Veterinary Ethics in Practice

James W Yeates

• Publisher: CAB International
• Year: 2020
• ISBN:
  9781789247220
• Topic: Médecine
• Subtopic: Médecine vétérinaire

Veterinary Ethics in Practice gives non-specialist veterinary professionals an introduction to ethics. It helps readers to think about, and discuss, ethical dilemmas and viewpoints faced by practitioners in their daily practice. The book: · Is an important primer and introduction to basic ethical dilemmas.· Helps improve ethical reasoning, through the use of numerous worked examples, leading to increased confidence in decisions and actions. · Explains key ethical concepts and terminology making the subject easier to understand. · Contains case studies which help bring real dilemmas to life. With carefully crafted themes and problem cases in farm animal, companion animal, equine, wildlife, zoo and laboratory settings, the book provides an important yet concise and accessible introduction to moral decision-making in veterinary practice.

1

Introduction: What Veterinary Ethics Is (Not)

As veterinary professionals, in a variety of roles, our work presents us with a series of difficult moral challenges – sometimes too frequently for comfort. In many of our cases, we have to decide what we should do next. However, we can sometimes find it difficult to understand the situation, to process the emotions involved, to work out what to do, or to do it.

If we recall challenging cases we have seen: what made them hard? How did we respond? How might ethics have helped us? Did we use ethical skills or just facts?

We face ethical challenges just as our patients face health challenges, as our environments and infective ideas from others interact with our internal ‘ethical physiology’. We respond to ethical challenges through our behaviour, motivated by instincts and learning, although sometimes the right behaviour is not obvious or easy to explain or justify (even to ourselves). We also respond internally by making ‘homeostatic’ responses so that our behaviours fit with our moral beliefs, but sometimes we make ‘allostatic’ changes, fundamentally altering our views so that we respond differently the next time we are presented with similar stimuli. Ethics can help us ensure we make these internal changes in ways that improve our consistency, resilience and ability to cope with future challenges.

Ethics (and morality) is practical because it relates our reasoning to our behaviour (as opposed to speculative or theoretical reasoning) and because it is directly applicable to what we do. In practice, we have to decide what we should do next (Box 1.1). So ethics is part of veterinary work. Indeed, our ethical concerns are what give purpose and legitimacy to our work. Ultimately, ethics is the ability to decide well. Veterinary professionals are often experienced in making difficult, high-pressure decisions, but we can develop our ethical skills by reflection, discussion and education (as we do for other skills), in helping us act, influence and feel better (or at least less bad sometimes).

Box 1.1. We have to decide what we should do next

The phrase, ‘We have to decide what we should do next’ highlights several important aspects to veterinary ethics.

• We – We ultimately decide for ourselves, while listening to others, openly but critically.

• Have to – We cannot (as owners may) duck responsibility by ‘letting nature take its course’ or letting others decide for us. We have responsibilities to make decisions (and for the consequences if we do not). Indeed, when we avoid making a decision, we are responsible for the decision not to make it (while giving up the chance to affect the outcomes).

• Decide – We choose our actions, actively and consciously. Some ethical choices feel easy or obvious to experienced practitioners. However, more difficult, novel, complex or finely balanced decisions may require more explicit reasoning.

• What – Ethics is about concrete options in real situations: choosing behaviours (e.g. keeping promises and not stealing), characteristics (e.g. compassionate and honest) or outcomes (e.g. healthier patients).

• We – I can only ultimately control what I think and do. We can advise others, but cannot make everyone perfect or solve every problem.

• Should – We need not only descriptive facts, but also morally motivational reasons to act.

• Do (and not do) – Ethics is about action. Theory and even reflection are only helpful when applied to real cases.

• Next – We cannot know the future; all we can know is the right thing to do now. We can use the past to self-improve constructively, but not to self-chastise destructively (or to self-justify).

Some of us may find ethics uncomfortable. We might link it to scary legal or regulatory processes (note that this book is not a source of legal advice), or dislike uncertainty, disagreement, or questioning ourselves and previous behaviour. We might have seen ethical methods being misused in ways that seem unconvincing, unhelpful, sanctimonious or over-sentimental. We might be more comfortable, as scientists and clinicians, with facts. We might be unwilling to think or talk about moral questions, preferring just to repeat whatever we have done before or do whatever others tell us, or to avoid making decisions in the hope that the situation will somehow get better anyway. Indeed, we might not need ethics if we had no morals, did not have to act in the real world, or had a complete set of strict, irrefutable protocols initiated by specific evidence.

However, we have professional responsibilities in a complex and uncertain world (not least since COVID-19), which means we need to make professional judgements. As veterinary professionals, we do not blindly obey textbooks, rely only on our intuitions, wash our hands of difficulties, or dismiss veterinary topics as mere matters-of-opinion because there are disagreements. Instead, we think carefully about each case, make responsible judgements, and continuously develop our skills. So too with ethics. Ethics can help us to be more confident in dealing with ethical conflicts, avoid later remorse or anxiety, and reduce our overall stress levels in practice. It can also help us to discuss our views with clients, colleagues and students, in order to improve mutual understanding, to constructively challenge and defend one another, and to reach agreements.

Ideas

Too clever by half

Sometimes being sceptical can make us feel clever or superior, but prevents us learning helpful new ideas or approaches. Instead, we should be open to approaches and fields outside our comfort zone.

Ethics isn’t nice

Sometimes we feel morally uncertain, perplexed, challenged, stressed, powerless, guilty or indignant. For caring professionals, unpleasant feelings are an unfortunate and undeserved aspect of the job, but can help us develop.

Self-confidence

Sometimes we feel unwilling to reflect on what we do, or have done before, for fear of feeling stupid or guilty. Occasionally, we feel overly defensive (like a sort of moral hypersensitivity), self-destructive (like a moral autoimmune disease) or overwhelmed (like a sort of moral Disseminated Intravascular Coagulation (DIC)). We need enough confidence to implement our ethical views assertively, but be open to questioning our preconceptions without defensiveness or bluster.

A bit too quick

We might have immediate thoughts about a case or jump to a solution that sometimes misses other issues (like treatment side-effects). Instead, depending on urgency, we should consider all relevant issues and sensible solutions.

But what do we actually do …?

Some cases make us feel sadness, anger, indignation or despair. While these might be justifiable feelings, we should not also feel guilty that we cannot perfectly solve problems due to other people, natural processes or chance. Ethics can help us focus on the question of what we can and should do. (It can also help us understand others’ behaviour, which might, partly, assuage our anger.)

Reflections

Reflecting on the cases we have experienced:

• What cases commonly occur in our own work?

• What cases do, or might, we find morally difficult or challenging? When have we felt confused, worried, distressed, overwhelmed or guilty? When did we lack confidence in our decisions?

• When were we completely clear and confident about what we should do? Were we ever too confident? Should we challenge ourselves more?

• When did we feel we knew what we should do, but still faced communications difficulties or emotional pressures because of others’ moral views? When do...