Veterinary Ethics

Introduction

This chapter provides a brief overview of what ethics is – just what do we mean when we talk about ethics and morality? What makes an ethical decision different from any other and why should veterinarians and associated professionals be concerned with ethics? We will explore why many of us find ethics challenging, and the place for teaching and developing ethical reasoning skills.

When it comes to animal health professions, ethics and animal welfare are inextricably linked, so we have provided a brief discussion of key concepts in animal welfare and how our values impact welfare assessment. We discuss the contentious issue of which animals are worthy of ethical consideration.

In this chapter we also look at common ethical dilemmas and sources of ethical conflict in veterinary practice, as well as the impact of those on veterinarians and associated professionals. Finally, we briefly explore policy, based on ethical reasoning, as an aid to decision-making in veterinary practice.

1.1 Cartoon

REPRODUCED WITH PERMISSION OF MATTHEW BOYD AND IAN MCCONVILLE

1.1
What is ethics?

Ethics is a branch of philosophy. Philosophy, which loosely translated means love of wisdom, is the study of general concepts such as principles of reasoning, the nature of knowledge and truth, reality, perception, and so forth. It asks the big questions, such as “Do I really exist?”

Unlike other areas of philosophy (for example, metaphysics), ethics generally presupposes reality – and in fact in the broadest sense considers the question “What should I do?” It assumes that there are, if not right and wrong answers to that question, better and worse answers. The word “ethics” is an umbrella term for beliefs, principles and rules determining what is right and wrong.

Let’s say that you are granted the power of invisibility. The ethics of invisibility concerns itself with how you use that power – whether to use that power for your personal gain by walking into a bank and stealing money in broad daylight, or for achieving a greater good, such as helping to expose the actions of those who perpetrate injustice.

Similarly, after years of study, veterinary, nursing and animal science students develop special skills and knowledge, as well as entitlement to registration (“powers”) that come with these roles – for example, the ability to diagnose and treat health problems in animals, to perform acts of veterinary science. It is possible to use these powers to help or harm others. Veterinary ethics concerns itself with how you use these powers.

Of course, poor ethical decisions may not simply result from deliberate abuse of power, but may also arise out of ignorance and laziness. One of the aims of ethics teaching is to generate awareness about decision-making so we don’t fall into these traps.

1.1.1 What do we mean when we use the word “ethics”?

Bernard Rollin, who taught the first veterinary ethics course at Colorado State University in the 1970s, makes a helpful distinction between Ethics₁ and Ethics₂ (Rollin 2006). Ethics₁ is our set of beliefs – what is right, what is wrong, what is just, what is unjust, good and bad and so on. Rollin argues that these beliefs are acquired from multiple sources: parents, school friends, teachers, authority figures and the mass media. Ethics₁ comprises our personal, social and even professional ethics.

Ethics₂ is the systematic study of Ethics₁. It examines Ethics₁ propositions (for example, “it is wrong to kill animals for sport”) and looks for consistency, contradictions and wider implications, as well as examining the way Ethics₁ propositions are justified.

According to Rollin, examples of non-debatable, consensus, socio-ethical principles include prohibitions against murder and other forms of violence (Rollin 2000). He argues that “personal ethics begin where social ethics are silent”, for example on matters such as whether we give to charity, how many offspring we have, what we eat or whether we adhere to religious tradition (Rollin 2000). Social media is full of examples where there is apparent crossover.

Anthrozoologist and author Hal Herzog writes that ethics is similar to journalism. Just as journalists investigate who, what and why (as well as when and where) something happened, ethicists look at who, what and why questions: “who is entitled to moral concern, what obligations we have to them, and why one course of action is better than another” (Herzog 2010).

There are other terms that are used frequently in the ethics literature.

Table 1.1 Ethics₁ and Ethics₂

ETHICS₁	ETHICS₂

Right vs wrong	The study of Ethics₁
Good vs bad	Analysis of ethical propositions
Fair vs unfair	How are Ethics₁ propositions justified?
Propositions from variable sources	Are Ethics₁ propositions held by this person/group/
Contradictory or conflicting beliefs	organisation consistently?
Personal ethics	How can we address conflict between Ethics₁
Professional ethics	propositions?
Social ethics

Normative ethics addresses the question “what should I do and why?” Ethical theories or frameworks attempt to generate and justify these norms or ethical propositions. These propositions are used to judge whether an action is right or wrong. An example of such a principle may be the widely accepted belief that it is wrong to harm another human being.

Descriptive ethics refers to the factual investigation of moral beliefs and conduct – the psychology, neurobiology, sociology and anthropology of beliefs. It describes moral and ethical reasoning and behaviour without judging or prescribing beliefs and conduct.

Metaethics is the study of ethical reasoning, moral knowledge and ethical “truth”. It is concerned with questions such as “what is good?”, “what are right and wrong?” and “how can we tell the difference between good and bad or right and wrong?”

1.2
What makes a decision ethical?

For philosopher William Shaw, ethical or moral decisions differ from non-ethical decisions in three ways. Firstly, they are concerned with actions that can seriously impact the welfare and in some cases survival of others. Whether or not to wear a particular coloured dress is not an ethical decision in most cases. Deciding whether to euthanase or treat an animal is an ethical decision.

Secondly, because of their importance, moral standards take priority over other standards. For example, if a veterinary nurse believes strongly that it is wrong to kill a healthy companion animal, most would argue that he or she should not participate in this just because it is a service a client has demanded.

1.2 It helps to become familiar with ethical terminology.

Thirdly, the soundness of moral standards depends on the reasons used to justify them. Thus it is unsound to justify an ethical action (for example, treating a wildlife casualty) on the grounds that it was done “because I could” (Shaw 2010). We would expect a justification referring to broader ethical principles – for example, “I treated this animal because the suffering involved will be short-lived and is outweighed by the likely successful rehabilitation” (a utilitarian justification) or “I treated this animal because I was acting in accordance with my duty to respect the value of the life of all animals” (a deontological justification).

In the clinical setting, ethical reasoning has been proposed to consist of four key components:

knowledge and understanding of ethical theory or frameworks;
awareness of different stakeholders and their interests in a given scenario;
awareness of one’s own morals as a practitioner;

the ability to incorporate all of the above in the clinical reasoning process (Edwards & Delaney 2008).

Veterinary medical ethics, along with medical ethics, has been criticised previously for focusing too much on intraprofessional etiquette (Magalhães-Sant’Ana 2015, Rollin 2000). To date, many codes of conduct focus on issues such as advertising, referral, client relations and not denigrating colleagues or bringing the profession into disrepute. It is clear that veterinary ethics is much broader than that; however, there is a large amount of overlap between ethics and etiquette.

1.5
Why should we study veterinary ethics?

There are a variety of reasons we should learn about ethics but fundamentally we are aiming to make more “right” decisions in the variety of settings that vets find themselves in.

“Vets are not just at the front line, they are also on an ethical highwire, constantly balancing their concern with animal welfare against the demands of the industries, clients and practices they work for, without necessarily having been given any training in how to do this.”

(Rawles 2000)

Box 1.1 Motivations for Behaving Ethically

1.5 Our motivations for behaving ethically are diverse.

ILLUSTRATION ENGESRAA

Our motivations for behaving ethically are diverse. When asked to give a reason for behaving ethically, or engaging in ethical decision-making, a group of 120 Australian second-year veterinary students gave a range of responses:

Because my religion dictates it
Because my parents told me
Because I am a role model
Because it will increase the likeliness of me being rewarded
Because it will decrease the likelihood of me being punished
To fit in with my peers
To get warm, fuzzy or positive feelings
To maintain a good reputation
Because it is the law
Because it leads to better outcomes for others
Because ethical behaviour is dictated by my professional code of conduct
To avoid stress/follow the path of least resistance
To increase the likelihood of the best outcome
To avoid feeling guilty
Because a good person would behave according to ethical principles and I am a good person (class survey, Fawcett 2012, unpublished).

1.6 Vets are on an ethical highwire.

CARTOON RAFAEL GALLARDO ARJONILLA

Many qualified veterinarians have had no formal ethics training and have found their own path through the ethical minefield in which they operate. Unfortunately, increased experience in practice does not reduce the stress of ethical dilemmas (Batchelor & McKeegan 2012). Furthermore, moral reasoning is not simply learned from repeated exposure to ethical dilemmas (Batchelor, et al. 2015). A preliminary investigation into the moral reasoning of UK veterinarians found that, despite having a professional degree, the moral reasoning skills of practising veterinarians were highly variable, and were often no better than those of members of the public (Batchelor, et al. 2015). The authors concluded that the moral reasoning skills of veterinarians may be insufficient to meet the demands of such an ethically challenging job. In this study veterinarians working in an academic setting fared better – perhaps because they are in a working environment that promotes critical thinking and discussion (Batch-elor, et al. 2015).

Concerningly, a study found that the moral reasoning of veterinary students was not improved during veterinary school (Self, et al. 1996). In one study, 78 per cent of veterinarians reported that their veterinary degree did not provide them with adequate training to deal with ethical dilemmas (Batchelor & McKeegan 2012). In a survey of veterinary educators who taught ethics, one motivation was to equip students to deal with ethical tension to prevent them “dropping out after a few years in practice” (Magalhães-Sant’Ana, et al. 2014). This involves recognising ethical issues and developing ethical reasoning and decision-making skills (Figure 1.7). What we don’t yet know is to what extent ethics teaching alters such outcomes.

Increasingly, veterinary students are being taught ethical theories and reasoning, not least to comply with the expected competencies of veterinary regulators. To determine the underlying reasons behind ethics teaching Manuel Magalhães-Sant’Ana and colleagues surveyed veterinary educators and found four major themes: raising ethical awareness, providing an ethical knowledge base, developing ethical skills and developing individual and professional qualities (Magalhães-Sant’Ana, et al. 2014).

These themes are associated with learning objectives as outlined in Figure 1.7.

Classroom discussions provide a relatively safe environment to discuss personal views and values (Magalhães-Sant’Ana, et al. 2014). There is, however, no accepted gold standard for veterinary ethics education and ethics curricula vary in terms of how the themes are prioritised. In addition, ethics can be taught within different subjects. A qualitative study showed that veterinary ethics teaching is grounded or framed within animal welfare science, laws and regulations, theories and concepts and professionalism.

Batchelor, et al. (2015) suggested that veterinary medicine adopt the successful teaching methods for ethics employed in medicine and nursing. In most cases student-centred, group discussions of ethical dilemmas or scenarios are used, with the focus on developing critical reasoning rather than simply transferring facts and values.

1.7 Learning objectives corresponding to themes in ethics teaching.

ADAPTED FROM MAGALHÃES-SANT’ANA, ET AL. (2014)

Sant’Ana proposed a common framework for the teaching of human and veterinary medical ethics based on three concepts: professional rules, moral virtues and ethical skills (Magalhães-Sant’Ana 2015). The professional rules approach is based on transmitting norms or deontological principles (see chapter 2) in legislation, professional codes, oaths and principles. The virtues-based approach is focused on development of moral attitudes and behaviours, and promoting the values and beliefs underpinning the rules. Teachers and senior colleagues act as role models, through example and socialisation (see chapter 2 for a discussion of virtue ethics). The skills-based approach aims to equip students with the tools for moral reasoning, allowing them to assess ethical dilemmas and conflict from different perspectives and take moral responsibility by using these tools or frameworks to come to their own decisions. We will discuss key ethical frameworks in chapter 2.

Each concept, when employed alone, has weaknesses which may impede ethical decision-making. For example, the rules-based approach fails to recognise differences between the law and morality, and the fact that there cannot be a rule, law or guidelines for conduct in every ethically challenging situation in veterinary practice or medicine. In addition, ethical reflection becomes redundant if one can simply follow the rules (Magalhães-Sant’Ana 2015). The cultivation of virtues cannot be cultivated within the timeframe it takes to teach a single subject, and vices can be role-modelled just as easily as virtues (Magalhães-Sant’Ana 2015).

A common criticism of the skills-based approach is that in providing numerous frameworks there is a risk that students may not have time to become properly acquainted with the merits and limitations of different ethical frameworks, hampering ethical decision-making (Magalhães-Sant’Ana 2015). Ethics courses that pit one theory against another, and require students to critique each theory, may give the impression that all ethical frameworks have flaws and thus all ethical opinions are simply that: opinion (Verrinder, et al. 2016).

Accepting that ethical frameworks are essentially complementary may be a means of avoiding such confusion and “disenchantment of relativism and pluralism often associated with ethics” (Verrinder, et al. 2016).

1.7
Ethics and animal welfare

1.7.1 How our values affect welfare assessment

The welfare of an individual or group of animals is usually central to any ethical decision about them. For example, the answer to the question “How much is my dog suffering?” might influence a decision about euthanasia; “What effect will box rest have on the welfare of my horse?” might affect which treatment option is preferable; “How much can mice suffer?” or indeed “How much can primates suffer?” may influence our decision (or the decision of an ethics committee) to approve the use of these animals in experiments. The very concept of “welfare” has been open to ethical examination with relative consensus that welfare science is not “value-free” (Rollin 1996).

There has been an increasing recognition that welfare science and philosophy must come together for an inter-disciplinary discussion on the nature of welfare and how best to assess it (Fraser 1999, Lund, et al. 2006, Sandøe & Simonsen 1992, Thompson 1999). In the main, welfare is considered as a continuum from extremely poor to excellent although not all components that contribute to this overall welfare have a similar continuum. For example, whereas happiness ranges through neutral to unhappiness and hunger passes through neutral to being positively satiated, thirst and pain do not have a positive equivalent, a lack of them being only neutral.

Fraser, et al. (1997) proposed a model of animal welfare that reflects three ethical concerns people might hold:

“(1) that animals should lead natural lives through the development and use of their natural adaptations and capabilities,

1.12 The question “How much can mice suffer?” may influence the decision to use these animals in experiments.

PHOTO ANNE FAWCETT

(2) that animals should feel well by being free from prolonged and intense fear, pain, and other negative states, and by experiencing normal pleasures, and
(3) that animals should function well, in the sense of satisfactory health, growth and normal functioning of physiological and behavioural systems.”

(Fraser, et al. 1997)

Proponents who value natural living are concerned that animals should live in a natural environment, fulfil a range of natural behaviours or live according to their naturally evolved characteristics, even in human-controlled environments. Many domestic animals have largely retained the core behavioural traits of their wild counterparts despite domestication as farm animals, for example, pigs (Stolba & Woodgush 1989) or pet animals such as rabbits (Stodart & Myers 1964). The concept of respect for “telos” – the essence of an animal, which can be thought of as “the dogness of a dog” or “the cowness of a cow” – is based upon a concern about naturalness of animals (Rollin 1993). However, telos, and indeed naturalness, are not always easily defined, particularly in a world of increasing man-made alterations to natural habitats. Natural living can result in negative feelings, such as fear of a predator or discomfort from cold, or in reduced physical fitness, such as poor breeding success when food is scarce.

The second ethical concern, for the feelings that animals have, both positive and negative, corresponds to ethical frameworks for human quality of life that focus on hedonism (pleasures) or the fulfilment of desires (which may or may not be pleasurable in themselves) (Jensen & Sandøe 1997). If affective state is considered important then welfare is promoted through increasing positive feelings such as contentment or excitement and minimising negative emotions such as fear, and avoiding suffering. Suffering has been variously defined but could be considered as:

“substantial physical discomfort and/or mental distress which affects our whole being and sidelines most (if not all) other considerations normally important to us.”

(Aaltola 2012)

1.13 Many domestic animals have largely retained the core behavioural traits of their wild counterparts despite domestication as farm animals.

PHOTO ANNE FAWCETT

1.14 Natural living can result in negative feelings, such as fear of a predator or discomfort from cold, or in reduced physical fitness, such as poor breeding success when food is scarce.

PHOTO ANNE FAWCETT

Suffering is relevant even if it occurs naturally, for example through heat stress in a wild animal, or without a reduction in capacity to function, for example if the animal were able to reproduce. Animals may be able to fulfil longer-term desires or “life goals”, such as nurturing their young or planning for the future through caching food, rather than having a purely hedonistic focus. Here it could be possible to define welfare in terms of feelings, as long as they are not harmful to these overriding “life goals”.

1.15 Red squirrels may demonstrate longer-term “life goals” through caching hazelnuts for use when food is scarce later in the winter.

PHOTO ISTOCK

1.16 Racehorses epitomise physical fitness, but this is lessened when injured, with the presence of gastric ulcers or if infertile.

PHOTO ISTOCK

The final ethical concern values physical fitness, which can be considered in the widest sense to include not just physical health and function but also behavioural systems. These behavioural systems would not have to be operating at all times, but would have to have the capacity should the need arise. For example, a physically fit prey animal may employ escape mechanisms only in the face of a predator. With focus on physical fitness, welfare can be considered to be reduced even in the absence of any conscious negative feelings. Examples include some types of infertility or early neoplasias, regardless of whether it satisfied naturalness criteria or not.

As Fraser, et al. (1997) point out, these concerns are often overlapping and considered to a lesser or greater degree by individuals and society who, despite favouring one concern, rarely exclude the others. For example, when considering animals that we have responsibility for, most people would be appalled at the idea of keeping animals on euphoria-inducing drugs (promoting positive feelings but against naturalness); they would be shocked if live gazelle were supplied for lions to hunt and kill in zoos (promoting naturalness and maybe fitness); and they would be concerned if the genetic determinants for faster racehorses were coupled with increased anxiety (promoting physical fitness but negative emotional states).

Each of us must consider where our values place these concerns in order to assess welfare holistically and be able to defend it to clients, colleagues and the public. Researchers have investigated the primary ethical concern of certain groups of people when making an overall judgement of animal welfare. For example, conventional farmers tended to favour a view of welfare that

1.17 More natural systems for keeping pigs allow extensive foraging behaviour.

PHOTO ISTOCK

focuses on the physical fitness of the animal and can be assessed by health and productivity indicators (Kling-Eveillard, et al. 2007) whereas organic farmers also valued naturalness (Bock & van Huik 2007). A survey of American citizens found that 40 per cent of respondents were primarily concerned that basic elements of physical welfare

1.18 Intensive pig farms only provide some basic elements of physical welfare such as food and water.

PHOTO ISTOCK

(food, water) should be provided to farm animals, whereas 46 per cent placed a strong emphasis on naturalness, for example the ability to exercise outdoors. In this study only 14 per cent of citizens were unconcerned about animal welfare, valuing a low product price above all other concerns, including welfare concerns (Prickett, et al. 2010). Vanhonacker, et al. found citizens in Belgium, compared to farmers, were more in favour of natural living for animals (Vanhonacker, et al. 2008). However, the researchers suggest that farmers were not disinterested in naturalness, but have a discord between their values and their interests in farming profitably through more intensive systems.

Historically, welfare scientists have investigated physical welfare and associated risk factors, but they have increasingly focused on the emotional capacities of animals and the effect of husbandry practices on their feelings. These are expressed through behaviour, occurring both unprompted and in response to tests such as for cognitive bias, where pessimistic and optimistic biases may be able to indicate the underlying affective state (Mendl, et al. 2009).

In order to ensure that welfare assessments – especially those aimed to deliver benefits to society such as in farm assurance schemes – reflect the ethical concerns of citizens, welfare scientists have worked in partnership with societal representatives. In the development of the Welfare Quality® farm animal assessment protocols, citizen focus groups and juries highlighted that, in comparison with the scientists, they more highly valued low-input natural farming systems, positive welfare and a holistic appraisal of welfare. This holistic concept of welfare was inextricably linked to other attributes such as environmental impact or product quality. The protocols were subsequently developed by scientists to take these concerns into account (Miele, et al. 2011).

1.7.2 The science of welfare assessment

Our ethical decisions can only ever be as good as the evidence they are based on. When welfare assessment of an animal is key to a decision it’s important to have the most accurate assessment available. But, how exactly can we do that? Ideally we would ask the animal themselves. We are gradually learning to understand what they are telling us. Animal welfare science has developed over recent decades to determine valid indicators of welfare or the preferences of animals.

1.19 In this T maze, a form of preference test, the hen was released into the centre and, having been previously trained to understand what is on offer in each of the two options, has chosen the one to the left.

PHOTO CHRISTINE NICOL

So, we now have a much better understanding of how restrictive types of housing for farm animals affect their welfare. Using the pig as an example, compared to those kept in group housing, sows in individual confinement stalls have been shown to have higher levels of stereotypies (Chapinal, et al. 2010, Zhou, et al. 2014); inability to express normal behaviours (Weaver & Morris 2004); higher levels of some health problems, such as bursitis, but lower lameness (Diaz, et al. 2014); and fewer aggressive interactions (Jansen, et al. 2007). In preference tests, stalled sows were shown to prefer shorter (30-minute) compared to longer (240-minute) periods of restriction (Spinka, et al. 1998).

However, there are problems inherent in the scientific assessment of animal welfare. Firstly, in terms of the welfare indicators, we must still interpret what such indicators mean. For example, stereotypies – repetitive, non-functional movements – are usually associated with other measures of decreased welfare. However, these may be a coping strategy and it may be that within stereotypy-inducing environments those individual animals not stereotyping actually have the worst welfare (Mason & Latham 2004). Even indicators that we assume to be associated with poor welfare, such as lameness, may be hard to quantify. It may help to assess the impact of lameness on other indicators. For example, lame broilers demonstrated changes in behaviour (Weeks, et al. 2000). Studies demonstrating self-selection of analgesic food give more insight into the mental state of lame broilers (Danbury, et al. 2000).

The second problem is how to extrapolate results from individuals to populations, and from populations to individuals. Individual animals may have different preferences, and thus be differentially affected by the same housing, human interactions and so on. Indeed, in a choice test, individual chickens have been shown to consistently choose their preferred housing environment which varied between birds (Browne, et al. 2010). Inferences about the welfare of individuals, as deduced from data about the group, are subject to the “ecological fallacy”. Thus in measuring a flock of chickens, it is impossible to determine if each individual within that flock experiences the same risk factors. If they aren’t the same, then inferences about the association between risk factors and outcomes are biased by the group effect (Siegford, et al. 2016). Trying to determine the best environment for a flock of hens may therefore be problematic. A sensible solution may be to offer choice to animals to allow them to maximise their welfare through exercising autonomy (Edgar, et al. 2013). As technology is refined, monitoring individual animals within large groups may become a viable option, but at present the cost is generally prohibitive (Siegford, et al. 2016).

Thirdly, preference testing – a direct way to “ask the animal” – has some limitations as animals can only choose between what is on offer (which could be the equivalent of a rock and a hard place) and we may not understand what motivates their choice and how well this relates to their feelings. Operant tests, where animals are actively engaged in a process to achieve something, for example pressing a lever to gain access to a resource, may be useful in determining the strength of motivation. However, they cannot indicate the effect on welfare if the animal has never had access to the resource, or the resource is withdrawn (Kirkden & Pajor 2006).

Fourthly, trying to combine the evidence from a range of welfare indicators into a holistic assessment is difficult in both principle and practice. Consider if one’s main ethical concern is even for just one element of welfare, such as affective state. For a pony outdoors on a mountain in winter, how do we weigh the relative importance of thermal discomfort, hunger, social interactions and freedom of movement in relation to how it feels? A single welfare index has been developed for cattle, pig and poultry farms by weighting in the Welfare Quality® scheme. In Welfare Quality®, indicators assess the welfare of individuals or groups of animals on the farm (Veissier, et al. 2011). However, further examination has suggested that the weighting may not be adequate to give a reliable assessment of whole farm welfare (Heath, et al. 2014).

Finally, welfare assessments are often performed at a point in time, and even if repeated over time may be inadequate to give a good indication of the welfare of an animal over its whole life. Here again we have the difficulty of weighing up a variety of welfare indicators and an additional problem that we just may not assess an animal enough – for example, we may not observe a single but very stressful experience during an animal’s life. This is problematic, since we often want to evaluate the whole life of an individual and rate husbandry systems based on their total living experience. In practice, part of a whole life assessment often relies on an evaluation of the risk of poor welfare or likelihood of good welfare.

1.7.3 How to conduct a welfare assessment

Despite the limitations already discussed, we should make use of appropriate evidence wherever possible. In assessing the effect of an action, disease or husbandry practice we should make full use of the literature and relevant experience of experts, be they scientists, animal keepers or others. When we are assessing the welfare of an individual animal, or group of animals, it is helpful to have a checklist to ensure that what we are assessing accords with our ethical concerns and that we cover all elements of welfare at that time, or over time as necessary. Our checklist should be based on evidence of valid indicators and how to combine them. Where the evidence is lacking we must make our best estimate.

Box 1.2 Steps for Devising a Welfare Assessment

Answer the following questions:

What are the best indicators for assessing the positive and negative elements of welfare of this animal/this group of animals?
Who can best perform the welfare assessment?
How can these indicators best be interpreted as a holistic welfare assessment?
How can this welfare assessment reflect the welfare of all animals in the group?
How can this welfare assessment reflect the lifetime welfare of this/these animal(s)?

It’s clear that most welfare science has focussed on indicators of poor welfare but there are good reasons for wanting to also assess positive welfare experiences (Yeates & Main 2008). For example, when discussing a euthanasia decision with a client, it can be very helpful to identify what their dog still enjoys in life. Unfortunately we have fewer validated measures of positive welfare but many owners will feel confident in telling you what their animal enjoys. Here owners have the great advantage when making, or contributing to, the welfare assessment that they know the individual animal(s) very well and will probably be best able to detect even small changes in behaviour. However, they may be limited by their ability to interpret some welfare indicators which their animal is displaying. For example, only 7 per cent of owners of geriatric dogs reported increased thirst when it was subsequently found to present in 56 per cent, and problems that were not recognised by owners were found after veterinary examination in 80 per cent of the dogs (Davies 2012). Owners may also have difficulty interpreting animal behaviour, particularly if limited by a lack of exposure to the species of animal experiencing a range in welfare states. To illustrate, one author met a UK pig farmer who had kept pigs in barren pens for 40 years but who had never been onto another pig farm, and he had never observed pigs exploring, manipulating, chewing and rooting in a substrate such as straw.

1.20 Owners know their animals best but may not always recognise signs of poor welfare.

PHOTO ISTOCK

There is also a possibility of conscious or unconscious denial. In the case of companion animals, owners may fail to recognise welfare problems due to the implications of doing so. For example, someone who is very attached to a horse may not wish to recognise the extent to which that animal’s quality of life is compromised, if they know that this means the best thing for that animal is euthanasia. Similarly, someone who is concerned about costs of veterinary fees may not wish to acknowledge the seriousness of an animal’s clinical signs.

We have discussed “argument by analogy” with regards to sentience, and, in the absence of other information, it is also a reasonable approach for a welfare assessment, where it can form the basis of our best estimate. Caulfield and Cambridge (2008) suggest the following as a starting point when considering the case of sow stalls:

“‘On the basis of human knowledge of the preferences of sentient animals, putting a sow in a sow stall is very likely to be distressing for that animal’. The next question is ‘What scientific evidence is there to disprove this?’”

(Caulfield & Cambridge 2008)

They argue that too often a lack of scientific evidence to prove non-harm to animals has impeded good judgement and enabled a system that would seem intuitively to be harmful to continue. Sometimes the original benefits that led to the introduction of such systems become redundant, for example through improved management practices. By appealing to the precautionary principle, and erring on the side of sentience or that some systems and interventions might cause an animal suffering, we are more likely to avoid poor welfare. However, this may come with a monetary cost to some groups, for example the expense associated with providing better conditions for more animals. Ghandi stated that the greatness of a nation can be judged by how it treats animals. Is modern society willing to pay the increased cost to improve the welfare of sentient animals? And what role do veterinarians have in helping to bring about greatness in our respective nations?

1.8
Veterinary ethical dilemmas

1.8.1 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.

Here is an example of an ethical dilemma: You have two children, both of whom are suffering from life-threatening medical conditions. With a particular treatment, there is a 98 per cent chance that one child can be saved – but this treatment will require all of your resources, leaving none for the other child. With another treatment, there is a 10 per cent chance that both children will be saved. Which treatment do you choose?

Part of your answer will involve weighing up the interests of each child. But “moral weight” is diffi-cult to define, and matters are complicated further for veterinarians as the moral status of animals is hotly contested.

Thus for example, if the scenario is altered such that it now involves not two children, but a child and a dog – both with medical conditions, only one of which you can treat – the dilemma evaporates for many people. They believe that the interests of the child have greater moral weight and therefore the child should receive the treatment. Or one might argue that the nature of the relationships – the fact that one relationship is that of a parent to a child – is important here, because certain duties flow from being a parent.

In practice, the strict definition of an ethical dilemma is expanded to include any difficult ethical situations, which may give rise to ethical conflict.

1.8.2 Sources of ethical dilemmas 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.

Examples of potential ethical dilemmas in veterinary practice are outlined in the box overleaf.

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 maxim-ise 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).

Similarly, those working with wildlife face unique challenges. A survey of 60 primatologists found that ethical dilemmas were common (Fedigan 2010). Even the most seemingly non-invasive approach, such as observing a population of wild animals in the field, can have negative effects which researchers need to weigh up. For example, habituation of primates to the presence of humans may render them vulnerable to harm by reducing their fear of humans and potentially facilitating undesirable behaviours such as crop-raiding (Fedigan 2010). Is research worthwhile if the primate population being studied is then decimated by hunters?

Box 1.3 Examples of Ethical Dilemmas in Veterinary Practice.

Requests to perform cosmetic procedures (tail docking, beak trimming, declawing) on animals
Requests to destroy a healthy animal
Inability or unwillingness of the client to fund treatment that is in the animal’s interests
Client wishing to continue treatment despite poor quality of life/welfare
Breaching client confidentiality to protect an animal or herd, or a client
To what extent is it appropriate to influence a client?
Performing a procedure on a patient for the first time
Whether or not to refer a patient

1.21 Requests to perform cosmetic procedures are a source of ethical conflict in veterinary practice.

CARTOON RAFAEL GALLARDO ARJONILLA

SOURCES BATCHELOR &MCKEEGAN (2012), MORGAN &MCDONALD (2007),YEATES &MAIN (2011).

Farm animal practitioners also have to deal with difficult problems, often treating animals to compensate for poor systems or management practices. The individual animals may benefit but future animals may be harmed through propping up unsustainable practices and allowing their continuation.

1.8.3 How common are ethical dilemmas and ethical conflict in practice?

Few studies have examined the incidence of ethical dilemmas and ethical conflict in veterinary settings. One factor that would affect the incidence of ethical dilemmas and ethical conflict would be ethical sensitivity or awareness of ethical dilemmas.

In one study, 58 veterinarians completed a survey reporting how frequently they faced ethical dilemmas (Batchelor & McKeegan 2012). Of these, 91 per cent faced at least one ethical dilemma per week (57 per cent faced 1–2 dilemmas per week and 34 per cent faced 3–5 dilemmas per week). Two respondents reported facing more than 10 ethical dilemmas per week, and three respondents stated they faced none (Batch-elor & McKeegan 2012).

Another study examined the number of times veterinarians refused euthanasia or wanted to refuse euthanasia requested by pet-owning clients. Although this was an uncommon issue, the majority of the 58 respondents had experienced this situation at least once a year. Two respondents reported refusing euthanasia “most months” (Yeates & Main 2011). Refusing euthanasia may not be a dilemma, as it may be clear to those veterinarians refusing euthanasia that the animal’s continued interest in welfare trumps euthanasia. Furthermore, the veterinarian may be legally entitled to refuse to perform euthanasia. But the request gives rise to ethical conflict.

1.10
Ethical policies

When we think about applying ethics we usually think about how ethical reasoning can improve decision-making in individual cases. But studying ethics can increase our ethical sensitivity and may inform policy.

Ethical policies are a useful way of ensuring that day-to-day practice reflects the ethical principles that are central to a group or organisation. The benefit of an ethical policy is that it pertains to ethical situations or dilemmas which have been considered in detail, away from time and emotional pressures that might otherwise impact decision-making. For example, a practice may develop a policy on the treatment and euthanasia of wildlife or managing clients who cannot afford the necessary treatment for their animals/stock.

Of course, any ethical policy is by necessity a “one-size-fits-all” (or at least “one-size-fits-many”) approach, and even if one broadly agrees with the principles one may be left feeling uneasy when applying it to exceptional cases.

Codes of conduct and professional ethics may have the advantage of establishing acceptable responses to common ethical dilemmas and protecting veterinarians from the pressure of those who may not be acting in an animal’s best interests (Campbell 2013). For example, where an equine veterinarian may be pressured by a trainer to undertake a harmful procedure on a horse to gain a competitive advantage, a code banning this technique or approach can give a veterinarian additional authority to refuse.

However, codes of conduct must be broad and it is difficult to develop a detailed code specific enough to instruct a busy practitioner on complex ethical dilemmas. An analysis of European veterinary codes identified eight overarching themes, including definitions and framing concepts, duties to animals, duties to clients, duties to other professionals, duties to competent authorities, duties to society, professionalism and practice-related issues (Magalhães-Sant’Ana, et al. 2015). The emphasis on different themes varied significantly between codes. For example, according to some codes the veterinarian’s primary responsibility is animal welfare, while others placed a greater emphasis on professional relationships. Strict adherence to these codes may result in different decision-making for the same scenario.

Chapter 1
What is Veterinary Ethics and why does it Matter?

Introduction

1.1
What is ethics?

1.1.1 What do we mean when we use the word “ethics”?

1.2
What makes a decision ethical?

1.3
Why should veterinarians and associated professionals be concerned with ethics?

1.4
Why is ethics challenging?

1.5
Why should we study veterinary ethics?

1.6
Who is worthy of ethical consideration?

1.7
Ethics and animal welfare

1.7.1 How our values affect welfare assessment

1.7.2 The science of welfare assessment

1.7.3 How to conduct a welfare assessment

1.8
Veterinary ethical dilemmas

1.8.1 What is an ethical dilemma?

1.8.2 Sources of ethical dilemmas in veterinary practice

1.8.3 How common are ethical dilemmas and ethical conflict in practice?

1.9
Impact of ethical dilemmas and ethical conflict on veterinarians and associated professionals

1.10
Ethical policies

Conclusion

References