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, ‘Managing a high publicity crowdfunded shelter puppy with head trauma', was submitted and is discussed by Wesley Cheung and 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 Steven McCulloch, senior lecturer in human animal studies at 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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Wesley Cheung graduated from the University of Sydney in 2016. Having spent time in general practice as well as completing an emergency and critical care internship, he is now pursuing a shelter medicine specialty internship at Cornell University, USA.
Anne Fawcett teaches professional practice and veterinary ethics at the University of Sydney. She also works in companion animal practice and is a European veterinary specialist in animal welfare science, ethics and law.
Managing a high publicity crowdfunded shelter puppy with head trauma
You are a veterinarian working in an animal shelter. An eight-week-old puppy was recently brought in after a table collapsed on her head and the owners could not afford treatment. You believe that the prognosis for her to return to a normal state is poor; however, you discuss the options with the shelter manager who decides to refer the puppy to an emergency hospital. The shelter begins crowdfunding on social media to support the hospital expenses, and they find someone who is willing to adopt the puppy in the hope that she is discharged in the future. After several weeks of hospitalisation, it is clear that the puppy will never fully recover and will require intensive home care. What should you do?
Issues to consider
The puppy is a central stakeholder in this scenario and the veterinarian’s recommendations should be based on the likely quality of life of the animal. This currently depends on unknown factors, including the capacity of the future owner(s) of the animal to provide appropriate care so that it can lead a life worth living.
Readers with views to contribute on ‘Managing a high publicity crowdfunded shelter puppy with head trauma’ should e-mail them to email@example.com so that they can be considered for publication in the next issue. The deadline for receipt of comments is May 17, 2019. Please limit contributions to 200 words.
The veterinarian may experience moral stress if they are required to provide treatment they consider to be futile or treatment that they believe will prolong suffering (Batchelor and McKeegan 2012).
A complicating factor is that the shelter may own the puppy, but crowdfunders have an invested interest in the fate and welfare of the animal, and may not accept euthanasia as a treatment. Any backlash on social media could harm the reputation of the shelter and any future donations.
The shelter's manager may feel obliged to continue treating the puppy due to a combination of public pressure and sunk costs. On the other hand, the shelter may benefit from any positive attention from the crowdfunding campaign, with increased publicity potentially leading to a surge in adoptions or donations.
Possible way forward
David Fraser, an animal welfare professor at the University of British Columbia, developed a 'practical ethic' for animals, based on four principles: 1) provide good lives to animals in our care; 2) treat suffering with compassion; 3) be mindful of unseen harms and 4) protect the life-sustaining processes and balances of nature which may be applied in the case (Fraser 2012). Principles 1 to 3 are most applicable to this scenario.
Principles 1 and 2 are aligned with a veterinarian’s obligation to base their recommendations on an assessment of the current and future welfare of the puppy (BVA 2016). If the puppy’s suffering cannot be treated and the prognosis is poor then euthanasia should be considered.
When it comes to principle 3, an unseen harm of crowdfunding is the potential conflict which might occur between the interest of the donors and the interest of the puppy. This may have negative consequences for the shelter.
If the patient’s welfare is compromised because of the shelter manager’s refusal to allow euthanasia, an initial step could be to seek a second opinion from another vet (RCVS 2019).
If the puppy is euthanased, the shelter can issue out a carefully worded statement explaining reasons why this was in the puppy's best interest. The statement should highlight that all donations helped offer hope and support to the animal in care.
It is easier to make a decision regarding such a case with the benefit of hindsight, but determining the prognosis of animals with traumatic head injuries can be challenging without initially resolving secondary lesions that perpetuate the brain injury (Sande and West 2010).
It may be prudent for the shelter to develop a policy around crowdfunding. For example, to minimise the risk of a backlash, the shelter may decide to crowdfund only those cases with a good prognosis for recovery and rehoming. This decision should be made with input from at least one veterinarian who has examined the animal.
Regardless, the crowdfunding page should highlight that donations are not conditional on a particular outcome and that decisions are always made in the best interest of the animal.
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