In Practice Everyday ethics

Accommodating cultural differences of opinion

Wells, K. — 2012-05-10T07:35:05-07:00

You work for an animal charity in a developing country. The organisation runs veterinary clinics and neutering programmes with the aim of improving animal welfare. Sometimes you find that differences in religious and cultural beliefs between you and the local staff employed by the charity lead to disagreements over the best course of action to improve animal welfare (eg, concerning handling, pain management or euthanasia). How far should you accommodate these differences when making decisions about individual cases and practice policy?

Comments on the dilemma in the april issue: 'repeat vaccinations'

Mullan, S. — 2012-05-10T07:35:06-07:00

The dilemma in the April issue concerned a client from the medical profession questioning why their dog required repeat vaccinations (In Practice, April 2012, volume 34, pages 246–247). Their understanding was that the immune response had a long memory following vaccination and they implied that yearly vaccinations were only being recommended to provide a regular income stream for vets. David Williams commented that this was a common concern of clients. While the assumption that vaccination should incite long-term immunity against a particular pathogen was correct, the issue was complicated by differences between pathogens, vaccines and the prevalence of the pathogen in the recipient population. Since most companion animal diseases being vaccinated against were no longer circulating in the population, there were no natural boosters for immunity, which meant vaccination was required more frequently. It was also a case of playing it safe for vaccinations with an uncertain duration of immunity. The benefits of vaccination outweighed the side effects. Aside from protection against disease, yearly vaccination encouraged owners to present their pet for examination more frequently, which meant that any conditions were more likely to be diagnosed at an early stage when they were more likely to be treatable. A way forward was to ensure transparent communication with clients so that the vet and the client could come to a rational and amicable decision about the vaccination protocol for the animal. A requirement that some services, such as vaccinations, should not subsidise others, such as the treatment of sick animals, would also be justifiable.

Repeat vaccinations

Williams, D. — 2012-04-16T02:16:26-07:00

An owner presents her one-year-old dog for its repeat vaccinations. She is a lecturer in immunology at the local university and asks you why her dog needs to be vaccinated again. The whole idea of an immune response is that it has a long-lasting memory, she says. As an example, she points out that children do not need to be vaccinated yearly against measles, mumps or rubella. She suggests that yearly vaccinations are only recommended to provide veterinary surgeons with a regular income stream and that she considers this to be unethical. How should you respond?

Comments on the dilemma in the March issue: 'Genetic testing for coat colour in cats'

Mullan, S. — 2012-04-16T02:16:26-07:00

The dilemma in the March issue concerned whether it was ethically acceptable for genetic testing to be carried out to determine coat colour in cats (In Practice, March 2012, volume 34, pages 174–175). Sean Wensley noted that some people were uncomfortable with the use of genetic testing to select for aesthetic preferences, but that, in effect, it merely accelerated the process of selective breeding to comply with phenotypic requirements, which had been carried out for many years. Just because someone selected for aesthetics did not mean that they would be unable to provide positive welfare outcomes for the animal. In fact, it could also be argued that selecting for phenotype would mean that those who were tempted to disregard kittens that did not meet their approval would euthanase fewer animals. On the other hand, the cat genome had been sequenced to facilitate research into inherited diseases – not for the purpose of selecting for aesthetics. Selective breeding had also been linked to welfare problems in some companion species, including cats. Selecting for coat colour would be less ethically justifiable if it was found to be associated with deleterious mutations, and it might distract breeders from health testing. Diagnostic laboratories could help by using market strategies to raise awareness of the availability of DNA tests to screen for diseases.

Genetic testing for coat colour in cats

Wensley, S. — 2012-03-13T02:26:52-07:00

You recently attended a cat show where a company was offering genetic testing for coat colour in cats. The test is performed on cells collected using a mouth swab. Is this an ethically acceptable scientific advancement?

Comments on the dilemma in the February issue: 'Shortcomings in locum practice procedures'

Mullan, S. — 2012-03-13T02:26:52-07:00

The dilemma in the February issue questioned what you should do if you disagreed with practice procedures while working as a locum (In Practice, February 2012, volume 34, pages 110–111). In the example discussed, a client asked for a repeat prescription for acepromazine tablets for a dog in the run up to bonfire night. You knew that it was not the ideal treatment from a behavioural point of view, but other clients' records showed that acepromazine was widely prescribed by the practice for firework phobias. Richard Green commented that locum vets had obligations to the animal, client, practice, colleagues and themselves, and that it was useful to use an ethical matrix to allow due consideration of each of these stakeholders' interests. It was inevitable that there would be differences of opinion on how to do things between the locum and the practice, but very few of these would impact on patient welfare. In instances where the practice was falling short of best practice, locums could use their influence to change things for the better. Many practices were willing to change but did not do so because of inertia or lack of awareness. Best practice changed all the time, and it should be possible to tactfully discuss alternative treatments to the customary ones without overtly criticising colleagues.

Shortcomings in locum practice procedures

Green, R. — 2012-02-13T06:11:41-08:00

While working as a short-term locum, a client asks for a repeat prescription for acepromazine tablets for a dog in the run up to bonfire night. You know that it is not the ideal treatment from a behavioural point of view, but other clients' records show that acepromazine is widely prescribed by the practice for firework phobias. It would be difficult to refuse the repeat prescription without upsetting the client and the practice, and it seems unfair to cause problems for this particular client when she could come in a week later and be given the tablets without any hassle. As a short-term locum, you feel that it is important to fit in with normal practice procedures as much as possible, and the RCVS requires you not to criticise colleagues. However, your client is likely to know other clients who are being prescribed acepromazine tablets by the practice at the same time as you are refusing to prescribe them. With this in mind, if you refuse to prescribe the tablets, how should you explain to the client that they're not an appropriate treatment?

Comments on the dilemma in the January issue: 'Promoting personal views in practice'

Mullan, S. — 2012-02-13T06:11:41-08:00

The dilemma in the January issue questioned whether it was ethical for a practice owner to provide literature in the practice waiting room sympathetic to their own personal views on farm animal welfare issues (In Practice, January 2012, volume 34, page 54). While promoting animal welfare was admirable, the question of whether it was morally or professionally acceptable to promote personal views to clients on which animal-derived products to reject was less clear. Paul Roger commented that it was fine for practice owners to promote what they saw as beneficial practices as long as no negative pressure was put on the alternative view. In fact, they had a duty to publicise their stance, while ensuring that the information they provided was accurate and reviewed regularly. This would help to maintain the focus of the public on important animal welfare issues, leading to an improvement in standards. A possible way forward was to consider using an ethical framework to help inform views on different farming methods and to evaluate each method based on how well they applied the Five Freedoms concept.

Promoting personal views in practice

Roger, P. — 2012-01-11T08:21:53-08:00

You own a successful small animal practice and have a good relationship with your clients. You are also keen to do what you can to promote all aspects of animal welfare. Your knowledge of farm animal welfare issues leads you to reject certain animal-derived products when buying for yourself. Is it morally or professionally ethical for you to provide literature sympathetic to your viewpoint about farm animal welfare issues in your waiting room?

Comments on the dilemma in the November/December issue: 'Owner access to isolation facility webcam images'

Hopper, D. — 2012-01-11T08:21:53-08:00

The dilemma in the November/December issue concerned a practice that had recently installed webcams to monitor its patients in an isolation facility where human and animal contact had to be kept to a minimum (In Practice, November/December 2011, volume 33, pages 558–559). Susana Silva discussed the issue of whether or not owners should be allowed access to such images. She argued that the relationship between humans and their animals had changed greatly over the past few decades and that, now, they were usually regarded as family members. As such, people tended to be very concerned about the welfare and quality of life of their pet when it was in an isolation facility. It was good practice to discuss with the owners what type of care was going to be provided so as not to give them false expectations, and to allow them to visit the facility before their pet was admitted. Allowing owners to view video footage of their pet in isolation could have variable outcomes. Some would feel reassured while others might become anxious about their pet's altered behaviour or about protocols that might be in place to keep human contact with the animal to a minimum. A compromise might be to allow the owner to see a short video of a couple of minutes per day, rather than a live stream, thus allowing the vet to decide which footage was most appropriate for which client. Although partial access had the potential for the owner to accuse the vet of censoring, vets were not currently legally obliged to allow access to such images.

Owner access to isolation facility webcam images

Silva, S. — 2011-12-21T04:02:11-08:00

You have recently installed webcams to monitor your patients in an isolation facility where human and animal contact must be kept to a minimum. It would be technically possible to allow owners to have access to the webcam images. Would this be a good thing to do?

Comments on the dilemma in the October issue: 'Mammary mass in an overweight dog'

Mullan, S. — 2011-12-21T04:02:11-08:00

The dilemma in the October issue concerned an overweight labrador with a mammary mass (In Practice, October 2011, volume 33, pages 493–494), which required biopsy and removal of the mass. However, when the client was advised that the dog would need to lose weight before surgery, they become aggressive, said ‘the dog is on a diet and the weight problem is under control’ and refused to discuss attending weight clinics or changing the animal's food. Practice records showed that the client had previously taken the dog to two weight loss clinics and, at the last visit, it had weighed 27 kg. It was now 33 kg. Rachel Casey commented that there were three options for dealing with this scenario: to ignore the problem until the client returned; to report the owner to the RSPCA; or to contact the owner and try to convince them to reconsider weight loss options. By not taking action, the weight issue would probably not be addressed by the owner and the mass would inevitably grow bigger over time, resulting in a decline in the dog's welfare, while reporting the client to the RSPCA might breach client confidentiality. Consideration also needed to be given to whether the welfare of the dog would be better in kennels or with its owner. She suggested that the best option was to contact the owner and to take the time to consider why the owner was reluctant to address the dog's weight problem. In addition, focusing on the mass and the requirement for surgery rather than the weight of the animal, or suggesting alternative weight-loss options, such as a balanced home-made diet, might achieve good welfare outcomes for the dog.