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24 POINT-OF-VIEW

Veterinary Times

RICH OR POOR, OUT OF YOUR DOOR?


THIS article is a continuation of case study presentations regarding veterinary ethics issues that may be encountered by private practitioners. 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 future articles. If you would like to share or discuss cases, please send your questions, comments or critiques to fb@vetethics.com

FRANK BUSCH
PhD, MRCVS

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discusses why animal well-being should not be determined by how fat an owners wallet is, and how the lot of lobsters can be improved
is exhibiting bad breath. Clinical examination reveals severe periodontal disease as the cause of the halitosis. You recommend extensive cleaning and extraction of several severely diseased

Case study one


An elderly client presents her 12-year-old schnauzer, which

teeth. Due to the patients age, the advanced oral pathology and the need for careful monitoring under general anaesthesia, the estimated cost of the procedure is between 350 and 450. The client is on a fixed income and does not know how she will pay for this. You send the dog home on oral antibiotics and ask the client to contact you regarding her decision as to whether to go ahead with surgery. You suspect she will decline for financial reasons. The next day, a prominent businessman comes in with a near identical case of periodontal disease in his aged poodle. You again explain the need for cleaning and extraction, but the owner

Most practitioners feel obliged to help as much as possible towards the financial aspect regarding the treatment of animals. Is this because of our self-imposed but also professional duty to care or because we have become humanists born out of our assigned societal obligation to help animals?
declines on the spot, saying the price is too high. As you reflect on how you should be dealing with this particular owner, you remember the pensioner from the day before. Should the financial status of the owner determine your approach to the welfare of a patient (Figure 1)? sible towards the financial aspect regarding the treatment of animals. Is this because of our selfimposed but also professional duty to care or because we have become humanists born out of our assigned societal obligation to help animals? For some clinicians, the knowledge that being unable to provide adequate medical care for an animal can be a major wound to an impoverished person4 may work as a catalyst. Rollin remarks that the key conceptual point is that just as the inability to pay for treatment should not create an impediment to human health care, neither should it preclude treatment for animals.5 As veterinarians continue to deal with these challenges in practice, some will undoubtedly face professional and moral stress, which I have previously alluded to6. How should the wealthy client, who will not spend the requisite money on treatment, be approached7? Here, Rollin remarks that the ability to deploy ones Aesculapian authority8 with success is paramount. Regarding our chosen case scenario, explaining that the dental condition will cause pain and suffering to the animal may cause the client to rethink his position 9 . More importantly, in as much as you, the practitioner, have a duty to inform the owner10, the owner has a duty to care for his animal11. Equipped with the new Animal Welfare Act12, it is easier to confront the affluent client and insist on appropriate treatment, even if the client does not see any value in such treatment.

Ju Ve ne pr E R

In Ve P an pr ot Ve

Discussion
Despite a widespread public perception that veterinarians have a duty to treat all animals, regardless of a clients financial situation, most small animal practices are run and function as businesses a concept that members of the public often find difficult to accept. The prevailing romantic view of the veterinarian as the compassionate guardian angel of all (sick) animals, who is able to provide free treatment, is incompatible with any business concept in veterinary practice1. Although veterinary practice is now understood to be a business, it clearly is a business with a difference: much of the daily tasks revolve around how the practitioner can minimise the impact of the financial status of the client on the well-being of the patient. Rollin points out some of the strategies that practices and practitioners can come up with to overcome daily predicaments in practice2. Colleagues approach this problem in various ways. In some cases, such as a fracture in a cat, they provide less expensive treatment modalities that are well above the threshold for adequate care bone pinning and plating may be the gold standard, but may not always be required for adequate results. Many veterinarians undertake a certain amount of work at cost, or for no charge. Others develop long-term payment plans for clients with financial difficulties. Even today, others accept barter of goods or services in lieu of monetary payment. Some work with welfare charities or establish funds where affluent, grateful clients underwrite treatment for animals belonging to the impoverished3. Another way, relating primarily to larger veterinary enterprises, is to establish a clinic staffed on a rotating voluntary basis for example, one evening a month by different clinicians. The net result is a free clinic open on a regular basis. Most practitioners feel obliged to help as much as pos-

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Case study two


In some countries, consumers prefer to view an animal alive immediately before it is killed to ensure that they receive a fresh and wholesome product from the market. Government-mandated antemortem and postmortem inspection procedures, together with modern refrigeration techniques, have made these consumer antemortem inspections unnecessary. However, in many modern markets, it is fashionable to display live fish and crustaceans in small holding tanks for consumers to view prior to purchase. Do such displays represent substandard animal welfare? What
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26 POINT-OF-VIEW

Veterinary Times
ethics, public perception and consumer demand can impact on business strategy is mirrored, for example, by a change in strategy regarding the Whole Foods supermarket chain in America, which banned the sale of live shellfish in 200618. However, regarding noncommercial issues concerning aquatic life, Rollin2 points out that there is still a widespread tendency among members of the public to view aquatic life, even when purchased in pet stores as companion animals, as mere objects as living room furniture. Expensive animals, such as koi carp, are the exception. The same attitude is prevalent regarding aquatic animals sold as food few people think of these animals as sentient beings capable of feeling pain, let alone distress. This is despite a body of neuro-physiological, biochemical and behavioural evidence that fish feel pain19. Fish can be anaesthetised and can be trained using electroshock, thus learning to avoid painful stimuli20. There is a similar set of reasons to believe that crustaceans feel pain. Indeed, an aversion by British housewives to dropping conscious lobsters into boiling water21 led to a drop in lobster sales until the industry developed mechanisms for stunning the animals in the market. In actual fact, it was the revulsion felt by one British barrister that led

RICH OR POOR, OUT OF YOUR DOOR? from page 24

is the status quo of consumer knowledge about the commercial trade and the handling of these animals for food?

that our understanding even of farmed and non-farmed crustaceans basic biology is still deficient, especially when compared with the fish species that have Discussion been farmed for centuries15. Commercial farming mostly conMost crustacean farming still cerns a few groups of decapod consists of open, as opposed to crustaceans, namely shrimps, closed systems (which are now freshwater prawns and crayfish increasingly developed), where (Figure 2), lobexchange of sters and crabs. The advances in viruses and other There are also agents of disease crustacean farming within the envisome non-decain the past have pod groups, such ronment is more taken place as Artemia, and l i k e l y. W i t h i n various copepthe domesticamostly through ods are raised as trial-and-error types tion process, the food for fish lardesired developof management vae. Marine and ment towards, sometimes brackish water and selection for, with grave shrimps make up evolutionarily susconsequences. the major portion tainable farming of the worlds strategies16 concrustacean farming, south-east tinues to be difficult. The same Asia being the leading market. is true regarding traditional agriOverall, crustaceans now culture, which I have alluded to make up close to one-fourth of before in this series. the worlds aquaculture crop13, Thankfully, ethico-environand this mostly benefits the devel- mental issues related to aquaoping worlds economies14. culture are gaining more attenSadly, as Wickins and Lee tion. This is not only because point out 14 , the advances in of coastal farmings negative crustacean farming in the past environmental impact and the have taken place mostly through fact that more research and trial-and-error types of manage- better overall regulatory policies ment sometimes with grave are implemented17, but it is also consequences. According to the due to public enlightenment and authors, one reason for this is pressure. How a change in social

Figure 1. When it comes to the welfare of the animal, what is the ethical difference between an owner who cant pay for treatment, and one who refuses to? Would your attitude change?

Even sub-clinical disease prevents high value calves reaching their full potential

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to the development of killing lobsters and crabs using electricity rather than heat22. The apparatus is available for restaurants, home kitchens (single stunner) and the market industry (continuous flow stunner)23. Nonetheless, too few people seem to complain about live fish or crustacean tanks in markets, supermarkets and fish stores, or about crabs and lobsters kept in tanks with rubber bands around their claws, despite animal advocates having demonstrated against such practices24. Yet, as aquaculturalists know, fish are at least as susceptible to stress as any other food animal25. Practices such as the sewing up of carp mouths during live transport (to avoid cannibalism) and leaving animals for too long on airport runways (causing them to die due to overheating) are issues warranting urgent remedy. Bearing in mind the relevant evidence, conditions for such animals in live markets are unacceptable and substandard, as much for aquatic animals as for birds and mammals. Clearly, this conclusion militates in favour of setting scientifically based

standards for the care and maintenance of these animals. Rollins stance is that of a welfarist or new welfarist26. We owe a decent life and a humane death to all animal life (including fish) that we choose to consume. Rollin seems content that the industry can self regulate itself appropriately 27 . But as with the production of all animal products, the adage out of sight, out of mind unfortunately still holds true.
Footnotes 1. The I thought you were doing it for the animals, not for the money accusational mantra puts every practitioner on the defensive. Confronted with such a statement, some may feel compelled to explain ones struggle between caring for the animals and generating enough money to pay for the costs of running ones enterprise. This adds further pressure on the clinician to explain and review any service charge made, but also puts the clinician in a position where he or she is having to explain the firms business model to every complaining client. 2. See Rollin B E (1999). An Introduction to Veterinary Medical Ethics: Theory and Cases, Iowa State Press. These examples highlight why veterinary medicine cannot be compared to any other business: the ethics component dominates most practitioners decision making. 3. Pooling and systemising these resources in a predictable and publicised way in the community can be a real challenge. One way, pioneered by an American colleague, Brian Forsgren, is for veterinarians to establish a well-publicised charity for which they raise money in the community to defray the cost of treatment for needy clients animals. 4. Rollin (see footnote two) rightly points out that a poor persons animal can mean as much, or more, to the impoverished person as a rich persons animal does to the rich person. 5. See Rollin (footnote two). 6. See VT38:03. The need to balance patient care and welfare, client needs and means, public protection and welfare and self interest can lead to what Rollin (1986) calls moral

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Frank Busch works in mixed practice. He has taken a particular interest in veterinary ethics and has followed veterinary medical teachings in the USA for some time. Having previously written for Veterinary Times and VN Times on various clinical and practical issues, his other interests include small animal surgery, physiotherapy and acupuncture.

stress. Moral stress particularly arises out of a fundamental conflict between ones reasons for going into animal work and what one is in fact doing or being asked to do. See footnote two. 7. Occasionally, one encounters a (wealthy) client who views the animal as a possession or status symbol and not a family member or companion. In this case, economics play a vital role and the client would argue that acquiring a new animal would be the preferred method of dealing with the situation. 8. The authority resulting from the respect towards a professional that existed before the dilution of knowledge brought about by the world wide web is called Aesculapian authority and, presumably, derives from the Greek god of medicine; see the ethics article in VT38.29. 9. Adams C L and Frankel R M (2007). It may be a dogs life but the relationship with her owners is also key to her health and well-being: communication in veterinary medicine, The Veterinary Clinics of North America (Small Animal Practice) 37(1): 1-17; Cornell K K and Kopcha M (2007). Client to veterinarian communication: skills for client-centred dialogue and shared decision making, The Veterinary Clinics of North America (Small Animal Practice) 37(1): 37-47; and Klingborg D J and Klingborg J (2007). Effective communication in veterinary practice and talking with veterinary clients about money, The Veterinary Clinics of North America (Small Animal Practice) 37(1): 79-93. 10. Veterinarians have a duty to inform about the particular needs of the animal and its specific behaviours, as well as how animals should be kept according to their nature, needs and behaviour. See http://ethics.iit. edu/codes/coe/vet.assoc.protect. animals.html 11. The legal phrase duty of care means just that: your client has the obligation to do as you suggest in your professional capacity. As much as the client is able to choose from treatment options, he or she cannot dodge treatment that you prescribe. Your indirect duty here could be, arguably, that you are reasonable and practical about such suggestions and treatment options. See www.defra. gov.uk/animalh/welfare/act/index. htm and www.defra.gov.uk/animalh/ welfare/act/affect.htm#2 12. Prior to the Animal Welfare Act 2006, keepers only had a duty to

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October 6, 2008
ensure that an animal didnt suffer unnecessarily. The 2006 act imposes a broader duty of care on anyone responsible for an animal to take reasonable steps to ensure that the animals needs are met, including suitable environment (housing), a suitable diet (food and water), the ability to exhibit normal behaviour, any need an animal has to be housed with, or apart from, other animals, and protection from pain, suffering, injury and disease (see footnote 11). 13. In previous articles (see VT38.07), I have alluded to the common practice of using a language that reduces non-human animals to things, rather than sentient beings, and conceals their individuality. It encourages the consumer to see non-humans as tools for our use. See Dunayer J (2001). Animal Equality: Language and Liberation, Ryce Publishing. For Dunayer, such deceptive use of language is responsible for maintaining a speciesist attitude. 14. Wickins J F and Lee D O (2002). Crustacean Farming: Ranching and Culture (2nd edn), Blackwell Science, Oxford. 15. An example of this is aquaculture in the Mediterranean region, which started many centuries ago. It is possible to find records of aquacultureactivities during the ancient Egyptian civilisation. The tomb of Aktihep (2500BC) shows what appears to be men removing tilapia from a fish pond. In the Etruscan culture (Italy), the earliest extensive marine farms date back to the sixth century BC. The growing of molluscan shellfish was practised in the fifth century BC by the Greeks. In the ancient Roman civilisation, seabass, seabream, mullets and oysters were cultivated or simply kept alive off the Italian coast in enclosed facilities see Barurco B and Lovatelli A (2003). The Aquatic Aquaculture Situation in the Mediterranean Sea: Predictions for the Future, International Action for Sustainability of the Mediterranean and Black Sea Environment (www.iasonnet. gr/past_conf/abstracts/Basurco.pdf) and Bequette F (1995). Fish farming: a 4,000-year-old growth industry, UNESCO Courier, November edition (http://findarticles.com/p/articles/ mi_m1310/is_1995_Nov/ai_ 17963688/print?tag=artBody;col1). 16. For an interesting presentation of a debate regarding fish farming see http://wiki.idebate. o r g / i n d e x . p h p / D e b a t e : Fi s h _ farming_ban#Exploitation:_Is_it_ OK_to_exploit_fish_and_subject_ them_to_physical_pain.3F 17. Primarily regarding freshwater prawns, see footnote 14. 18. See www.independent.co.uk/ environment/cruelty-to-crustaceanssave-the-lobster-406697.html 19. See the ethics article in this series in VT38.07. In addition, see the fish consciousness section at www.sciencemag.org/cgi/content/ summary/306/5703/1888b 20. Rollin comments that in evolutionary terms, without the ability to feel and react to pain, fish would not fare well in terms of survival. See footnote two. 21. Unfortunately, however, this method of killing and cooking still exists (despite a common sense prerogative not to do so), even on British soil, as witnessed in the BBC documentary series When Love Comes To Town, in which a lobster was dispatched in said fashion. For other outrageous and unsuitable methods of killing lobsters, and as an example of consumer ignorance, see www. lobsterlib.com/canyoukill.html 22. The barrister and his wife had just returned from a holiday in France, where they had tried to buy a live lobster for the first time. The inventor of the CrustaStun was startled when the fishmonger offered to boil the stillanimated lobster. He soon learned that the boiling-alive method was common in the lobster-eating world. But to him, the idea that a living animal with eyes, a nervous system and a sensory system was incapable of feeling pain simply did not seem right (see www.nytimes.com/2006/06/25/ business/yourmoney/25goods.html). 23. See www.crustastun.com 24. See, for example, consumer information provided by PETA at www.lobsterlib.com/wycd.html 25. See Rollin, footnote two. For an interesting, if in parts polemic, article about fish and the fish industry, see www.animalaid.org.uk/h/n/ campaigns/vegetarianism/all/539/ 26. See the article that appeared in this series in VT38.20. 27. It was particularly impressive to me that the vast majority of industry people worried about these animals well-being, rather than dismissing such concerns as evidentially baseless Rollin B E (1999). An Introduction to Veterinary Medical Ethics: Theory and Cases, Iowa State Press. n

POINT-OF-VIEW 27
Too few people seem to complain about live fish or crustacean tanks in markets, supermarkets and fish stores.
Figure 2. Crayfish form a significant part of aquaculture.

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