Aspinall's Complete Textbook of Veterinary Nursing E-Book

Nicola Lakeman (Previously Ackerman), Victoria Aspinall

• Publisher: Elsevier
• Year: 2016
• ISBN:
  9780702066092
• Edition: 3
• Topic: Medicine
• Subtopic: Veterinary Medicine

The third edition of Aspinall's Complete Textbook of Veterinary Nursing is the ideal text for both student and qualified veterinary nurses as it covers the entire veterinary nursing syllabus. Now written in the main by veterinary nurses this book comprehensively covers all aspects of the veterinary nursing role from client communication to nutritional support.

All chapters have been revised in line with changes in legislation and regulation but also theoretical and practical aspects. Greater emphasis on the veterinary practice structure including the role of corporate businesses and use of social media bring this edition fully up to date.

The new edition welcomes Nicola Ackerman as principal editor. Nicola is past officer of the BVNA and past executive editor of the Veterinary Nursing Journal. Nicola is a winner of several awards including the Blue Cross/BVNA Veterinary Nurse of the Year and the Barbara Cooper / CAW Professional Development Award for outstanding service to the veterinary nursing profession. Nicola was the first Veterinary Nurse in the UK to become a veterinary nurse specialist in nutrition.

Evolve Resources containing

• Self-assessment questions for every chapter to test learning
• Image Bank of over 700 figures
• Additional chapters

• Comprehensive content ideal for both student and qualified veterinary nurses
• Over 700 full colour illustrations for enhanced understanding
• Written by veterinary nurses for veterinary nurses
• Recommended reading given for each chapter to aid further research

• New chapters on Emergency Critical care, Fluid therapy, Practice and Staff management and Consulting skills.
• Anaesthesia and Analgesia chapter fully revised and updated.
• New chapter on Equine Behaviour and Handling, including recognition of pain in equines.

1

Ethics and Animal Welfare

James Yeates

Key Points

• Ethics is about what one should do.

• Think about problems in advance and reflect after you have made decisions.

• Rules-based and virtue ethics schools of ethical thought are primarily concerned with the person acting, e.g. the nurse.

• Consequences-based and rights-based schools of thought are primarily concerned with who is affected, e.g. animals, owners, colleagues, the practice, the profession and the environment.

• Discussion with other people is useful and sometimes necessary, but letting other people tell you what to do is still an ethical choice.

What are ethics and morality?

Each individual, society and profession has a way of making decisions about how to act and how other people should act. Individual veterinary nurses have a personal way of making decisions, which they reveal in what they do and what they say. The veterinary nursing profession also has its way, which it describes in the Royal College of Veterinary Surgeons (RCVS) Guide to Professional Conduct. A society has its way, which leads to its laws.

Ethics is the study of these ways of making decisions. It can be studied by sociologists, such as a survey of whether people approve of tail docking – this is called descriptive ethics. It can be studied by philosophers, who try to decide the best way to make decisions in general. This is called normative ethics and is discussed later; however, normative ethics is not limited to philosophers. It is done whenever one considers the ethics of a person, a profession or a society. People can then decide how to make decisions in real-life cases – this is called applied ethics. Applied ethics is an important part of many scientific and medical professions, and recently, the veterinary profession has begun to consider applied ethics in more depth.

Ethical conflicts

For much of the time, one obvious ethical responsibility must be followed, and in these situations, a nurse may not need to think about how to act, let alone have any complicated theories about it; however, at other times, nurses have conflicting ethical responsibilities. An ethical conflict is a situation in which a person has two or more ethical pressures that cannot both be fulfilled.

It is worth looking out for ethical conflicts that you deal with each day. Common ones include decisions about:

• Balancing an animal's quality of life and its quantity of life

• Balancing an animal's welfare and the owner's or practice's finances

• Being asked to assist in a procedure that you think is unethical for any reason

• Situations where the ‘best option’ is illegal

• Possibly reporting a colleague or owner to authorities

• Being given contradictory instructions by different vets or employers.

There are several ways to solve an ethical conflict. Two common methods are asking someone else or relying on ‘gut feeling’. Both are quick and easy and involve a minimum of thought, and these characteristics make them useful for situations where a nurse has to act fast. However, just as such methods might not always reach the best solution in clinical issues, so too are they likely to be ethically less accurate than decisions that are better thought out.

It is worth following a rough procedure for dealing with an ethical conflict such as the one shown in Box 1.1. It is not necessary, and sometimes impossible, to follow this order rigidly, but the scheme lists important steps and describes them in more detail.

Box 1.1

A rational approach to ethical conflicts

• Think about the predictable problems in advance

• Describe the question and your choices

• Identify the choices that you have available physically

• Identify the choices that you have available legally

• Identify the stakeholders and predict how each one might be affected

• Choose a school of thought or a framework

• Identify choices you think are ethically acceptable

• Discuss your decision with other stakeholders

• Act

• Reflect on the decision and outcomes

• Prepare for next time

Think about the predictable problems in advance (Box 1.1)

Many conflicts can be predicted and anticipated.

• Some problems are created by the owners, e.g. some dog breeders breed bulldogs but the puppies often need to be delivered by Caesarean section. Some veterinary nurses consider it unethical to breed bulldogs because of the health problems that they have and unethical to help to perform a Caesarean, or think that one should insist on neutering the bitch at the same time.

• Other dilemmas are caused by the vet, e.g. when a nurse sees a vet acting unethically, there is a dilemma as to whether to ‘whistle-blow’.

• Other dilemmas are caused by the law, e.g. in the UK non-native species such as grey squirrels cannot be released back into the wild after treatment.

• Many dilemmas depend on the owner, the law and the vet, e.g. nurses can expect many different cases of euthanasia. Some animals brought for euthanasia are completely healthy and might have a good life if the owner and vet did not agree to euthanise it. Others have been suffering for some time but their owner does not want them euthanised. Some do not have owners. Each case causes a different ethical dilemma.

Thinking about these issues in advance allows you time to think when you are relaxed and not pressured by other people. It gives you time to get more information and discuss matters with other people. For example, you may need to discuss with an owner whether to resuscitate an animal if it crashes under anaesthesia before the animal crashes, as there is no time when it does. If you have some idea in advance that you might not be happy to assist a vet with a procedure, then it is useful to say so before the animal is admitted because:

1. It may avoid the vet trying to do the procedure on his or her own because you refused to help after the vet had committed himself or herself.

2. You may end up helping with the procedure to prevent the vet doing it on his or her own and then feeling inconsistent and weak.

3. Your decision might make the vet change his or her mind before committing himself or herself.

Describe the question and your choices

You cannot make a decision without knowing what that decision concerns. It is useful to describe the question as neutrally as possible so that it does not determine your answer in advance. For example, questions such as ‘Should I fail to care appropriately for this animal?’ or ‘Should I act uncharita­bly to this owner?’ will be answered by ‘No’, even though there might actually be very good reasons not to care for the animal, e.g. because it would cause danger to your colleagues, or to act uncharitably to the owner, e.g. because it would cost the practice money.

It is useful to separate the question you have to answer from the situation. Often situations could and should have been avoided, and it is very easy to moan about the situation and fail to make a decision. For example, if an animal is aggressive because it has been poorly trained or is unsuitable for the owner, then this is a situation that should have been avoided, but you still have to make a decision now about what you are going to do.

Once you have phrased the question, you can consider the possible answers. Some options are not immediately obvious and are revealed only by reflection. Doing nothing is always a choice but often not the right one. As an example, your choices when faced with a decision about euthanasia are listed in Box 1.2. It is useful to think of all these choices at this point, however imperfect or silly they seem, because you may find that the sensible options are not possible in some cases.

Box 1.2

Common options when faced with a case of euthanasia

• Kill the animal

• Let the animal die naturally

• Try to cure the animal's disease

• Palliate any suffering

• Rehome the animal with the owner's consent

• Take the animal and rehome it against the owner's wishes

• Do nothing

• Report the owner for cruelty

Identify the choices that you have available physically

Very often you will find that some choices are physically impossible. For example:

• Treating an aggressive dog may be much more difficult than treating a nicer dog because you may be unable to get close to it.

• Some diseases may not be treatable because a cure has not yet been discovered.

• Sometimes you are limited by your own competence levels or available time.

It is psychologically important not to feel guilty for not achieving the impossible, and in some cases it may be better to be realistic.

Identify the choices that you have available legally

Legal rules and the rules in the RCVS Guide to Professional Conduct are based on the official ethics of your profession and of society. Following the law is generally the right thing to do, and breaking the law is not usually an ethical option.

The law is discussed in more detail in Chapter 5, but here it is worth noting that the law often agrees with one's own ethics, e.g. allowing unreasonable suffering is illegal...