As part of our recent ethical challenge run in April, we are now publishing the ethical dilemma faced by one of the participants plus a few extracts taken from Veterinary Ethics.
What is an ethical dilemma?
Technically an ethical or moral dilemma occurs when there is a conflict between responsibilities or obligations of equal moral weight (Morgan & McDonald 2007). Ethical dilemmas arise when we have competing responsibilities with no obvious way to prioritise one responsibility over others (Morgan & McDonald 2007). Put in a different way, moral dilemmas occur where moral obligations “appear to demand that a person adopt each of two (or more) alternative but incompatible actions, such that the person cannot perform all the required actions” (Beauchamp & Childress 2013). In such a case, one may feel torn between two equally appealing (or unappealing) actions.
In veterinary practice, dilemmas can occur due to differences in beliefs about the value or status of animals, differences in beliefs regarding obligations and responsibilities to animals, differences in the assessment and weighting of interests of stakeholders, differences in assessment of outcomes or consequences of actions, or a combination of these. While most of the discussion in veterinary ethics examines dilemmas in a companion animal private practice setting, many dilemmas arise outside of this context. For example, veterinarians and associated professionals may be involved in the use of animals in sport. Here, as in human sports medicine, there can be an overriding, economically driven demand to return the athlete to competition (Campbell 2013). There can be a conflict between the desire to give the best treatment to maximise long-term welfare, and treatment that will yield improvement in performance in the short term. Additionally, clinicians may be pressured to treat beyond their expertise, use treatments for which there is little to no evidence base in the hope of a “quick fix”, undertake harmful treatment at the client’s request or disclose clinical information selectively (Campbell 2013).
Here is the ethical dilemma one of our participants encountered and shared with us:
“Whilst covering out of hours duties for a neighbouring practice I encountered numerous pets being kept alive when they clearly should not have been. The owners were often exhausted and emotionally drained trying to cope with a very sick animal, including one cat in advanced renal failure being kept alive on a drip at home, undergoing blood tests every other day, the results of which I could see. I would often euthanise these pets to end their suffering and owners would often weep with relief. I would then face a barrage of abuse on Monday mornings from the intimidating and chauvinistic practice owner because I had removed a source of income for him (he openly stated this). He was like a God to his clients who wouldn’t question him and my boss was fearful of him. (We were both female, more than 15 years qualified each. He was a bully.) We eventually stopped covering his out of hours duties because of this behaviour. I walked a tightrope between doing what was best for the animal, whilst trying to not make the owners feel guilty for keeping it alive or deciding to euthanise it, and not contradicting their vet, but being appalled at a fellow colleague’s conduct and taking abuse from him for my actions. I sometimes did not euthanise an animal even though it should have been because of the consequences for myself. I never reported him as his clients wouldn’t have spoken against him but I felt guilty for walking away leaving him to carry on this practice. I will never forget how that situation used to make me feel”.
Two questions that seem to come up repeatedly in veterinary practice are:
1. Surveys of the types of ethically challenging situations encountered by veterinary teams repeatedly identify financial limitations as a common challenge. Is this consistent with your experience? How can veterinary teams navigate situations like this?
2. Is it better to work within a poor welfare system to effect change, or is it more ethical to reject that system altogether?
If you want to share your experience with us, please email us at hello [at] 5mbooks.com
Also, if you want to further explore these and other ethical dilemmas veterinarians have to face in their jobs, you may find a wealth of information in Veterinary Ethics, edited by Siobhan Mullan and Anne Quain. The book is available on our website here and on Amazon.