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VeTerinary eThical dilemmas: underfeeding and euThanasia
SO far in this series, we have discussed a variety of aspects of our relationship, perception and treatment regarding non-humans. Although some topics are still to be introduced 1a , and others elaborated on1a2, it is hoped that the articles presented so far have provided a foundation to facilitate discussion on most aspects of ethical issues arising in our society and those that impact on the veterinary practitioner’s performance. It is hoped that this series of case studies will encourage participation and discussion among colleagues and that readers will share some of their ethical dilemmas so that these may be presented and discussed in a future series on veterinary ethics1b. In an ever-changing society, human and human-animal interactions will continue to undergo transformation. Some changes may be subtle; others may be fundamental and far reaching1c. Despite the various guidelines and regulations steering our profession, dealing with complex issues can be overwhelming. Such stress will negatively impact on job satisfaction and may even result in self harm1d. Although it is impossible to be prepared for any eventuality arising within the realm of clinical practice, a broad knowledge of veterinary medical ethics may increase confidence and job satisfaction, and may even prevent litigation. When confronted with challenging ethico-moral issues, the maxim would be to create a win-win situation where your patient, yourself or the practice will benefit from your actions or guidance1e. The handling of veterinary medical cases is as diverse as the variation of mental sets and individual experiences within our profession. It is anticipated that all the cases presented will elicit an element of discourse, which will be welcome.
examines two case studies that illustrate the ethico-moral challenges veterinary practitioners may face as they strive for a win-win outcome
Case one: anorexic client who is not feeding her dog
Presentation A seven-year-old golden retriever is presented to your clinic with a complaint of chronic weight loss. The dog weighs only 27kg and appears to have lost around 10kg since you administered its vaccinations seven months ago. You observe that the owner, a young woman, also appears to have lost a lot of weight. When you carefully comment on this, she changes the subject. You hospitalise the dog and run a series of tests, all of which are within normal limits. The dog eats ravenously while hospitalised and gains almost 2kg. You discharge the animal with strict instructions about feeding, and schedule a follow-up examination in two weeks. When the dog returns, it weighs only 26kg. The owner assures you she has adhered to the diet.
Discussion: what should your response be? If your suspicion that the owner’s psychological problems are responsible for the animal’s weight loss is correct – and you have ruled out any metabolic problem or disease process in the dog – your primary work as a clinician is done. If you suspect that the owner is, indeed, having
eating problems and projecting these on to her dog, it would be in the animal’s interest to seek a dialogue with its owner. Alternatively, you could tap into some of the ever-increasing support networks that assist various agencies and authorities 1f. However, the issue of client confidentiality may prove obstructive in practice. Many veterinarians working in rural areas will know that, as the only professional in their area, they are often sought out by clients for more general advice, unrelated to the veterinary domain. In those rarer situations where the veterinary surgeon still has maintained aesculapian authority1g, “counselling” by the veterinary surgeon is welcome and accepted, making problem solving a rather more straightforward procedure1h. Rather than relying wholly on your personal world view, tainted by your personal experience in practice, a more professional approach would be to establish a close professional relationship with a clinical psychologist and/or psychiatrist in your area for an expert opinion on how to handle the more difficult client with care. However, in a highly technology oriented society that seeks its wisdom primarily via the search engines of the worldwide
“Your primary obligation is with the animal patient. In most, if not all, jurisdictions, failing to provide adequate nutrition equates to unnecessary suffering. Just as it is immoral to allow a mentally impaired person to beat an animal, it is immoral to permit starvation.”
web, such aesculapian authority has largely ceased to exist. Some universities are trying to prepare fledgling veterinarians to address the vacuum that surrounds the various taboos in our society. Coping mechanisms regarding pet loss situations are also taught. At Colorado State University, for example, veterinary students learn to look for signs of depression or suicidal tendencies in grieving clients1i. Closer to home, The Blue Cross and the Society for Companion Animal Studies have done much to raise awareness and to establish a sound support network in the UK, which has become an indispensible tool in the care of grieving clients1j. If no such network exists, you may wish to discuss the issue openly with the client, making clear clinical notes accordingly. In this case, clearly state your concern that the client is having eating problems and is likely to be projecting them on to the animal. You could offer to use your connections to assist her in finding counselling. Since it is well known that many anorexics have a distorted body image1k, the owner may deny that there is a problem. In this case, you could ask the owner to leave the dog with the practice for the time being. Following this, you should document the dog’s weight gain. If your client refuses to have the dog looked after at your clinic1l, or if she again fails in her duties to look after the animal according to your instructions and dietary suggestions, you should contact the welfare enforcement authorities. You have vowed to care for your animal patients1m and your primary obligation is with the patient; the wants of the client are merely secondary. In most, if not all, jurisdictions, failing to provide adequate nutrition equates to unnecessary suffering1n. Just as it is immoral to allow a mentally impaired person to beat an animal, it is immoral to permit starvation. Similar ethical issues are discussed in the human field in cases where mothers with anorexia nervosa underfeed their children1o. For some individuals, confrontation by the authorities may be the only way to force owners to seek help for themselves1i.
“Is the source of revulsion mere moral concern at taking a (young) life, or is the aesthetic component for the majority of consumers nowadays so far removed from the food production process?”
about this practice, you are told that there is no market for buck kids, so they are routinely destroyed at birth2a, with the exception of one or two with potential value for breeding. Further enquiries on your part confirm that there is no economically viable market for these goat kids in your area. Discussion: is it ethically correct to condone this practice? This situation addresses several unresolved and perplexing dimensions of social attitudes toward the treatment of animals, which we have partly discussed in previous articles: – Does the killing of an animal in a humane manner pose a moral problem for our society (our social ethic)2b? – Why do we accept the killing of pigs, cattle, sheep and chickens, of all ages, for food, but generally condemn – or at least mind – the killing (painless or not) of healthy dogs and cats that are surplus to requirements2c? – When and why do we accept the terminal use of laboratory animals, even if no pain is involved in their use2d? Many people who do not consider the killing of food animals to be morally problematic would, nonetheless, feel perturbed at seeing an animal killed in this fashion. Similarly, many people who think they do not find slaughter morally problematic change their views when they witness the procedure for the first time2e. Is the source of such revulsion mere moral concern at taking a (young) life, or is the aesthetic
Case two: killing a newborn farm animal
Presentation A goat dairy in your area is an infrequent client. On a visit, you hear of an employee killing a newborn goat with a single bullet to the head. When you enquire
component for the majority of consumers nowadays so far removed from the food production process? Rollin ponders if part of that revulsion is made up by a sense of waste – the feeling of regret that the paradigmatically innocent creature has not had a chance to fulfil its telos2f. As a veterinary surgeon, should you condone this practice? Should your thought process be different merely because, as a large animal practitioner, you are more likely to have subscribed to the validity of raising animals to be killed for food? In this case, to create a winwin situation for the farmer and the animal you could advise the farmer to tap into the expanding hobby farming “industry”2g. In these circumstances, farming is not a primary source of income; hobby farmers raise animals not for monetary reasons, but as a choice of lifestyle. Similar to the situation in case study one, these circumstances come down to your active engagement to either establish a network for placing unwanted newborn goats or calves, or to liaise – with your client’s consent – on your client’s behalf. In a network with many contacts, demand could spread and prices rise. Actions like these would augment the practice profile. Farmers subscribing to such a no-kill network2h could realise a new source of income (even if it was to be minimal) and the animal could fulfil its telos. l To share, present or discuss any veterinary medical cases, please email the author directly at email@example.com
VT38.29 master.indd 14
co.xml 2h. Shrewsbury.telegraph. Prometheus Books. org/wiki/James_Herriot). this was not done out of a moral obligation to the animal. See a previous article within this series (June 2 issue) regarding the abolitionist idea. Although more difficult. which was willing to highlight RTA cases with “before and after” pictures of the animal. the interest created about the practice was deemed to be effective advertising (see Rollin reference in footnote 1b). That means less frowns for more dogs of all shapes and sizes. body image and eating disorders. Russell G F M. Fax: +44 ( 0 ) 1743 462111. more often than not. Most cases presented within this series have been taken with the knowledge and consent of Bernard Rollin from Rollin B (1999).com to share or discuss any veterinary medical cases.org. we highlighted issues surrounding moral stress regarding convenience euthanasia. bringing rapid and prolonged relief to surface pyoderma such as acute moist 1 dermatitis and skin-fold dermatitis in dogs. more succulent meat. however. 1a2. Talke Pits. 1l. In any case. Vet survey into understanding mental health and wellbeing. “In as much as the privilege of membership of the Royal College of Veterinary Surgeons is about to be conferred upon me. The Veterinary Record 157: 397.bbc.org/onlnews/javma/ sep06/060915d. would solve the problem for human and animal (see also http://en. Fuciderm gel has an aqueous carbomer base. co. An Introduction to Veterinary Medical Ethics: Theory and Cases. Purdue University Office of Agricultural Research Programs. Cambridge University Press 28: 93-108. 1j.sasi. animal production and the food industry. 2008 Introductory footnotes 1a. Medicine and Psychiatry 28(4) December. of the Ontario Ministry of Agriculture. Animal production and the new social ethic for animals. 1g.worldwatch. Rollin comments that regarding laboratory animals. The term “animal exploitation”. his other interests include acupuncture. Website to support vets to be launched at BVA Congress. are in place to fill that void (see www. In Aristotle’s system. In previous articles. 1b. writes primarily on veterinary ethics and animal welfare issues. Cartmel Drive. I promise and solemnly declare that I will abide in all due loyalty to the Royal College of Veterinary Surgeons and will do all in my power to maintain and promote its interests. 2d. 4513124. but treatment is not deemed economically feasible (a scenario particularly valid within intensive agricultural systems). many farmers prefer to have hunt kennel personnel perform the killing of newborn animals (personal communication).edu and Rollin reference from footnote 1b. Most colleagues may be good carers for animals. The Veterinary Record 161: 246. inspection and killing (slaughter process) of veal. as proposed by Gary Francione. Churchill Livingstone Further information is available on request from: Dechra Veterinary Products. Continuum/Cornell University Press.org/ node/813 (food democracy) and http://findarticles. allegedly due to financial constraints. CVJ 47 and www. Other cases are the author’s and his colleagues’. Halliwell R E W and Hoskin B D (2005). is the accurate description when seen in the context of animal confinement agriculture or animal production on an industrial scale. this support was taken with gratitude and. Veterinarians who swear: animal welfare and the veterinary oath. a mixed animal practitioner. 1m. Questioning “culture of death”: why are vets prone to suicide? Veterinary Times 37(44): 6-7. Here. Registered in England No. Iowa State University Press. If not. Western Culture and the Body. See the following references: Bordo S (1993). (2007). The staggering figures of meat consumption are sobering. The dog’s owner cannot be established. he or she would more than likely be willing to pay for the animal’s treatment. our intuitions vary depending on species and purpose (see footnote 1i). Eat It (see www. such a network may even be established for farms under TB restrictions. 1i.col1 (statistics). derived from the original oneness of religion and medicine from which springs “the right to control and direct by reason of God given grace” (see http:// theologytoday. Thanks are also extended to Tim Blackwell. 1d.indd 15 24/7/08 15:03:45 . and charismatic authority.C (Ed. in the case presented.com Fuciderm® gel contains fusidic acid. Interestingly. 2008 issues). In the first articles of this series. Not all charitable organisations or rescue centres operate a “no kill” policy for healthy animals. 2b. Likewise. presumably. Aesculapian authority (the name presumably derived from the Greek god of medicine) has three constitutive elements: sapiential authority. It penetrates to the site of the infection. Shropshire SY1 3TB. Another form of stress arises when the practitioner is able to heal an animal. Interestingly. The BBC3 series Kill It. the newspaper would ask for volunteers willing to adopt the animal. Any individual (animals included) needs to nurture and fulfil his or her telos.August 4. provided by The Blue Cross in conjunction with the Society for Companion Animal Studies. no established network exists to support the veterinary practitioner in such cases. These figures highlight how much our society is built on the backbone of animal use.gov. See also article three of this series (April 7 issue). Animal use. we protect key interests of the individual (such as freedom of speech and assembly) because we consider these essential to human nature.htm and www. Other networks have been established regarding the much-debated link between animal and child abuse – a well-researched topic that is gaining recognition by the authorities.com/p/articles/mi_ m3778/is_1992_April/ai_12150909/ print?tag=artBody. Animal Rights and Human Morality. See also www.org.jhtml?xml=/ property/2007/01/16/pfarm16. the telos of an entity is the purpose or function for which it was designed.ptsem. Rollin proposed this term for an animal’s genetically encoded “nature” – see Rollin B (1992). Pathologies of the West. The issue of suicide within our profession has been well documented.cvmbs. R (2004). Environmental ethics. Globalisation.uk/Petlossandbereavement/ Pet_Bereavement. animals also have natures that are as essential to their well-being as speech and assembly are to us – see Rollin B E (1993). Stoke-on-Trent. Treasure J and Eisler I (1998). world religions and their influence on societies’ treatment of animals. See also article four within this series (May 5 issue).pdf (statistics).uk/bbcthree/programmes/kill_it) demonstrated the rearing. Littlewood.gov.uk/en/HomeAndCommunity/InYourHome/AnimalsAndPets/ DG_10025980). VT38. although emotionally laden. Frank has taken a particular interest in veterinary ethics and has followed veterinary medical teachings in the USA for some time. www. California University Press.asp). culture. See the following references: Mellanby R J (2005).uk/worldmapper/posters/ worldmapper_map126_ver5. Rollin highlights the case where a member of the public arrives at a veterinary practice with an injured dog. I promise above all that I will pursue the work of my profession with uprightness of conduct and that my constant endeavour will be to ensure the welfare of animals committed to my care” – see Hewson C J (2006).stm Persaud R (2007).co. the practice owner had an agreement with a local newspaper. Littlewood R (2002). advertising of animals and animal by-products. Assuming that the animal is killed humanely and pain and suffering does not apply (see previous articles in this series that appeared in the April 7 and May 5. Tel: +44 ( 0 ) 1743 441632. 2e. See www. we traditionally have not been prepared at university level to deal professionally with grieving clients. 1o. B65-B68. we have highlighted that for these industrial animal operations (breaking the “ancient contract” – see June 2 issue) the term “husbandry” cannot be applied any more: the care and upkeep of animals raised for human consumption has devolved into an industrial operation focused on maximising economic return while paying little or no heed to the needs of the animals – see Cassuto D N (2007). 1k. betamethasone valerate POM-V Dechra Veterinary Products is a trading division of Dechra Ltd. The animal is in shock and has an open fracture of the pelvis. A staff member may be willing to look after the dog at his or her home.group.colostate. or wisdom about illness.29 master. http://news. moral authority. Unbearable Weight: Feminism. small animal surgery and physiotherapy. Registered Office: Dechra House. Law and Contemporary Problems 70(1): 59-87.uk/1/hi/health/ 4310596. Harlescott.wikipedia.htm and www. Veterinary Times 37(36): 30. 1e.asp). The Veterinary Record 157: 415.farmtalking. 2c. Bred Meat: The Cultural Foundation of the Factory Farm.ac.dechra-uk. The use of firearms (used properly) provides one of the quickest and most effective methods of animal destruction. support systems like the Pet Bereavement Support Service. kid goats and suckling pigs that are slaughtered regularly in UK abattoirs to feed a growing appetite for younger and.) Therapeutic Drugs (1991). The Animal Welfare Act 2006 subscribes to the duty of care principle. The trusted veterinarian in a small community dispensed advice regarding all aspects of life. The act imposes a broader duty of care on anyone responsible for an animal and to take reasonable steps to ensure that the animal’s needs are met. Psychological Medicine. 1= Dollery. A similar issue was raised in article five of this series (June 2 issue) when we discussed the killing of bull calves by farming personnel. Almost any episode of James Herriot’s All Creatures Great and Small will underline this point. 2g. scas. Thankfully.defra. which he had accidentally hit with his car.uk/animalh/ welfare/act/affect.avma. n POINT-OF-VIEW 15 FRANK BUSCH. com/the_vet. Having previously written for Veterinary Times and VN Times on various clinical and practical issues. Reducing the suicide rate among veterinary surgeons: how the profession can help. Creating a “win-win” situation in this case could be to afford the injured animal the same treatment as if it had an owner who was willing to pay for any treatment deemed necessary. direct. 1h.aspx? and www. He invites readers to email him directly at fb@vetethics. www.uk/ property/main. Jamage Industrial Estate. Food Animal Well-Being. not only the duty to ensure that an animal does not suffer unnecessarily (see www. Footnotes from case study one 1f. If the owner was to come forward due to the publicity. 2f. Rollin noted that in human society. 1c. Mothers with anorexia nervosa who underfeed their children: their recognition and management”. bluecross. Cook It.edu/jan1976/ v32-4-bookreview5. See www. Culture. or goals for the patient that are admirable from the viewpoint of society. Staffordshire ST7 1XW.uk/web/site/AboutUs/ PetBereavement/PBSSIntro. Incidence of suicide in the veterinary profession in England and Wales.html 1n. shef. as a profession. milk-fed lambs. West Lafayette: 37-54. Bartram D (2007).bbc. So far. Footnotes from case study two 2a. “What’s that? Fuciderm treats skin-fold dermatitis?” ® Simple and easy to use.
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