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, ‘The case of the whelping bitch’, was submitted and is discussed by Steven McCulloch. 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 ‘Dealing with dark desires’, which was published in the January issue of In Practice, appears on page 103.
The series is being coordinated by Siobhan Mullan, of the University of Bristol. It is hoped it will provide a framework that will help practices find solutions when facing similar dilemmas.
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Steven McCulloch graduated from the University of Bristol in 2002. Since then, he has worked in small animal practices in the UK and Hong Kong. He holds a BA in philosophy from the University of London and is currently writing up his doctoral thesis in veterinary and agricultural ethics at the Royal Veterinary College.
The case of the whelping bitch
You are presented with a whelping purebred shih tzu bitch being looked after by a friend while the breeder is away on holiday. You have given oxytocin but now feel a caesarean is indicated and estimate the costs could come to about £700. The carer contacted the owner who has declared she has no intention of paying for any veterinary treatment. While there is no guarantee about the outcome of the caesarean you know that the breeder sells her puppies for about £400 each. The carer has offered to pay £250 towards the costs. How should you proceed?
Issues to consider
At the outset we should look at how the various individuals are impacted by different treatment options, in this case, C-section or euthanasia. The affected individuals are the bitch, the unborn fetuses, the veterinary surgeon, the owner of the dog, the representative of the owner and the owner(s) of the veterinary practice. These individuals have been listed in roughly the order that they are affected, both positively and negatively, by the case.
Does the euthanasia of a dog, which could otherwise have a life worth living (ie, experience net positive value) constitute a moral harm? The issue can be contested but I would argue it is, since it forecloses any future wellbeing. The ethical implications of killing the unborn puppies are even more controversial. When there is doubt in such cases the precautionary principle should be applied, therefore this short analysis will assume the puppies are harmed if killed.
Euthanasing a whelping bitch that is otherwise in a good state of health is likely to cause moral stress to a veterinary surgeon. It is a clinical scenario that should be taken seriously, perhaps discussing options in the practice with colleagues before such an event occurs.
There are three options which could be considered in this scenario.
The owner has declared that she has no intention of paying for the C-section, and we can assume in this situation that payment plans have been declined. The veterinary surgeon has judged that a C-section is indicated. The bitch is suffering on presentation, or her condition will progress to this state. Clinically, there are two reasonable treatments. The optimal is a C-section and the second best treatment is euthanasia.
In many clinics, the veterinary surgeon as an employee is constrained to perform euthanasia in such a case. The act of euthanasia results in the following harms and benefits:
The bitch and puppies are harmed due to loss of life;
The veterinary surgeon is harmed due to moral stress;
The owner is harmed due to loss of bitch and puppies;
The owner's friend is harmed due to unpleasant experience;
The effect on the veterinary practice owner is neutral.
In the event that the vet chooses to conduct a caesarean section, the harms and benefits are as follows:
The bitch and puppies benefit;
The effect to the veterinary surgeon is neutral;
The owner benefits;
The effect to the owner's friend is neutral (lost money but happy to save the dog);
The practice owner loses or the effect is neutral (if the owner's friend makes the contribution).
Caesarean section with ovariohysterectomy
It is also possible to conduct the C-section on the proviso that the bitch is spayed at the same time. This means that the same scenario cannot happen again in the future, at least with the same bitch. To eliminate the possibility of a repeat scenario with the same client, a letter could also be sent out to the owner accompanying the full bill, advising she will not be welcome to use the services of the practice in the future, should the bill remain unpaid.
Possible way forward
In these three options, the harms and benefits have not been outlined to conduct a utilitarian (cost-benefit) analysis. The veterinary surgeon is constrained to practice according to the RCVS Code of Professional Conduct, which is deontological in structure (ie, concerned with principles and duties). Specifically, the code prioritises the welfare of the animal, in this case the whelping bitch and the unborn puppies.
The preferred option of the veterinary surgeon will be influenced by contextual factors, but, fundamentally, it will depend on the issue pointed out earlier. If the veterinary surgeon believes euthanasia to be harmful to the bitch and her unborn fetuses, it will result in moral conflict. The vet will be faced with destroying the very animals which the profession endeavours to help, acting against moral conscience and, indeed, against the ethos of our professional code of ethics. For this reason, it may be unreasonable for employers to expect their employees to perform euthanasia in such cases, since this could result in severe moral stress.
The author's preferred option in this case would be to perform a C-section with conditions. A C-section alone would allow for the situation to be repeated in the future, which is difficult to condone. I believe the profession ought to be charitable at times, but in this scenario a deliberate act on the part of the owner has resulted in the bitch's predicament. This, together with the idea that the owner is set to benefit financially, makes a straightforward C-section morally problematic.
Conducting a C-section with conditions is good for the bitch, the puppies, the veterinary surgeon, the owner and the owner's friend. If the practice owners permit discretion in such cases, they can rest assured that the businesses most important assets – its employees – will be sleeping well at night and doing a great job during the day.
Of course, the owner could refuse the conditions, and the original problem would resurface, but there is a significant difference now. The owner has been offered a carrot and turned it down. If the options are C-section plus spay, or euthanasia, it is irrational to decline surgery, since the owner would herself be disposing of a companion as well as financial gains. If this reasoning is put to the owners, with delicacy of course, a reasonable outcome for all should be achieved and the bottom line – the welfare of the whelping bitch – ensured.
Readers with views to contribute on ‘A whelping bitch of a case’ should e-mail them toso that they can be considered for publication in the next issue. The deadline for receipt of comments is Friday, February 21. Please limit contributions to 200 words.
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