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, ‘A request for euthanasia: handling the client’, was submitted and is discussed by Andrew Knight. 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 ‘Using the evidence’, which was published in the June issue of In Practice, appears on page 359.
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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Andrew Knight is professor of animal welfare and ethics, and director of the centre for animal welfare, at the University of Winchester, and is currently establishing a distance learning MSc in animal welfare science, ethics and law. He is a European, RCVS and American specialist in this field.
A request for euthanasia: handling the client
A client brings you a friendly, well-socialised two-year-old male neutered cat named ‘Bob’ for ‘euthanasia’. Apparently the client is moving to a new flat that does not allow cats. ‘What a shame,’ you declare. ‘I'm sure he would make a wonderful pet for someone else. Have you thought about rehoming him?’ But the client replies, ‘I couldn't possibly bear to have someone else own him! Please just put him to sleep.’ What should you do?
Issues to consider
Quite obviously, your first duty is to your patient (RCVS 2016), and it is not in Bob's interests to be killed. At least, not where reasonable potential for a good life, or even just a life worth living, still exists. It has long been argued that killing, when conducted under perfect conditions, is not a violation of an animal's welfare, because no stress or suffering is involved. This has been paraphrased as ‘death is not a welfare issue’. More recently, it has been recognised that death forecloses all future opportunities for fulfilling any of an animal's interests, including the interest in experiencing positive welfare states, and so actually constitutes one of the most profound harms that may be inflicted (Yeates 2010).
The main exception occurs when severe illness or injury makes future positive states very unlikely, or unlikely to be sufficient to compensate for previous periods of suffering. In this situation, killing may genuinely be termed euthanasia, which, translated from the original Greek, means a good death. In the field of veterinary (and, where legal, human) medicine, euthanasia means a death that is both a matter of humane disposition (ie, in the patient's interests), and also a matter of humane technique (ie, conducted without inducing stress or suffering) (AVMA 2013).
As a healthcare professional, you are obliged to exercise professional judgement in the course of your duty, and are not required to accede to this request, or any other. As stated by the RCVS (2016) Code of Professional Conduct for Veterinary Surgeons, ‘No veterinary surgeon is obliged to kill a healthy animal unless required to do so under statutory powers as part of their conditions of employment.’ However, you also have a duty to your client. Their statement that they ‘couldn't possibly bear to have someone else own him’ suggests strong attachment. Presumably, then, it will be upsetting to the client to lose Bob. Clearly, you should handle the request with great tact and sensitivity. You also have duties to your practice, employer and even the profession at large. These can be upheld by doing your reasonable best to maintain good relations with this client, and by charging appropriately for any services you provide.
Finally, you have a duty to yourself and those who depend on you. To uphold these duties, you need to be able to live with any decisions you make. Killing a patient is a grave matter morally, and you would need to be able to justify this to your own conscience. Inability to do so is likely to be extremely stressful. Most of us continue to be haunted by such decisions, sometimes years later. The high rates of stress and suicide among veterinarians suggest that we give too little weight to such potential sources of stress.
Possible way forward
Your communication skills will be paramount in this case, and you should proceed with great care. You could explain that, while you understand and sympathise with your client's predicament, as a veterinarian your primary duty must always be to your patients, and it is not in the interests of a young, healthy cat to be ‘euthanased’, and thereby denied the many years of life and positive experiences he might otherwise enjoy. You could explain that, unfortunately, it would be a violation of your professional ethics were you to proceed to ‘euthanase’ in this case.
You could acknowledge that the client obviously cares a great deal about Bob, and could gently move on to exploring rehoming options. It might be possible, for example, to home him (or at least, surrender him to a shelter where rehoming is a possibility) so far from their address that they would be very unlikely to ever have to see him again. It is always wise to have contact details available of any charitable organisations that might be able to assist.
If, after such a discussion, the client remains firm in their request for ‘euthanasia’, you might politely offer to refer them to another veterinarian for a second opinion. However, you might warn them that another veterinarian might well also decline the procedure.
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