by the fact that there may be no direct financial constraint on treatment. Other members of staff can be affected by the cat physically, eg, by being attacked, or emotionally, eg, if bonds are formed but the repair is ultimately unsuccessful leading to euthanasia. Lastly, the charity arguably has an over arching moral duty to ensure the cat's current and future welfare are acceptable, given it has legally taken responsibility for it under the Animal Welfare Act (Anon 2006). Each charity may have different perspectives, but, ultimately, there should be a justice ethic consideration as to how the charity's money should be spent on cases. In this scenario, euthanasia, in light of the high costs of hospitalisation for an uncertain outcome and, if released, one where no money would be recouped by rehoming fees, may be more attractive.
Possible way forward
None of the options for this cat are ideal. An inventive way forward may be to consider the cat's values. This will involve an anthropomorphic approach, which need not be woolly: one such as that outlined by Morton and other (1990) as ‘critical anthropomorphism’ has much to recommend it, especially its theme of precautionary ‘over-endowment’ of faculties to prevent underestimating emotional states.
It seems obvious that we can ascribe basic values to this cat, such as an interest in avoiding suffering and continuation of a life worth living. While some suffering in any veterinary intervention is inevitable, even if brief, this cat's suffering has the potential to be significant, prolonged and severe. This is especially so, given the immediacy of an animal's mental life, and the lack of understanding of its current suffering for future benefit. As discussed, the quality of the cat's life in the future is not guaranteed.
It may also be possible to endow the cat with more complex values. These may run along hedonistic (maximisation of pleasure) or naturalistic (as close to ‘natural’ as possible) lines (Sandøe and Christiansen 2008). The cat is unlikely to meet many hedonistic criteria during hospitalisation and possibly not beyond. Similarly, naturalistic criteria are breached during intervention/hospitalisation and subsequent disability or morbidity may prevent realisation of a natural life if released.
The root of the problems in this case seems to be the unknowns of the future. We like to be confident that what we do is going to be of overall benefit with minimal welfare cost; the cat and condition in this scenario make this calculation very difficult. Consideration of patient values may help crystallise the cat's welfare and interests. In this case, potential for severe suffering with no end gain may make euthanasia the more ethically appropriate option.
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