Julie D. Dinnage Modern animal shelters provide an array of services with population control and animal welfare at the forefront (Zawistowski and Morris 2013; Miller and Zawistowski 2017). Shelters operate under the direction of a board of directors or government body and must follow the overarching mission of the organization. Attention to animal welfare and the growing importance of the human–animal bond lead to decision-making complexity in shelters. The shelter veterinarian often navigates ethical challenges involving sensitive topics (Turner et al. 2012). At the same time, the veterinarian must abide by state veterinary practice acts and stay current on standards of care (Newbury et al. 2010). Veterinarians working in shelters provide advice on both management and medical issues. Shelter veterinarians’ training makes them uniquely qualified to assist organizations with ethical decisions, balancing the interests of animal populations versus the welfare of individual animals. Open admission shelters intake any animal in need, then make decisions about their care and outcome. Municipal shelters are often mandated by state or local laws to provide services to animals in need. A limited admission shelter (sometimes referred to as “no kill”) is more selective about which animals to intake, often prioritizing highly adoptable animals: however animals in limited admission shelters may endure prolonged stays (The Humane Society 2012). Open admission shelters may have to choose between treating injured and ill animals or euthanasia due to lack of space or resources. The veterinarian should be integrally involved in these decisions, providing expert opinion to ensure the prevention or alleviation of suffering through appropriate care or, if that is not possible, by performing humane euthanasia. Several longstanding and heated ethical dilemmas surround euthanasia – from how to perform the procedure in a humane manner (Rhoades 2002) to its utilization to control populations (American Veterinary Medical Association [AVMA] Euthanasia Guidelines 2020). Shelters that refuse to perform euthanasia have unique ethical dilemmas in ensuring they are not contributing to animals suffering in their care due to extended lengths of stay or by burdening potential adopters by placing animals with medical or behavioral conditions. Shelter professionals who perform euthanasia must be thoroughly trained in appropriate injection techniques and safe drug and animal handling. Shelters should provide compassion fatigue training and opportunities to discuss the stressors of performing euthanasia as one means of minimizing burnout (Figley and Roop 2006). There are ethical questions surrounding what constitutes an adoptable animal and the veterinarian’s perspective may differ from that of other decision makers. A key ethical responsibility has been to provide medically and behaviorally healthy animals for adoption. More recently, shelters may strive to increase live release rates (LRR). LRR is defined as the number of animals leaving a shelter by means other than euthanasia or in‐shelter death. This is generally achieved through rehoming, owner reclaim, or transfer to another agency (Scarlett et al. 2017). Increasing LRR may involve preventing and treating diseases but could also result in rehoming animals with chronic medical or behavioral conditions. Consideration for the potential financial and emotional toll on an adopter should be carefully reviewed along with the potential for repeat relinquishment. Methods to dependably assess the behavioral health of shelter animals to minimize repeat relinquishment and prevent potential risk to the public due to aggressive or fearful behavior are also subject to significant debate (Patronek and Bradley 2016). The quality of life for animals in a shelter is closely associated with its capacity for care (Newbury et al. 2010), which can change on a day-to-day basis. Veterinarians should work with shelter leadership to regularly assess capacity for care and to operate within that capacity, including offering environmental enrichments. Ultimately, the ethical role of a shelter veterinarian involves balancing their responsibility to provide appropriate care and ensure the best possible welfare for the animals with often limited resources. Sterilization programs have been an integral part of shelter missions to control overpopulation and stop the influx of unwanted animals into shelters. State laws and/or local ordinances often mandate that animals adopted from shelters be sterilized. Pediatric sterilization has been proven safe in the short term and has long been a common practice in shelters. Later studies raised ethical and medical questions regarding age of gonadectomy and the potential link to long-term health risks, especially in certain breeds (Torres de la Riva 2013; Hart et al. 2014). The overall benefit to the community and pet population has long been the first ethical consideration. As demand for pets increases, the shelter veterinarian may face a new ethical question if delayed gonadectomy could increase long-term well-being of an individual animal. Increasingly, areas in the United States no longer have an overabundance of unwanted pets (Rowan and Kartal 2018). Consequently, shelters may transport animals in from other geographic areas to provide a supply of desirable pets. Transport of animals, sometimes from foreign countries or different geographies, creates an ethical responsibility to prevent spread of diseases or other pathogens to nonendemic areas (Wright et al. 2020; American Heartworm Society 2021) and to ensure humane transport while abiding by all animal health regulations involving movement of animals (United States Department of Agriculture Animal and Plant Health Inspection Service [USDA-APHIS] 2020). Andrew Rowan Discussions about outdoor cats and their management are controversial. Conservation biologists complain about the outdoor presence of domestic cats and their impact on wildlife, while animal advocacy organizations (who support the need to develop successful measures to control outdoor cats), oppose the catch-and-kill approach promoted by some conservation biologists (Marra and Santella 2017; Read et al. 2020). The veterinary profession is divided on how best to manage outdoor cats with some supporting the arguments of conservation biologists (Jessup 2004; Jessup et al. 2018) while others promote trap–neuter–vaccinate–return (TNVR) programs (Levy et al. 2014; Kreisler et al. 2019). Unfortunately, good data to answer this question are scarce. Current estimates of pet cat populations in the United States vary from 58.4 million (AVMA 2018) to 94.2 million (American Pet Products Association [APPA] 2018). Given the big differences in the estimated pet cat populations produced by major pet surveys, there are no reliable estimates of the total number of outdoor (stray and feral) cats in the United States. Based on the average density of outdoor cats, Rowan et al. (2020) estimated that there could be 32 million outdoor cats in the continental United States. In 1973, the intake of cats into US shelters was around 8–9 million (7 million were euthanized that year by shelters) (Rowan and Williams 1987). In 2019, total cat intake into US shelters was an estimated 3.8 million (PetHealth n.d.) even though the pet cat population had almost doubled since 1973. This 50+% decline in the shelter intake of cats is an indication that outdoor cat populations might be declining (NB cat euthanasia in shelters has declined by over 90% since 1973; Rowan et al. 2020). Some shelters have stopped taking in unsocialized cats and euthanizing them. Instead, these cats are now being sterilized, vaccinated, and returned to field (RTF) (Johnson and Cicirelli 2014). RTF has raised concerns that outdoor cats do not thrive but the euthanasia rate of outdoor cats that are trapped, sterilized, vaccinated, and then returned to the capture site is very low. Levy and Crawford (2004) report that only 0.4% of cats were euthanized for health reasons in an outdoor cat sterilization program in Florida. However, it is widely recognized that kittens born to outdoor cats have high (70+%) mortality rates. Hence, sterilizing an outdoor cat prevents the subsequent litter production and high kitten mortality (Boone et al. 2019). It has also been reported that sterilized outdoor cats live longer than intact outdoor cats so there may be a positive welfare impact of sterilization (Tabor 1983). Conservation biologists criticize TNVR claiming that such programs do not “work” (Read et al. 2020). In contrast, cat advocates claim that TNVR programs will lead to the eventual elimination of outdoor cat colonies or, at least, a big reduction in outdoor cat numbers (Kreisler et al. 2019; Wolf et al. 2019). In examining the various publications cited by both opponents and advocates of TNVR, it is apparent that population reductions in cat colonies where TNVR has been practiced generally take at least three to five years to become evident. Several of the papers cited by opponents of TNVR as supporting the “do not work” argument described projects that lasted from one to three years at most. In addition, papers criticizing TNVR take issue with the removal of some of the cats (kittens and socialized individuals) for adoption. Such removal may account for an immediate halving of the outdoor cat population and this, it is argued, artificially increases the outdoor cat population reduction. But the longer running TNVR projects report population reductions after adjusting for the removal of cats that may be adopted (Levy et al. 2014; Kreisler et al. 2019; Wolf et al. 2019). While an obvious role for veterinarians in the outdoor cat issue would be to become involved in sterilization projects, there are other recommendations that could be offered to cat-owning clients. Animal advocacy and wildlife conservation groups promote the keeping of pet cats indoors and these campaigns have had considerable success, almost doubling the percentage of cats that are indoor-only pets (APPA 2018). Therefore, veterinarians should promote maintaining cats as indoor pets but should be aware of behavioral issues that might arise. One way to address behavioral problems would be to suggest the construction of a “catio” that allows a cat outdoor access but would prevent it from catching and killing wildlife (see http://www.feralcats.com/catio-resources for examples). If one’s cat-owning clients do not want to restrict their cat’s outdoor access, then a recent study from the UK has some additional options (Cecchetti et al. 2021). Households where a high meat protein, grain-free food was provided, and households where 5–10 minutes of daily object play was introduced, recorded decreases of 36% and 25%, respectively, in the numbers of animals captured and brought home by cats. Fitting Birdsbesafe collars (https://www.birdsbesafe.com/index.html) reduced the number of birds captured and brought home by 42% but had no discernible effect on the number of mammals brought home. Andrew Rowan In the 1970s in the United States, there were reports in news outlets and academic journals (including an editorial in Science; Feldman 1974) that drew attention to the “overpopulation” of dogs and cats and the euthanasia of millions of animals every year by animal shelters (Djerassi et al. 1973). This led to meetings that included representatives of veterinary and animal protection organizations. A Legislation, Education and Sterilization initiative was proposed to address the overpopulation crisis although most agreed that sterilization would not be able to mitigate the problem. However, those arguments were incorrect. Over the next 45 years, companion animal euthanasia by shelters has been reduced by over 90% (Table 10.3.1). Table 10.3.1 Change in US dog and cat (D&C) populations and shelter intake/euthanasia. aThe numbers for “stray” dogs refer to dogs identified as unowned strays (1950) or all dogs entering shelters in 1973 and 1982. From 2011 to 2019, the numbers for stray dogs and cats refer only to animals picked up as strays and not to animals entering the shelter as a result of being relinquished by owners or for some other reason. bMarbanks 1954. cRowan and Williams 1987. cRowan and Williams 1987. cRowan and Williams 1987. dAVMA dog and cat population reports (AVMA 2012, 2018) or derived from equations developed from AVMA data. eDerived from PetHealth (n.d.) industry reports (https://www.petpoint.com/Industry_Data). There are no conclusive data identifying what caused the significant declines in dog and cat shelter intake and euthanasia, but it has been argued (Rowan and Kartal 2018) that surgical sterilization of pet dogs and cats and roaming outdoor cats has been a significant factor. An AVMA (2018) survey indicated that 70% of pet dogs and 80% of pet cats in the United States were sterilized (Trevejo et al. 2011). Sterilization appears to have been a key factor in reducing the euthanasia of unwanted animals in shelters from around 13 million a year in 1973 to just over a million in 2019 (Rowan and Kartal 2018; PetPoint n.d.). Approximately two-thirds of the sterilizations have been and are currently being carried out by private veterinary practices (AVMA 2018). The dog and cat overpopulation crisis in the 1970s coincided with surgical sterilizations becoming routine in private clinics. However, surgical sterilization sparked conflicts between the veterinary profession and animal protection organizations because the profession argued tax-exempt organizations had a financial advantage and that clients would gravitate to the shelter clinics. As more animal shelters offered surgical sterilization, organized veterinary medicine launched a variety of challenges to such clinics with varying success. This century, surgical sterilization offered by animal protection groups has become much more common, but some state veterinary associations continue to try to control or eliminate the competition from animal shelters. These actions are perceived by the animal protection movement to be against the best interests of animals. At the same time, the Association of Shelter Veterinarians was launched this century and has grown rapidly, and one can now become a board-certified specialist in shelter medicine (Levy et al. 2020). Individual veterinarians have been a key resource in addressing the problem of too many puppies and kittens, but the opposition of organized veterinary medicine to high volume sterilization clinics operated by animal organizations has tended to be a barrier to addressing overpopulation effectively. Another related issue that is stirring debate is the question of the impact of sterilization on the health of individual dogs and cats. Several recent reports have identified adverse consequences (increased cancer rates, joint injuries, and incontinence) in animals that have been sterilized, especially those that were sterilized prepubertally (Kutzler 2020). But sterilization can also offer health advantages (e.g. reduced rates of mammary cancer). In addition, sterilized dogs live longer than intact animals (Hoffman et al. 2013). Longevity may be a better indicator of overall health and welfare than the incidence of a few specific diseases or ill-health conditions (O’Neill et al. 2013). Ironically, we have now reached a point in the United States where the supply of puppies may not be sufficient to satisfy demand. Around 9–10% of the dog population die each year. Therefore, we need around 8 million puppies to replace the pet dogs that die and another 800,000 to accommodate the annual increase in the overall dog population. In 2019, the Centers for Disease Control (CDC) estimated that 1.06 million dogs were imported into the country, up from 400,000 ten years earlier (CDC 2019). Therefore, we need around 7.8 million domestically sourced puppies to sustain the US pet dog population. The percentage of dogs under one year of age has dropped from 20% in 1986 to 10% today (AVMA 2018). This trend should be of concern to the veterinary profession as fewer pet dogs will result in fewer paying clients for veterinary clinics. Veterinarians need to pay attention to pet supply–demand curves for many reasons affecting both animal well-being and their own (Bauer et al. 2016). Veterinary expertise is going to be in demand as the nation grapples with how to manage a humane and balanced supply of pet dogs and cats. Anne Quain Neutering (gonadectomy) involves the surgical removal of gonads. It is performed primarily to prevent companion animal overpopulation. Other indications for gonadectomy include: Gonadectomy is differentiated from convenience surgeries because of its benefits to the individual animal. In countries such as the United States and the UK, routine gonadectomy of companion animals not intended for breeding is synonymous with responsible pet ownership (Palmer et al. 2012; BVA 2019; AVMA n.d.c). Gonadectomy is the most common surgical procedure performed in dogs in the United States (Trevejo et al. 2011; Root Kustritz 2018), and is therefore an important source of income to companion animal practices. The AVMA has promoted surgical and nonsurgical sterilization of privately owned intact dogs and cats (AVMA n.d.a). More recent policy supports routine sterilization of all cats not intended for breeding by five months of age but offers no consensus recommendation for dogs (AVMA n.d.b). Yet, routine gonadectomy is not considered ethical in some countries, such as Norway and Sweden, where it is only recommended for medical reasons (Wongsaengchan and McKeegan 2019). Gonadectomy raises several ethical questions, including whether it should be performed routinely, and whether current practices are ethically acceptable. To explore these questions, I will apply Professor David Fraser’s “practical ethic” for animals (Fraser 2012). This is based on four principles, addressed sequentially below. Gonadectomy is an elective procedure, and like other procedures carried out by veterinarians, is performed without the consent of the patient. There are risks associated with anesthesia, and the potential for surgical complications, which can be minimized through careful patient screening and appropriate anesthetic and surgical techniques. The development of safe, effective nonsurgical alternatives may reduce harms associated with gonadectomy, but these are not readily available at this time (Root Kustritz 2018). Gonadectomized animals benefit from a reduced incidence of sex hormone-associated conditions, enjoy a closer bond with their owners, and may be less likely to suffer from sexual frustration (Trevejo et al. 2011; Palmer et al. 2012; Wongsaengchan and McKeegan 2019). But, it may be argued that reproduction is an important element of a “good life” for animals, and therefore removing the ability to reproduce may be considered a harm (Palmer et al. 2012). Alternatively, one could contend that a sexually intact animal who is unable to reproduce may experience sexual frustration (Palmer et al. 2012). Whether a life where an animal can reproduce is better or worse than a life where reproduction is prevented is difficult to resolve. Unless indicated for medical reasons, gonadectomy itself does not treat suffering. However, it is justified as a means of preventing suffering. Gonadectomized animals are spared suffering associated with whelping and queening and potential complications such as dystocia. Potential offspring are spared the fate of unwanted animals, who it may be argued are more likely to experience “a life worth avoiding.” Many of the diseases prevented by gonadectomy are also painful and potentially fatal.
10
Companion Animals
1 Shelter Medicine
Types of Shelters
Euthanasia
Adoptability
Capacity for Care
Sterilization
Animal Transport
References
2 Outdoor Cats
Is the Outdoor Cat Situation Getting Worse or Better?
The Health of Outdoor Cats
Does TNVR Work?
Veterinary Options for Addressing the Outdoor Cat Issue
References
3 Overpopulation
1950b
1973c
1982c
2011
2016
2019
Total US dog population (millions)
32.6
35
46
69.9d
76.8d
80d
US pet dogs and cats (millions)
52
65
92
146d
135d
140d
Stray dogs and/or stray shelter intake (millions)a
10
8–9
4–5
1.7e
1.3e
1.1e
Percentage stray dogs (of total dog population)
30%
22.9–25.7%
8.7–10.9%
2.4%
1.7%
1.4%
Stray cat shelter intake (millions)a
2.0e
1.65e
1.83e
D&C shelter euthanasia (millions)
13.5
7.6–10
3.4e
1.5e
1.2e
% D&C euthanized in shelters
20.8%
8.3–10.7%
2.4%
1.1%
0.9%
References
4 Neutering/Gonadectomy
Principle 1: Provide Good Lives for Animals in Our Care
Principle 2: Treat Suffering with Compassion