An Introduction to Veterinary Medical Ethics

Theory and Cases

Bernard E. Rollin

• Publisher: Wiley-Blackwell
• Year: 2013
• ISBN:
  9781118704516
• Edition: 2
• Topic: Medicine
• Subtopic: Veterinary Medicine

One of the most difficult issues that confronts veterinarians and staff today concerns the profession's obligation to the animal and the sometimes conflicting demands from clients, peers and society. The veterinarian's role has become more complex with new ethical challenges posed by issues such as growing public awareness regarding animal welfare, increasing economic value of companion animals, growth of veterinary specialization, experimentation with alternative and complementary medicine, and concern for pain management and mental well-being of animals.

Written by an acknowledged pioneer in veterinary ethics, An Introduction to Veterinary Medical Ethics addresses the ethical challenges that veterinarians face daily as they seek to balance obligations to animal, client, peers, society and self. The book offers a highly readable and approachable introduction to the nature of ethical theory, reasoning and decision-making, and its practical application to veterinary medicine. Now with over 100 real-life veterinary case histories and analysis, this edition also includes new discussions of animal pain, distress and happiness, ethics of critical care, alternative medicine, legal status and value of animals, and Aesculapian authority.

An Introduction to Veterinary Medical Ethics: Theory and Cases, Second Edition is recommended as essential reading for all veterinary students and practitioners, as well as those interested in general animal welfare.

• New edition from an acknowledged pioneer in veterinary ethics
• Addresses ethical challenges that veterinary medicine, with over 100 real-life cases
• Includes new discussion of legal status and value of animals, alternative medicine, Aesculapian authority, ethics and critical care, and animal pain, distress and happiness
• Ideal for veterinary students and practitioners

Part I Theory

Theory

There is an ancient curse that is most appropriate to the society in which we live: “May you live in interesting times.” From the point of view of our social ethics, we do indeed live in bewildering and rapidly changing times. In less than thirty years veterinary medicine, reflecting this rapid change, has seen itself transformed from an essentially male profession to a profession soon to be dominated by women. Similarly, the rigid, almost military, rules governing the demeanor, conduct, and deportment of veterinary students have vanished, to be replaced by a laxity literally unimaginable thirty years ago. Whereas sporting a beard, mustache, or long hair was sufficient reason for a faculty member to order a student out of class at my institution as recently as the late 1970s, woe to the instructor who now questions a student’s bare feet, halter top, or nose ring. Indeed, the instructor may be so attired.

These changes are of course reflective of changes in society in general, or more accurately, in social ethics. The traditional, widely shared, social ethical truisms that gave us stability, order, and predictability in society for many generations are being widely challenged by women, ethnic minorities, homosexuals, the handicapped, animal rights advocates, internationalists, environmentalists, and more. And all of these changes will inevitably be reflected in veterinary medicine. Most veterinarians now realize, to take a very obvious example, that society is in the process of changing its view of animals, and of our obligations to animals. Laboratory animal veterinarians have probably seen the most clearly articulated evidence of such a changing ethic, but it is also patent to any companion animal practitioners, food animal practitioners, or zoo veterinarians who take the trouble to reflect upon the new social expectations shaping and constraining the way they do their jobs.

It is very likely that there has been more and deeper social-ethical change since the middle of the twentieth century than occurred during centuries of an ethically monolithic period such as the Middle Ages. Anyone over forty has lived through a variety of major moral earthquakes: the sexual revolution, the end of socially sanctioned racism, the banishing of IQ differentiation, the rise of homosexual militancy, the end of “loco parentis” in universities, the advent of consumer advocacy, the end of mandatory retirement age, the mass acceptance of environmentalism, the growth of a “sue the bastards” mind-set, the implementation of affirmative action programs, the rise of massive drug use, the designation of alcoholism and child abuse as diseases rather than moral vices, the rise of militant feminism, the emergence of sexual harassment as a major social concern, the demands by the handicapped for equal access, the rise of public suspicion of science and technology, the mass questioning of animal use in science and industry, the end of colonialism, the rise of political correctness—all provide patent examples of the magnitude of ethical change during this brief period.

With such rapid change come instability and bewilderment. Do I hold doors for women? (I was brought up to do so out of politeness, but is such an act patronizing and demeaning?) Do I support black student demands for black dormitories (after I marched in the 1960s to end segregation)? Am I a bad person if I do not wish to hire a transsexual? Can I criticize the people of Rwanda and Bosnia for the bloodbaths they conducted without being accused of insensitivity to cultural diversity? Do I obey the old rules or the new rules? Paradoxically, the appeal to ethics, and the demand for ethical accountability, have probably never been stronger and more prominent—witness the forceful assertion of rights by and for people, animals, and nature—yet an understanding of ethics has never been more tentative, and violations of ethics and their attendant scandals in business, science, government, and the professions have never been more prominent. There is probably more talk of ethics than ever—more endowed chairs, seminars, conferences, college courses, books, media coverage, journals devoted to ethical matters than ever before—and yet, ironically, most people probably believe that they understand ethics far less than their progenitors did. Commonality of values has given way to plurality and diversity; traditions are being eroded; even the church is no longer the staunch defender of traditional ethical norms.

In such a world it is exigent to understand the logical geography of ethics, and to possess the tools with which to negotiate reasonably what is often tortuous and slippery terrain. This is especially true for professionals, because in order to maintain their autonomy, professions must anticipate and accord with changing ethical thought, as we shall shortly see in detail. Our ensuing discussion will provide a conceptual map of the nature and role of ethics in general, and of veterinary ethics in particular. Attempting to analyze difficult ethical cases with many threads or to debate complex ethical issues without such a map is relevantly analogous to attempting to do surgery without an understanding of the basic concepts of anatomy, anesthesia, and asepsis: One can do it, but one literally doesn’t know what one is doing and cannot, therefore, adapt to the unexpected. Conversely, once a person has mastered the relevant basic concepts, that person can go well beyond what he or she has hitherto done by rote.

As we shall see, I am not saying that one cannot behave ethically without mastering the conceptual map we shall present. After all, few people make a study of ethics. Most of us just behave properly in an automatic way. And many of our ethical decisions are obvious and straightforward and routine: We don’t overcharge a gullible client; we don’t attempt to steal another veterinarian’s patients; we don’t prescribe useless medication; and so on. What we often cannot do, without a conceptual map and a reflective stance on ethics, is see the subtleties and variegated dimensions posed by complex cases; we tend to react to one obvious component and ignore others. Just as it takes training and practice and a conceptual map of medical possibilities to learn differential diagnosis of disease, so too it takes training and practice to dissect all of the ethical nuances of many complex situations.

Detecting ethical questions is, in some ways, like detecting lameness. Prima facie, ordinary people not particularly knowledgeable about veterinary medicine would think that anyone can tell when a horse is lame and which leg is affected. After all, we can do so easily with humans. In fact, when actually confronted with a lame horse, inexperienced laypeople, and even veterinary students, can at best detect that something is wrong (and sometimes not even that), but they can rarely pinpoint the problem. This is exactly analogous to the activity of identifying ethical problems. People (sometimes) know something is problematic, but they have trouble saying exactly what the problem is.

A true case embracing a multitude of ethical issues illustrates the difficulty of recognizing, sorting out, and dealing with ethical questions:

A man brought a small comatose dog with a head injury into our veterinary school clinic. He freely admitted, and even boasted, that he had struck the dog in the head with a frying pan because it barked too much. When the dog did not regain consciousness and the man’s wife became upset, he took the dog to his regular practitioner. The veterinarian advised him to take the dog to the veterinary school hospital. The dog died there, and the animal’s body was brought to necropsy and presented as a case to a group of students by a pathology instructor.

Coincidentally, one of the veterinary students in that class was an animal control officer, among whose duties was investigating cruelty complaints. With the instructor’s permission, the student took the client’s name from the file and began to investigate the case, phoning the client’s home and speaking with his wife. The client became irate and complained to both the referring veterinarian and to the veterinary school clinician who had taken his case that his right to privacy had been violated. The private practitioner and the veterinary school referral clinician in turn were furious with the student. The student was frightened, was worried about the effect of the incident on his academic and subsequent career, and sought help.

“What moral conflicts and problems does this case raise? Initially, the referring practitioner, the veterinary school clinician, and some administrators saw only one issue— the betrayal of client confidentiality by the student. As the case evolved, administrators were also troubled by the involvement of the pathologist who had “betrayed” the identity of the client. Only after much dialogue with an ethicist, the pathologist, and the student did the parties begin to realize that there were many other concurrent issues.

First, there was an animal welfare issue: The client should not be allowed to fatally beat an animal with impunity. In addition, there was a social or moral obligation to report the occurrence of a crime, the same sort of moral obligation (now also a legal one in human medicine) that exists for health care professionals to report suspected child abuse. Furthermore, there was the moral (and legal) question of whether one could invoke confidentiality in a public teaching hospital, where it is implicit that cases will be discussed with students as part of their learning process. Lastly, the pathologist argued that, as a veterinary teaching institution, the school had a high moral obligation not to condone that which society as a whole has recognized as immoral and illegal.

Some veterinarians argued that the pathologist was within his rights to reveal the name, but that the student ought not to have acted upon the information. To this point the student replied that, as a law officer, he had a sworn duty (a moral obligation) to enforce the law. Some veterinarians hypothesized that if confidentiality isn’t strictly observed, abusers of animals will not bring animals in for treatment. A controversy also arose over the fact that the school clinician had at least obliquely threatened the student with recriminations when he came to the clinic. Others worried that the information about the case and these issues had not been sent back to the referring veterinarian for that party to handle. The issue of a conflict of interest between being a veterinary student and serving with animal control was also raised.

Ultimately, the situation was resolved, at least for future cases, by the university’s drafting a formal policy that suspected abuse cases of this sort would automatically be reported to the school and government authorities. One of the noteworthy features of the case was its dramatic teaching value in demonstrating just how complex a single ethical problem or case can be.

This case beautifully illustrates why a conceptual map of ethics can be valuable. People perceive not only with their eyes and ears, but with their expectations, mental sets, preconceptions, habits, acculturations, and theories as well. The clinicians had been trained with a fairly limited ethical conceptual map—they thus perceived only an issue of confidentiality and initially missed the others we noted.

It is worth pausing to illustrate this salient point: We see with more than our eyes. When I teach this idea to my students, I begin with the following child’s trick: I ask them to give me a single word for each thing I describe.

I say: What is a cola beverage that comes in a red can?

They say: Coke.

I say: If I tell a funny story, we call that a …?

They say: Joke.

I say: If I puff on a cigarette, I…

They say: Smoke.

I say: I put some dirty clothes in a tub so they can …

They say: Soak.

I then say: What is the white of an egg called?

Most will automatically say: Yolk.

I go on to provide more serious examples of the ways that background, theory, and expectation can determine perception. The famous Rosenthal effect in psychology (Rosenthal, 1966) provides a nice scientific example. Researchers studying rat behavior were told that one of the groups of white rats they would be working with was a special strain of highly intelligent rats. In subsequent studies, the researchers found that the bright rats did better than the ordinary rats in learning trials. In fact, they were all “ordinary” rats—the “brightness” came from the researchers’ expectations. Often we experience the same “halo” effect with students in our classes, when we are told by other instructors of a particular student’s brightness.

We can all recall the first time we looked at a radiograph. The radiologist pointed to what he said was a fracture, but we saw only dark and light, even though the same stimuli impinged upon our retinas as upon his. As one’s knowledge of radiography broadens, however, one sees differently, though once again the retinal stimulation is unchanged.

Another amusing example is provided by a “paradox” that used to perplex people in the 1960s and 1970s called “The Boy with Two Fathers,” which was presented as follows:

A father and son are involved in an automobile accident. Both are seriously injured and are rushed to separate hospitals. The son is immediately readied for emergency surgery; at the first sight of him, however, the surgeon says, “I can’t operate on this patient—he’s my son!” How is this possible?

Twenty and thirty years ago one could perplex almost everyone in a class with this case. Today it falls flat—everyone sees the answer immediately: The surgeon is the boy’s mother. Nothing in young people’s expectations today precludes the possibility of a female surgeon.

Finally, let me cite a very poignant example from veterinary medicine. In the mid-1980s I was team-teaching a veterinary ethics course with a prominent surgeon. I was discussing the tendency in veterinary medicine (and in science in general) through most of the twentieth century to ignore animal pain. In the midst of my lecture the surgeon stopped me. “My God,” he said, “I was trained in the mid-sixties and was taught to castrate horses using succinycholine chloride [a curariform drug]. This is the first time it ever dawned on me that the animals must have been hurting!” I shall return to the relationship between human mind-set and animal pain later in this book.

For now, however, the important point to realize is that the study of ethics provides a way of forcing people, on ethical matters, to go beyond their mind-set and expectations— indeed, that is why many people find it discomfiting. Of course, one can to some extent free oneself from the shackles of univocal perspective by seeking out people with strongly divergent opinions as discussion partners; I often recommend to veterinarians that they orchestrate discussion of ethical matters at meetings wherein they can hear a wide variety of viewpoints. But this alone will not fully assure a deepened perception in the absence of an understanding of what we have called the “logical geography” of ethical or moral questions. Hearing differing opinions is not enough; one must also understand the criteria by which one judges and critically assesses divergent opinions, else one runs the risk of creating a Babel of incommensurable ethical voices—a chorus of individual opinions with no way to generate the consensus that viable ethics requires in a community, and no method for changing others’ opinions in a rational way. So it is to an examination of the nature of ethics to which we must now turn.

Social, Personal, and Professional Ethics

There are two very different senses of “ethics” that are often confused and conflated and that must be distinguished at the outset to allow for viable discussion of these matters.

The first sense of ethics I shall call ethics₁. In this sense ethics is the set of principles or beliefs that governs views of right and wrong, good and bad, fair and unfair, just and unjust. Whenever we assert that “killing is wrong,” or that “discrimination is unfair,” or that “one oughtn’t belittle a colleague,” or that “it is laudable to give to charity,” or that “I think abortion is murder,” one is explicitly or implicitly appealing to ethics₁—moral rules that one believes ought to bind society, oneself, and/or some subgroup of society, such as veterinarians.

Under ethics₁ must fall a distinction between social ethics, personal ethics, and professional ethics. Of these, social ethics is the most basic and most objective, in a sense to be explained shortly.

People, especially scientists, are tempted sometimes to assert that unlike scientific judgments, which are “objective,” ethical judgments are “subjective” opinion and not “fact,” and thus not subject to rational discussion and adjudication. Although it is true that one cannot conduct experiments or gather data to decide what is right and wrong, ethics, nevertheless, cannot be based upon personal whim and caprice. If anyone doubts this, let that person go out and rob a bank in front of witnesses, then argue before a court that, in his or her ethical opinion, bank robbery is morally acceptable if one needs the money.

In other words, the fact that ethical judgments are not validated by gathering data or doing experiments does not mean that they are simply a matter of individual subjective opinion. If one stops to think about it, one will quickly realize that very little ethics is left to one’s opinion. Consensus rules about rightness and wrongness of actions that have an impact on others are in fact articulated in clear social principles, which are in turn encoded in laws and policies. All public regulations, from the zoning of pornographic bookstores out of school zones to laws against insider trading and murder, are examples of consensus ethical principles “writ large,” in Plato’s felicitous phrase, in public policy. This is not to say that, in every case, law and ethics are congruent. We can all think of examples of things that are legal yet generally considered immoral (tax dodges for the superwealthy, for instance) and of things we consider perfectly moral that are illegal (parking one’s car for longer than two hours in a two-hour zone).

But, by and large, if we stop to think about it, there must be a pretty close fit between our morality and our social policy. When people attempt to legislate policy that most people do not consider morally acceptable, the law simply does not work. A classic example is, of course, Prohibition, which did not stop people from drinking, but rather funneled the drinking money away from legitimate business to bootleggers.

So there must be a goodly number of ethical judgments in society that are held to be universally binding and socially objective. Even though such judgments are not objective in the way that “water boils at 212°F” is objective (that is, they are not validated by the way the world works), they are nonetheless objective as rules governing social behavior. We are all familiar with other instances of this kind of objectivity. For example, it is an objective rule of English that one cannot say, “You ain’t gonna be there.” Though people, of course, do say it, it is objectively wrong to do so. Similarly, the bishop in chess can objectively move only on diagonals of its own color. Someone may, of course, move the bishop a different way, but that move is objectively wrong, and one is not then “playing chess.”

Those portions of ethical rules that we believe to be universally binding on all members of society, and socially objective, I will call the social consensus ethic. A moment’s reflection reveals that without some such consensus ethic, we could not live together, we would have chaos and anarchy, and society would be impossible. This is true for any society at all that intends to persist: There must be rules governing everyone’s behavior. Do the rules need to be the same for all societies? Obviously not—we all know that there are endless ethical variations across societies. Does there need to be at least a common core in all of these ethics? That is a rather profound question I shall address later. For the moment, however, we all need to agree that there exists an identifiable social consensus ethic in our society by which we are all bound.

Now, the social consensus ethic does not regulate all areas of life that have ethical relevance; certain areas of behavior are left to the discretion of the individual or, more accurately, to his or her personal ethic. Such matters as what one reads, what religion one practices or doesn’t practice, how much charity one gives and to whom, are all matters left in our society to one’s personal beliefs about right and wrong and good and bad. This has not always been the case, of course—all of these examples were, during the Middle Ages, appropriated by a theologically based social consensus ethic. And this fact illustrates a very important point about the relationship between social consensus ethics and personal ethics. As a society evolves and changes over time, certain areas of conduct may move from the concern of the social consensus ethic to the concern of the personal ethic, and vice versa. An excellent example of a matter that has recently moved from the concern of the social ethic, and from the laws that mirror that ethic, to the purview of individual ethical choice is the area of sexual behavior. Whereas once laws constrained activities like homosexual behavior, adultery, and cohabitation, these things are now left to one’s personal ethic in western democracies. With the advent during the 1960s of the view that sexual behavior that does not hurt others is not a matter for social regulation but, rather, for personal choice, social regulation of such activity withered away. About ten years ago the mass media reported, with much hilarity, that there was still a law on the books in Greeley, Colorado, a university town, making cohabitation a crime. Radio and TV reporters chortled as they remarked that, if the law were to be enforced, a goodly portion of the Greeley citizenry would have to be jailed!

On the other hand, we must note that many areas of behavior once left to one’s personal ethic have been since appropriated by the social ethic. When I was growing up, paradigm cases of what society left to one’s personal choice were represented by the renting or selling of one’s real property, and by whom one hired for jobs. The prevailing attitude was that these decisions were your own damn business. This, of course, is no longer the case. Federal law now governs renting and selling of property, and hiring and firing.

Generally, as such examples illustrate, conduct becomes appropriated by the social consensus ethic when how it is dealt with by personal ethics is widely perceived to be unfair or unjust. The widespread failure to rent to, sell to, or hire minorities, which resulted from leaving these matters to individual ethics, evolved into a situation viewed by society as unjust, and led to the passage of strong social ethical rules against such unfairness. As we shall see, the treatment of animals in society is also moving into the purview of the social consensus ethic, as society begins to question the injustice that results from leaving such matters to individual discretion.

The third component of ethics₁, in addition to social consensus ethics and personal ethics, is professional ethics. Members of a profession are first and foremost members of society—citizens—and are thus bound by all aspects of the consensus social ethic not to steal, murder, break contracts, and so on. However, professionals—be they physicians, attorneys, or veterinarians—also perform specialized and vital functions in society. This kind of role requires special expertise, special training, and involves special situations that ordinary people do not face. The professional functions that veterinarians perform also warrant special privileges, for example, dispensing medications and performing surgery. Democratic soci...