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, ‘One health and antimicrobial resistance’, was submitted and is discussed by Anne Fawcett. 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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Anne Fawcett teaches professional practice and veterinary ethics at the University of Sydney. She co-edited Veterinary Ethics: Navigating Tough Cases with Siobhan Mullan. She works in companion animal practice and is a European veterinary specialist in animal welfare science, ethics and law.
One health and antimicrobial resistance
You participate in a one health interest group involving medical doctors, epidemiologists, veterinarians and others. A key concern of the group is antimicrobial resistance (AMR). One of your medical colleagues, an infectious disease physician who frequently sees patients with multidrug-resistant infections, makes it clear that she believes that antimicrobial use in animals should be severely restricted. How can veterinarians use antimicrobials in an ethical way?
Issues to consider
A review of antimicrobial resistance (AMR) is beyond the scope of this article, but it is hoped that discussions would consider current evidence regarding the extent to which antimicrobial use in animals contributes to AMR in people, the extent to which practices in veterinary and human medicine contribute to AMR, and the efficacy of steps taken to minimise and reduce transfer of AMR.
AMR is a problem that impacts the health and welfare of people and animals, as well as impacting the environment (Boxall 2004). The use of antimicrobials as growth promoters in animal agriculture is prohibited in the EU; however, veterinarians do rely on antimicrobials to treat animals with infectious diseases. Unduly restricted access to antimicrobials may lead to increased suffering and mortality of animals, and associated costs.
Readers with views to contribute on ‘One health and antimicrobial resistance’ 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 April 20, 2018. Please limit contributions to 200 words.
Possible way forward
In recognising that human behaviour impacts animals intentionally an unintentionally (Fraser and MacRae 2011), and in seeking common ground between the concerns of conservation biologists and animal welfare scientists (Fraser 2010), David Fraser has developed a ‘practical ethic’ consisting of four principles (Fraser 2012):
Provide good lives for animals in our care;
Treat suffering with compassion;
Be mindful of unseen harm;
Protect the life-sustaining processes and balances of nature.
The principles can be applied to the one health interest group scenario outlined.
Given concerns about AMR, veterinarians – and indeed all health professionals – should strive to prevent the need for antimicrobials in the first place. Veterinarians can develop best practice husbandry and herd-health programmes, including vaccination, to minimise risks of disease.
Sick animals should be treated with compassion by being attended to as quickly as possible. Accurate diagnosis may lead to early identification and appropriate treatment of infectious as opposed to non-infectious diseases. Responsible use of antimicrobials may be required to ensure that animals have the best care throughout their lives. Veterinarians can ensure animals are appropriately confined or isolated and monitored during treatment, and provide timely follow-up examinations to ensure that either the problem has resolved or is worked-up further. If euthanasia is required, it should be performed promptly and humanely.
There is much that remains to be understood about AMR. Observing withholding periods is important but may not be enough to prevent transfer of AMR. Therefore, monitoring for antibiotic residues is important. Research may help determine the level of risk to people and the environment from clinical use of antimicrobials in animals. Veterinarians can monitor antimicrobial susceptibility in conjunction with veterinary laboratories, which in turn feedback information about antimicrobial susceptibility and resistance to practices. The impacts of reducing antimicrobial use in animals should also be monitored.
With regard to the environment, veterinarians can advise on appropriate management of effluent (including carcases) so that antimicrobial residues do not escape into the environment and cause ‘horizontal’ transfer of resistance to other animals, including wild-life species that would not normally be treated with antibiotics. Veterinarians can take a proactive role in educating producers on prudent antimicrobial use, withholding periods and minimisation of environmental antimicrobial residues. Veterinary professional organisations can play a role by disseminating evidence-based prescribing and infection control guidelines, and data from monitoring, including antimicrobial susceptibility of infectious agents and antimicrobial residues in food and environmental niches, will facilitate detection and management of unseen harms.
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