The Brief History: Veterinary Ethics in Research and Practice

In recent decades, ethical challenges have been investigated in veterinary ethics, a field which has experienced enormous development. Starting in the 1990s with Tannenbaum (1995) and Rollin (2006 [1999]), veterinary ethics has been institutionalized not only as a research field in academia but as a discipline that aims to provide guidance and support for veterinary professionals. Veterinarians have always faced ethical challenges, but the subject matter as well as the perception and responses to these challenges have changed over time (Woods 2013). Especially at the time when veterinary medicine became a legally recognized profession and veterinarians gained the right to treat animals with corresponding duties (e.g. 1948 Veterinary Surgeons Act in the UK) (Woods 2013; Kimera and Mlangwa 2015), considerable changes in the normative self-understanding of veterinarians have led to an increasing awareness of ethical questions such as “What must I do to be a proper veterinarian?” or “What do I consider as legitimate and what do I refuse to accept as part of my job?” Veterinarians have increasingly considered such concerns (Woods 2013) and have received support from professional ethicists (Tannenbaum 1995; Rollin 2006 [1999]).

The recognition of the varied and sometimes conflicting interests of animals, owners, the public, veterinary professionals, and legal requirements is at the core of debates in veterinary ethics. Expectations from these groups confront veterinarians with challenging situations and force them to rethink their responsibilities as professionals in society (Woods 2013). The fruitful collaboration of veterinarians and ethicists with a background in philosophy and theology as well as sociologists in dealing with challenging questions has been called veterinary ethics.

Although starting off as a problem-oriented discipline, veterinary ethics has evolved as an academic field. In doing so, it strongly borrowed from the debates in medical ethics, animal ethics, research ethics, and animal welfare (Kimera and Mlangwa 2015). However, it quickly became apparent that veterinarians’ real-life problems can only be addressed and solved by considering the contextual complexity and requirements of the veterinary profession that result from the relationship between the animal, the client, and the veterinarian. Hence, it is the aim of veterinary ethics to address evolving problems by not only developing solutions but also reflecting on the problems’ nature, e.g. in terms of their origin and normative background. To give an example of how the profession is oriented along normative goals, the protection and promotion of animal welfare is illustrative, which has often been understood as the paradigm to act in the best interest of the animal (Rollin 2006 [1999]; Grimm et al. 2018; Coghlan 2018; Gray and Fordyce 2020) (see Chapter 7). However, most veterinary oaths acknowledge that veterinarians are faced with additional duties related to other stakeholders such as clients or society that go beyond the best interest of the animal. Accordingly, the question arises if the patient’s best interests alone should be the sole normative goal and orientation in a highly diverse profession.

Diagnosis: Moral Diversity and Context-Specific Responsibilities

Although the interest of animal patients is often proposed as the main responsibility of veterinarians (Coghlan 2018; Kipperman et al. 2018), the veterinary profession is a medical profession with various responsibilities toward different stakeholders. Students are trained as generalists and are equipped with skills and knowledge that are not only suitable to maintain animal health and welfare, but also human or public health. Veterinary students encounter the diversity of their profession on a regular basis in their study programs as is shown in the first of four examples we will use to develop and illustrate our arguments (Case Study 23.1).

In fact, most students start their veterinary training because they want to help animals and put their interests first (Kipperman et al. 2020). However, due to context-specific responsibilities in different fields of work, veterinarians are not always able to pursue animals’ best interests but have to take owners’ or the public’s interests into account as well. Getting a structured overview of the main ends of veterinary medicine and related goals of treatment in order to understand the diversity better, is a first step to any possible strategy of dealing with it.

Table 23.1 demonstrates two important concepts: first, animals are seen differently in different veterinary working contexts; and second, how animals are treated is linked to the goals of the specific contexts. For instance, within the field of companion animal medicine, veterinary interventions are generally directed to the animal as a patient and the overall aim is to promote patients’ health and well-being and prevent disease (Rollin 2006 [1999]). This recent development led authors to the normative claim that veterinarians should act in the best interest of the animal and give them first allegiance in their decision-making and actions (Rollin 2006 [1999]; Coghlan 2018). Even though decision-making processes can be strongly influenced by factors related to the client (e.g. financial constraints or strong emotional attachment) and/or the veterinarians themselves (e.g. working background and/or level of specialization) (Springer et al. 2021), consensus can be found in the fact that the animal’s best interest constitutes an important basis to justify veterinary interventions. If a particular treatment is in the best interest of the patient and carried out, something good has been done (Grimm et al. 2018). More challenging cases are those where it is questionable whether a treatment option is in the best interest of the animal, such as excessive treatment or undertreatment.

However, it is important to note that not every treatment that is not aligned with the best interest of the animal is immoral. Even though the duty to act in the patient’s best interest structures the scope of veterinary actions, veterinary practice, for instance in the farm animal sector, is characterized by medical interventions that are often not (exclusively) aimed at the best interest of the animal. For instance, take the ovarian cyst in dairy cattle. The cow’s ovarian cyst receives medical attention as an obstacle to effective reproduction, and hence milk production, that results in financial losses for the farmer (Huth et al. 2019). This illustrates the fact that the health of the animal can become a means for other ends, like efficient production. Consequently, the primary goal of therapy is to restore production efficiency and not to focus primarily on the patient’s well-being and health. Even though the best interest principle provides a strong normative basis in companion animal medicine, that cannot be easily transferred to other contexts. Farm animal medicine and laboratory animal medicine are indispensable for secure food production, medical knowledge, and public health.

Against this background, an important task of veterinary ethics is to recognize the prevailing diversity within the profession. With respect to the aspiration of veterinary ethics – to provide guidance for veterinary professionals in dealing with ethical challenges – it is crucial to appreciate emerging uncertainties and investigate the profession’s diverse moral infrastructures. Although the literature in veterinary ethics often favors bringing the veterinary profession under one single vision and voice (FVE 2019), it raises the question of whether the profession can be aligned along a single normative ideal (e.g. following the best interest principle of the patient) or if a plurality of normative ideals is more appropriate to respond to multidimensional challenges. Hence, veterinarians might not be well advised to prioritize the interests of the animal irrespective of the context they are working in, since they might lose sight of further significant moral ideals. In the small animal clinic, veterinarians are expected to care and cure by focusing on the animal’s best interest. Whereas in the case of a zoonotic and/or epidemic outbreak, veterinarians are legally bound to kill and cull in order to safeguard public health.

Keeping this in mind, the field of veterinary ethics can promote awareness and discussions within the profession as well as in public, and should aim to reflect on the diverse moral infrastructures and context-specific responsibilities that emerge in different fields of work. But what follows from that with a view to the future of veterinary ethics? A recently published executive summary of the Veterinary Future Commission (VFC 2019) indicates intrinsic aspects of the future veterinary professional culture. Among other things, the authors summarize that ethical reasoning, compassion, critical thinking, problem solving, and intra-professional collaborations are decisive competencies in order to meet future challenges of the profession. Why is that? Well, if we know one thing that the future will bring, it is change. Most of the addressed likely changes in the VFC (2019) are articulated in relation to the advancement and digitalization of the veterinary profession, which not only enhance the quality of patient care but additionally lead to new challenges.

In the following section, we aim to focus on ethical challenges that emerge due to the advancement and digitalization of veterinary medicine. Second, we will present the potential and limitations of different tools to support practicing veterinarians in ethically challenging decision-making processes. Finally, we will discuss proposals for teaching within the field of veterinary ethics that can support future veterinarians.

Prognosis: Responses, Support, and Education for an Evolving Profession

Responding to Future Challenges

In recent years, the veterinary profession has experienced enormous advancements with respect to patient care. Especially, the implementation of digital technologies for diagnostics (e.g. magnetic resonance imaging [MRI] and computerized tomography [CT]) and health monitoring (e.g. wearable devices), or the development of innovative methods and sophisticated skills (e.g. minimally invasive surgery) that allow detection of diseases at an earlier stage or enable treatment of animals where this was not possible previously. A driving force of these advancements is digitalization, a global phenomenon finding its way into all spheres of life, and which constitutes an indispensable part of veterinarians’ professional lives. For instance, digital tools for herd management (e.g. livestock management software) have been established with the potential not only to improve feeding efficiency, disease, and reproduction management, but also to support clinical decision-making (Fejzic et al. 2019). Further, digital information and communication tools within clinical practices lead to an improvement in patient care and practice management by including electronic health records, billing, and financial analysis (Fejzic et al. 2019). Against this background, the increasing digitalization not only leads to more reliable disease detection, diagnosis, treatment, and continuous real-time monitoring, but also increases the productivity and efficiency of the professional by saving time and human resources (ECCVT 2019; VFC 2019).

However, such developments have their challenges and downsides as well. Case Studies 23.2 to 23.4 highlight challenging aspects that might occur due to the increasing use of advanced diagnostics and treatments in veterinary medicine. The overall aim is not to prescribe what the right or wrong decision or action would be, but rather to stimulate the reader to reflect on possible (future) challenging situations.

It is a main characteristic of challenging situations that there are several possible ways to deal with them. On the one hand, the GP could advise the client not to follow the proposed treatment plan and inform the client about her doubts. On the other hand, the GP could contact the specialist colleague to discuss her concern regarding suspected overtreatment of the dog. Or the GP might accept the plan despite her concern because she credits the specialist with the expertise and/or because the owner has already agreed to the treatment. Regardless of which option is chosen, important considerations regarding morals, knowledge, and trust arise that are strongly intertwined:

1. Moral considerations: Whether or not all available methods for treatment should be exhausted by veterinarians and/or clients and whether the treatment is or is not in the best interest of the patient (i.e. over/undertreatment).
   
2. Professional assessment: Different levels of specialization and/or experience may lead to different assessments of the risks and benefits of therapies.
   
3. Trusting colleagues’ judgment: Increasing availability of specialists and referring patients requires not only a trustful and respectful relationship between the client and the veterinarian but also between veterinary colleagues.

Nowadays, veterinary medicine, and companion animal medicine in particular, is able to offer options for diagnostics and therapies that are, in some respects, as advanced as in human medicine (Springer et al. 2019a). At the same time, an increasing challenge for veterinary professionals is to reflect on when it is appropriate to advise advanced treatment options and when to advise only palliative or no treatment or euthanasia (Yeates 2010; Grimm et al. 2018). No matter if innovative methods are involved or conventional treatment options are in place, overtreatment is described as a treatment that is not in the patient’s best interest and causes more harm than potential benefit for the patient (Yeates 2010; Knesl et al. 2017). Especially in relation to the ever-increasing possibilities in veterinary medicine, the problem of disproportionate use of diagnostics or therapies will be a central topic in the future. Clients’ personal preferences and emotional relationships to their animals, financial motivation on the veterinarian’s side, as well as the growth of veterinary specialization are contributing factors for this problem (Yeates 2010; Springer et al. 2019a). As a consequence, the concept of the best interest principle will increasingly move to the fore by focusing not on the question of what is medically feasible, but rather whether the medically feasible option is in the best interest of the animal or against it.

There is no doubt that the plethora of medical options goes hand in hand with an increase in veterinary specialization since the use of diagnostic tools (e.g. MRI or CT) and therapies (e.g. radiation or sophisticated surgeries) requires specific knowledge and skills. As in human medicine, clients increasingly expect advanced care and make more use of specialists in veterinary medicine (Springer et al. 2019a). In doing so, GPs see an advantage in referring their patients to university hospitals or referral clinics since they know their limits – both in terms of their expertise and the availability of advanced diagnostic tests and treatments (Tannenbaum 1995; Springer et al. 2019a). However, these aspects of veterinary specialization can cause challenges at the same time. For instance, the specialist might focus only on issues relative to their expertise and therefore might lose sight of the “big picture” or the patient as a whole and tend to initiate more diagnostics and therapies than necessary (Springer et al. 2019a).

Even though the combination of specialization and a specific working background such as at a university hospital may justify enhanced use of technologies and new methods (Springer et al. 2019a), it can also lead to disagreements about the suggested diagnostic and/or treatment plans, as indicated in Case Study 23.2. The availability of advanced tools paired with veterinarian’s skills and ambition to make use of them might lead a specialist to go further with therapies compared with GPs. Such disagreements among veterinary colleagues can be stressful (Moses et al. 2018). Therefore, the availability of advanced diagnostics and treatment options paired with the need for specialized knowledge and relevant skills will not only influence veterinarians’ and clients’ decision-making but will also impact discussions among colleagues with varying working backgrounds and levels of specialization.

Accordingly, besides the recognition of positive aspects in relation to veterinary specialization and the possibility of referring patients, acknowledgment of the value of both general veterinary practice and specialized fields in future veterinary medicine will be important. As a consequence, increasing attention on developing trustful relationships between the client and the veterinarian as well as among veterinary professionals (Tannenbaum 1995) enabling transparent communication during referring processes (American Veterinary Medical Association [AVMA] 2021) will prepare for the future. Thereby, digital communication tools can facilitate discussions about specific cases and exchange between professionals.

This scenario reveals the following three aspects that are strongly interwoven:

1. Clients’ expectations: Clients’ demands for high-standard patient care and expectations of immediate and bespoke service.
   
2. Privately financed healthcare: He who pays the piper calls the tune.
   
3. Role of veterinary professionals: Veterinary medicine as a healthcare profession and service provider.

Many companion animals enjoy the status of friends or family members. Undoubtedly, the moral status of companion animals (see Chapter 1) and the emotional relationships between owners and their animals impact veterinary services (Timmins 2008; Waters 2017; Pyatt et al. 2020). Even though it can be assumed that the impetus for the development of veterinary medicine lies in the aspiration to improve patient care, the specific status of companion animals and clients’ increasing expectations toward veterinary service also represent an important driver (Springer et al. 2019a).

Companion animal medicine can meet these expectations, which are often measured up to the standard of human medicine regarding the provision of medical options. However, even though we can draw parallels between companion animal and human medicine, there remains a specific distinction with respect to the provision of medical services: in comparison to human medicine, veterinary medicine is privately financed and strongly embedded in the service model. Veterinary medicine is provided in the form of a service that is paid for and is consequently structured via economic factors. To put this more straightforwardly: only those clients who are willing and able to pay

Only gold members can continue reading. Log In or Register to continue

Share this:

• Click to share on Twitter (Opens in new window)
• Click to share on Facebook (Opens in new window)

Related

Related posts:

1. Veterinary Ethics and the Law
2. Veterinary Advocacies and Ethical Dilemmas
3. Laboratory Animals
4. Animal Use in Veterinary Education

Stay updated, free articles. Join our Telegram channel

Join