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, ‘Cleft palate in boxer puppies’, was submitted and is discussed by David Williams. 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.
The series is being coordinated by Dr Steven McCulloch, acting director of the Centre for Animal Welfare, University of Winchester. It aims to provide a framework that will help practising veterinarians find solutions when facing similar dilemmas.
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David Williams qualified from the University of Cambridge in 1988. He teaches veterinary ophthalmology at Cambridge veterinary school and is director of studies in veterinary medicine at St John’s College, Cambridge. He is also involved in animal ethics and welfare teaching and research at both undergraduate and postgraduate levels, and is a diplomate of the European College of Animal Welfare and Behavioural Medicine.
Cleft palate in boxer puppies
You are performing a caesarean section on a boxer and four of the six puppies have significant cleft lip and palate. You have seen mild cases before that survived, but recall a paper in which similarly severely affected puppies died after a few days. You telephone the owner, a well known breeder, advising her that
the kindest thing for these puppies would be euthanasia. You are about to recommend a hysterectomy for the bitch as well when her stern voice down the line tells you that the puppies and bitch are legally hers and should be cared for until she arrives to take them all home. She tells you that successful corrective surgery is documented in the USA. If you cannot do it she will find a referral clinic that will. By now, two of the puppies are regurgitating milk and struggling to breathe. What do you do?
Issues to consider
This case illustrates the problems that often arise between a veterinary surgeon’s responsibility to the animals under their care and to the owners of the animals. It also demonstrates the conundrum that exists between what is possible from a technical perspective and what is ethical to undertake – the dichotomy between what could be done and what should be done. Your memory serves you correctly: Moura and others (2012) reported a case where the puppies died a few days after birth. However, the client is also correct: corrective surgery has been reported (Fiani and others 2016), but whether it is appropriate in this case is a difficult issue.
Readers with views to contribute on ‘Cleft palate in boxer puppies’ 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 June 29, 2018. Please limit contributions to 200 words.
We need to remember the declaration we made when becoming members of the Royal College of Veterinary Surgeons – ‘that, above all, my constant endeavour will be to ensure the health and welfare of animals committed to my care’ (Bones and Yeates 2012, RCVS 2014). The welfare of the puppies is, in all probability, best served by euthanasia, especially given the current state of two of them (regurgitating milk and struggling to breathe).
From a legal perspective, the owner is correct that the dogs are her property, but even as far back as 1822, legislation made it an offence to illtreat animals not withstanding that they are someone’s property. The Animal Welfare Act (2006) requires us – indeed requires society at large – to prevent unnecessary animal suffering and promote animal welfare. While it might be possible to operate on these puppies in weeks’ or months’ time, their current situation, in my view, requires them to be euthanased to prevent unnecessary suffering.
Possible way forward
These puppies are suffering and keeping them alive for future surgery is neither ethically nor legally the right thing to do. Obtaining the opinions of other veterinarians and nurses in the practice is likely to support this decision. A further telephone conversation with the owner is needed to impress on her that professionally and legally euthanasia of the puppies is important to prevent their welfare being compromised further. But, it might be sensible to wait until the owner can be present so that she can see the situation for herself.
However, if this delay impinges on the welfare of the puppies too much, euthanasia may have to be performed before the client arrives, as the wellbeing of the puppies must come first. In such a situation, it is important to make notes on the case and take photographs and videos to be able to explain the problem to the owner when she does arrive, as well as for legal reasons should she decide to contest your actions. Although ovariohysterectomy would seem sensible to perform under the same anaesthetic, politically it is probably better to concentrate on the welfare of the puppies and bitch and leave that bridge to be crossed at some time in the future.
Have you faced a dilemma that you would like considered in a future instalment of Everyday Ethics? If so, e-mail a brief outline to email@example.com
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