Abstract
Although veterinarians encounter ethical challenges in their everyday practice, few studies have examined how they make sense of and respond to them. This research used semi-structured interviews and a qualitative methodology (phenomenological and constructivist/interpretivist approaches) to explore ethical challenges experienced by seven small animal city veterinarians and their ethical decision-making strategies. Thematic analysis of the interview transcripts identified four broad ethical issues: The first concerned disagreements about the best interests of the animal; the second centered on clinical uncertainty about the most appropriate treatment for the animal; the third involved factors influencing ethical reasoning and decision making; and the fourth concerned how ethics education might prepare veterinary students for future ethical decision making. An overarching theme identified in the analysis was one of enormous personal distress. Furthermore, a sense of veterinarians being interested in how others might think and feel about ethical challenges came through in the data. The results give insight into how veterinarians experience and respond to ethical challenges. The research also provides empirical information about everyday practice to inform future education in ethics and ethical decision making for veterinary students.
Veterinarians face ethical challenges in daily practice,1–3 including demands for convenience euthanasia of healthy animals, financial limitations of animal owners that put constraints on veterinary intervention, and dealing with clients determined to treat gravely ill animals against veterinary advice.1,4 Some surveys have focused on specific moral challenges, such as the conflict veterinarians experience between patient and client interests.5 Other research has explored ethical perceptions, reasoning abilities, and empathy levels among veterinary students and practitioners. Such studies have suggested, for example, that the hidden curriculum might decrease empathetic responses and that ethical reasoning ability does not increase with greater experience in veterinary practice.6–9
However, comparatively little is known about how qualified practitioners respond to a range of common ethical problems, how exactly they make ethical decisions, and what they believe would support them in responding to ethically challenging situations.2,5,10,11 While the relevant literature contains several quantitative studies, there are very few qualitative studies that probe in more detail the ethical challenges encountered by small animal veterinarians and their thoughts about the value of ethical support.
This article contributes to the growing body of veterinary ethics research by addressing the above research limitations. We deployed qualitative research methods to investigate ethical challenges in small animal practice and to capture a more in-depth understanding of veterinarians’ perceptions and responses to them. Our research questions were as follows:
What types of ethical challenges and problems do veterinarians encounter working in small animal practice?
What ethical decisions do veterinarians make, and what factors do they consider and weigh when making these decisions?
To what extent has past ethics education prepared veterinarians for these types of ethical decisions?
To answer the above research questions, the methodological framing for this project deployed both phenomenological and constructivist/interpretivist paradigms. Phenomenology as a research method was first introduced by the German philosopher Edmund Husserl (1859–1938) to explore a person’s lived-in world and to find the truth through their lived experience.12–14 Constructivism espouses a hermeneutical approach, maintaining that meaning is hidden and must be brought to the surface through deep reflection. This meaning was elicited in this study by the interactive researcher–participant dialogue.15 The in-depth interview questions were loosely structured around the research questions. Within each of the interviews, participants were asked to describe their practice context and their experiences of encountering ethical dimensions within that context.12,13,16 The interview questions sought to reveal not only the type and nature of some common ethical challenges but also the normative stances adopted by participants—the way they constructed and experienced ethical challenges in their everyday practices.
The study was granted human ethics approval through the University of Melbourne, Medical Education Human Ethics Advisory Group, number 1749089.
Veterinarians were recruited via key informant purposive sampling to target veterinarians from small animal city veterinary practices and with different backgrounds and levels of experience.12 This involved LR contacting known colleagues via email, asking whether they would be willing to participate in the study. These colleagues were from small animal city practices known to be of a range of ages, genders, and years since graduation, hence ensuring a good cross-section of participants.
The interviews began with demographic questions, such as years of experience, and questions about prior ethics and veterinary education. As the research was exploratory, the questions were open-ended. Participants were asked to describe some typical ethical challenges they had encountered in veterinary practice and how they responded to these challenges (Table 1). With the consent of participants, interviews were audio recorded and transcribed in full.
|
| Question no. | Question |
| 1. | Can you remember a time in your practice where you weren’t sure about the right thing to do? |
| 2. | Can you describe these occasions briefly? |
| 3. | Would you like to talk about one of these issues in more detail?
|
| 4. | What did you decide to do?
|
| 5. | Was there anything from your past education or experience that helped you? |
The main method of analysis was inductive content analysis. This involved two phases. The first phase involved a close reading of the transcripts in order to highlight words or phrases that seemed to be meaningful and relevant to the research questions.17 Authors LR and CD separately read interview transcripts and highlighted phrases and ideas from the interview, marking them up in the margin as codes of interest. The second phase of analysis involved reviewing and then grouping the codes into common ideas or themes that emerged across the data set.16 This inductive analytic step involved asking questions of the data such as the following: How do participants respond to these challenges? How do they decide what to do? Are there any patterns or themes which emerge concerning ethical decision making from their discussions?12,16,18 Researchers (CD and LR) read the manuscripts separately and had multiple discussions to refine and decide on the final themes.
Seven veterinarians were recruited—four male and three female—with ages ranging from 27 to 62 years (Table 2).
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| Interview | Age | Gender | Graduation year | Has been or is a practice owner | Further qualifications | Formal ethics education |
| 1. | 59 | F | 1980 | Y | Y Diploma Accounting | N |
| 2. | 62 | M | 1982 | Y | N | N |
| 3. | 51 | M | 1990 | Y | Y Master’s (Clinical Studies) | N |
| 4. | 32 | F | 2012 | N | N | Y |
| 5. | 31 | F | 2009 | N | N | Y |
| 6. | 35 | M | 2005 | N | N | N |
| 7. | 29 | M | 2015 | N | N | N |
Through analysis of the content of interview responses, we identified three main areas of ethical concern or challenge. The first concerned disagreements about the best interests of the animal—that is, disagreements between the veterinarian and the owner and, interestingly, between owners themselves. The second main ethical challenge involved clinical uncertainty in choosing and recommending the most appropriate treatment overall for the animal patient. This challenge also manifested in doubt (and in some cases lack of confidence) in how best to communicate treatment options and costs. The third concerned how veterinarians made their decisions. These ethical challenges are reported below, with exemplar quotes drawn from participants. Further inductive analysis of these responses resulted in an overarching theme of moral/personal distress in having to deal with these challenges. This theme is also discussed below.
An ethical challenge raised by several participants was that of disagreements between what they as veterinarians perceived to be in the interests of the patient and what the animal owners requested be done or not done to the patient:
I recommended euthanasia, strongly recommended it, discussed it for a long time, and the owner declined it and took the cat home. And . . . I think about . . . we found out 4 or 5 days later that the cat died at home. (P6)
[There] was a dog that was in dire straits, but the wife was very attached to this dog and had made several suicide attempts, and he just said it’s not going to happen he . . . also was not prepared to—well I think that he was just overwhelmed, yeah, so the animal was definitely suffering, and I talked about pain relief and a whole lot of other things, but he was so overwhelmed he just couldn’t cope. (P1)
In addition to disagreements with owners, moral concerns were also expressed about how to deal with unwell but treatable animals that presented to the clinic without owners:
Dilemmas of having animals with very treatable conditions where they were either strays or not owned, and so you were presented with the option of euthanising when, from a professional point of view, you knew that this was not actually a difficult one to fix. (P1)
Sometimes practitioners expressed clinical and ethical uncertainty about the right treatment path to choose, where risks and benefits were perceived to accompany each treatment option or where the prognosis was uncertain or very likely to be poor.
Multiresistance staph, terribly resistant staph, that was receiving a lot of drugs at the time, and the one concern I voiced with our medicine specialists at the time was, especially in a hospital [intensive care unit], whether the ethics from the other patients, was it ok, could [it] be ok to continue treating a multiresistant bug in an otherwise terminal patient with, ah, you know, practically no chance of recovery? (P7)
The ethical difficulty (of knowing how to proceed) which resulted from clinical uncertainty was compounded if the veterinarian perceived a lack of understanding or disagreement from the owner about proposed treatment pathways, or if the veterinarian was concerned about the negative impact of particular treatments on owners in addition to animal patients. An associated difficulty was that of knowing how to communicate a complex situation to the owner.
[A] real ethical dilemma I have is trying to, um, trying to work with owners in a way that they can understand and see it from how I’m seeing it. (P5)
You know like some cases as well, I think that if this person didn’t have this animal, they would really struggle in life, like they’re struggling as it is and this is everything to them. (P5)
Very often . . . the veterinarian [has] to remain impartial, but also to make . . . guided decisions is actually quite difficult. (P1)
The third theme to arise in the data concerned how veterinarians processed these ethical challenges and what factors seemed to influence their ethical decisions. The four factors we identified were professional responsibility, legal boundaries, peer influence, and moral intuition. Although reported separately below, these factors were discussed by participants as important ideas without specific priority given to one over another.
The idea of professional responsibility to the animals centered on the responsibility of the veterinarian as the protector of animal welfare.
A sense of professional responsibility for the welfare of the animal:
The buck stops with me . . . I have a responsibility to my pets, I deal with ethical questions and dilemmas primarily on a legal basis. (P2)
To make sure that we look after the welfare of the animal, that’s very important to me and that’s why I’ve continued to be a vet. (P5)
Another factor which influenced ethical thinking was the role of the law and veterinary practice regulations. The law was discussed as a solid barrier which sometimes supported decision making and sometimes acted as a boundary or limit to available options.
Awareness of legal boundaries:
I am legally allowed to put this dog to sleep, and therefore I’m happy to do it with one caveat: I won’t break the law, and I won’t allow anything that would come under the grounds of cruelty for example to happen. (P2)
Unfortunately, the law is still on the owner’s side when it comes to the animal and there isn’t a lot of ways [sigh] around it. (P7)
You also have to . . . honor the fact the owners do have the legal and emotional right to make decisions on behalf of their pet. (P5)
Several participants spoke of depending on peers for support, advice, and sometimes judgment about their ethical decisions, or they spoke of being affected or influenced by their peers. Sharing stories and ethical decisions with other practitioners was valued as a source of advice, a sounding board, and a comparative benchmark for their own experiences.
The value of peers:
Small network of colleagues of friends and things and we talk. So we talk here, and I talk to some friends, and I’ve got some friends who have specialized and others who haven’t—and it’s interesting . . . having this huge pool of opinions to draw on. (P4)
My wife’s a veterinarian and so we do speak about a lot of cases, and that certainly helps. I speak to people here at work. (P6)
However, some participants also worried about being judged negatively by their peers:
I run my own practice. But the biggest ethical dilemmas that I tend to face [pause] are where I want to do something for my client or I . . . wish to um do something but my business partner or my team disagree with me.Those are the [pause] probably cause me more angst. (P2)
[Reflecting on an incident involving the treatment decision made of a cat], three of the nurses were really quite upset that happened, and they often seem to be frustrated, and often it comes across they’re a little bit upset with me. (P3)
A further idea to emerge was the idea of using gut instinct or professional intuition about the right thing to do.
A reliance on ethical intuition about what should be done:
It’s more than, talking to, you know, sort of colleagues and friends and, you know, other vets and going, you know, what would you have done, but in the end it is up to me and how I feel. (P4)
[I make the decision] by previous experience to some degree, but the other thing is from gut feeling—there is going to be a gut feeling of whether this is really bad or not. (P1)
One good reason not to—except that it doesn’t feel right, to me. (P6)
We identified an overarching theme of personal distress when we examined the data as a whole, inquiring as to whether there were some common ideas in the way that participants discussed ethical challenges and made decisions about how to respond. Comments about feeling distressed, or anxious, were common when participants described the types of challenges they encountered and the effect it had on them.
For example, the idea of feeling the weight of responsibility was evident when participants discussed having to act within strict limits imposed by the law, or by their practice environment, or by their personal lack of experience:
I think I felt that I couldn’t really approach any of my bosses because in fear of sounding or looking stupid or inadequate. (P2)
I was a newish grad at the time, and I just didn’t feel like I could, you know, sort of decide what to do, you know, take a stand, but I didn’t know what to do, and how to approach the conflict. (P4)
You are trying to defend the rights of the animal and their need for, ah, relief of suffering and treating the problem, but you are also have to . . . honor the fact the owners do have, um, the legal and emotional right to make decisions on behalf of their pet. (P2)
[When discussing a case that went horribly wrong]: This is a massive screw up, how, how could this have happened, um, and so if I’m doing, and, and I think I mostly feel that way when I’m doing things that I am perhaps not terribly experienced [with]. (P7)
The idea of personal distress emerged across the data as a whole. Participants not only recalled the types of ethical challenges they encountered; they also discussed how those experiences made them feel, how the experience affected them physically and emotionally, and, as highlighted in the final quote below, how small everyday ethical challenges can have a cumulative impact:
Even now I lose sleep. If I’m going to an operation out of the normal, I won’t sleep. Even after I’ve had a couple weeks off I don’t sleep. (P3)
The really confronting part, because, as you say you are in such an immediacy, ah, situation, you’ve got to make um decisions, um, form opinions, provide advice, all in a short space of time when you feel that you have your back to the wall. (P2)
It wasn’t sitting very well with me and, um, I didn’t feel that my concerns were heard. (P4)
Dealing with it afterwards, within yourself or within your clinic, is there, is, an ongoing concern: whether there is something else. (P3)
But these types of issues have a big flow . . . in your life both professionally and personally. (P6)
I don’t think I could just put myself out there to work in that situation . . . [racing greyhound euthanasia] because again, [it] probably would cause me anxiety. (P6)
When I have to be part of treatment that causes pet suffering, that has an emotional impact on me. (P5)
Every day I will go into work and there will be some kind of ethical dilemma that I’m dealing with um, and . . . they’re not always big either. Yeah and sometimes it’s just that accumulative effect as well. (P5)
The final element of these research data were the responses to questions about the extent to which prior education and ethical support prepared veterinarians for these ethical challenges. Participants spoke of a need for more formal ethics education during their veterinary training and, in particular, for more exposure to ethical dilemmas in the clinical years at university. They emphasized the importance of professional ethics education using case scenarios of both hypothetical and real-life varieties:
Opportunities within the university, um, education to have kind of role plays and um case situations where you really think about the ethics of it. (P5)
I think creating an environment where they have to . . . whether, you know, it be by exposing them to certain situations, or showing them, sort of, case studies, or whatever it is . . . would potentially enable them to have an actual opinion. (P4)
In addition, some participants indicted that, in their experience, veterinary educators sometimes shielded students from potentially educational real-life ethical cases and that this is probably not helpful:
I think sometime[s] the vets just say, “oh this one’s a bit difficult, how about you leave the room.” (P1)
One participant went even further, suggesting that when students apply for entry to veterinary medicine courses, their responses to questions about ethical situations should be weighed as part of the selection process. Participants also discussed the need for students to learn to be aware that people differ in terms of their values and opinions, and that this diversity is important for veterinarians:
Very helpful I think if everybody learnt back when they are an undergraduate that yeah we all have different moral compasses, and you’re going to have to work with all of those, as I had no idea that other people in the world thought differently to me. If we could, if we all could learn some different ways to interact with those people who just have a different viewpoint to ours. (P1)
This article aimed to examine the kinds of ethical issues veterinary practitioners encounter in small animal practice, the way in which they make ethical decisions, and their perceptions of whether and how previous experiences and education has influenced their ethical deliberation and decisions.
We found that veterinarians face distinctive ethical challenges on a regular basis. This finding, though not novel, resonates with and supports findings from studies that have demonstrated, for example, that companion animal veterinarians encounter ethical dilemmas one to five times per week1 or in some instances on a daily basis.2
The study identified four broad ethical issues: (a) disagreements about the best interests of the animal, (b) clinical uncertainty about appropriate treatment for the animal, (c) factors influencing ethical decision making, and (d) how ethics education might prepare veterinary students for future ethical decision making. An overarching theme identified in the analysis was participants’ experience of personal distress. Furthermore, a sense of veterinarians being interested in how others might think and feel about ethical challenges came through in the data. These findings have implications for future ethical support and education for small animal practitioners.
A strong idea to emerge from the data was the participants’ characterization of ethical challenges as a type of conflict or tension between their own professional judgment about the best course of action for the animal patient and clients’ differing judgments or intentions. The need to negotiate what the veterinarian might regard as best interests pet care, which utilizes optimal available treatment (and sometimes the more expensive treatment) with what the client can afford or is willing to do, is also a familiar theme in the literature.19–21
Our study reinforces the perception that companion animal medicine often requires practitioners to handle difficult ethical decisions arising from characteristic features of veterinary work. One of the most important of these features relates to the cost of interventions and the client’s inability and/or refusal to accept recommendations that protect the interests of the animal.1,22 Another feature with ethical implications identified by this study is that of clinical uncertainty, in which a single clear or best treatment pathway is not apparent. While clinical uncertainty need not always cause ethical problems and stresses, this study shows that it does sometimes gives rise to ethical uncertainty in knowing how to proceed. The interaction between clinical uncertainty and ethical challenges in veterinary medicine—such as the impacts of clinical uncertainty on ethical decisions about how to make recommendations to owners about complex situations—is little explored and deserves further research.
There has been some discussion of ethical dilemmas in the veterinary literature. These ethical dilemmas are sometimes understood as situations in which a veterinarian is confronted with choices involving competing interests of equal moral weight, with no obvious way to prioritize one responsibility over others.2,23 While this understanding partly captures their nature, ethical dilemmas can also involve awareness of two or more possible courses of actions that are open to a veterinarian, both or all of which she perceives as equally wrong, leaving her with the feeling that it is impossible to escape wrongdoing, whatever course of action is taken.24–26
An overarching finding of our study was one of enormous personal distress arising from everyday ethical challenges. Participants described feeling anxious and personally stressed when they felt forced to act against their moral ideals or judgment—such as saving the life of an unowned animal with a “very treatable” condition.27–29 Jameton26 originally described this type of response as moral distress—where (a nurse) knows the right thing to do but because of institutional or other constraints is unable to pursue the right course of action. In our data, participants described instances of this type of moral distress. However their descriptions could also be characterized as a type of personal distress, where professional responsibility, and also relying on their feelings and intuition to decide what to do, weighed heavily on them. Kipperman et al.2 similarly found that small animal veterinarians often do not make use of ethical theories and frameworks in their ethical decision making, instead relying on “gut instinct.” Although such feelings and reactions are not surprising, the role of emotions as a trigger for recognizing and responding to ethical practice dimensions has been less discussed in general ethics education curricula. These curricula have tended to categorize ethical issues according to principles and to justify ethical decisions on the basis of ethical reasoning.30 However, there is a growing literature discussing the role of emotional responses in ethical deliberation.30 For example, Gillam et al.30 claim that emotions are a necessary and positive ingredient in decision making rather than a hindrance to rational decision making, and that ethical deliberation should include explicit consideration of the emotions of those involved. This claim highlights the need for future research and education regarding how we might assist practitioners in understanding the role of emotions as a trigger for ethical concerns, and how this reliance on emotional responses or gut instinct can be framed as integral to making ethical decisions rather than as an emotional burden.
A related and new finding that emerged from our investigation was that veterinarians value and rely upon their peers as a kind of ethical resource and support network for the emotional and the cognitive aspects of ethical decision making.3 Participants appeared to view some of their colleagues as means of support for, and an acknowledgment of, their encounters with ethical challenges. They valued opportunities to share and compare stories involving ethical decisions, and they often appreciated their colleagues’ opinions, experience, and advice. From an ethics education perspective, Burbules and Rice31 highlight the learning value in participating in discussions and conversations with peers. Conversations with colleagues about ethical challenges enables differing views and perspectives to be shared.31,32 Such interactions create opportunities for deeper self-understanding and reflection about commonly held assumptions that typically frame daily decisions.
However, such dialogue requires a high level of trust and a knowledgeable and sensitive facilitator.33 For example, some participants acknowledged with concern that they might be judged negatively by their peers.3 This shows that the views and opinions of other practitioners can function both as a source of support for ethical decision making and also as a cause of stress or anxiety, depending on the context and the personalities involved.
An important implication of this research is how it might inform debates and discussion about effective and relevant veterinary ethics teaching.34,35 Formal teaching and assessment of veterinary ethics in schools is a mandated component of accredited veterinary programs such as the American Veterinary Medical Association but may not be consistently established.34–37 As a result, veterinarians enter practice with varying levels of preparation for thinking through and managing ethical problems.
Two insights about ethics education for veterinary practitioners emerge from this study. The first concerns the focus of the education. Participants spoke of the need to ground ethics education in real-life (or at least realistic) cases in order to bring ethical values and ideas to life and to better reflect the realities of veterinary practice. Based on their own practice (and educational) experiences, participants recommended that veterinary students should have more exposure to the ethical dimensions of clinical practice, rather than being shielded from difficult ethical dilemmas on clinical placements. Other writers have touched on the importance of education that enables practitioners to identify the professional and ethical scope and boundaries of veterinary practice.35,36,38 The use of scenarios and vignettes for role play in education has also been discussed.39
The second insight about ethics education to emerge from this study is the importance to practitioners of peer-to-peer discussion in what others have called a shared community of practice.40 Participants discussed the need for students to gain an awareness that people differ in terms of their values and opinions, and that knowledge of this diversity is important for understanding client wishes for their pets. Such communities of practice may well reduce practitioners’ sense of ethical and professional isolation and their feelings of anxiety associated with ethical decision making. Fostering these communities may therefore support practitioners and their capacity to manage ethical decisions and stresses.
Some veterinary professional associations already have programs for supporting newly graduated practitioners. For example, the Australian Veterinary Association has a graduate mentoring program that affords mentees the “opportunity to reflect on professional challenges and opportunities” with a more experienced colleague.41 While this and other programs like it seek to support new graduates, there is the potential for designing programs that allow practitioners of varying levels of experience to discuss ethical problems and to learn from others’ experience and wisdom. After all, ethical challenges occur not just soon after graduation but in all stages of a career in veterinary medicine, a finding that this study reinforces.
Another possible mechanism for providing ethical support for practitioners is the creation of clinical ethics committees for small animal practice.42 In hospital settings, clinical ethics committees (CEC) comprise a multidisciplinary group of practitioners, including an ethicist. Their role is not to impose ethical judgments on practitioners but rather to identify and illuminate real ethical concerns as they arise in clinical practice, to resolve conflict, to facilitate communication, and to ease moral distress in health care.43 CECs involve sustained ethical deliberation in order to provide well-considered suggestions for an ethically appropriate response. Because they draw on the experience and expertise of a number of individuals, CECs may reveal novel and illuminating ways of thinking about ethical problems that a single individual, isolated from the thoughts of others, would overlook or simply never register. CECs can provide a useful framework to guide clinicians and clinical educators in both modeling ethical behavior and reflection and more purposefully teaching students and trainees.44
Although the history of ethics review committees that govern animal research is decades old, CECs are extremely rare in veterinary medicine. Rosoff et al.42 describe the operations of perhaps the first CEC in North America. In Australia, however, the Lort Smith Animal Hospital in Melbourne has run a CEC for a number of years. This Australian CEC reviews and provides non-prescriptive guidance to staff—that is, veterinarians, nurses, and shelter staff members—in relation to ethical challenges that occur in that veterinary hospital.a The value of CECs as another means of addressing one of the issues raised by this study—namely, the need for ethical support and communities of practice in veterinary medicine so that individuals may gain ethical insight from contact with others—is certainly something that requires further study.
Our research demonstrates that the participating veterinarians in this study were actively seeking answers to their ethical challenges even though, as noted above, they were not necessarily using concrete, step-by-step ethical frameworks in their everyday ethical decision making. Instead, the methods of ethical reasoning used included a combination of, on the one hand, recourse to their sense of professional identity, responsibility, and the boundaries imposed by the law and, on the other, discussion with colleagues and the use of moral intuition.
In reflecting on our study findings, we suggest that a multipronged rather than single strategy may be required for assisting veterinarians in ethical decision making in practice. A multipronged approach may include formal lectures, role play,38,45 discussion of realistic case scenarios, ongoing CECs, and facilitated peer-to-peer dialogue. Further studies will be useful in determining the value of various kinds of ethical decision-making supports for veterinary practitioners. Such work will be vital in driving veterinarians’ awareness that they are not alone in confronting stressful and challenging ethical decisions and that a range of supports are available that might be made available to them.
Limitations of this study include a reliance on participants recalling their experiences and making sense of them in retrospect. This may not accurately reflect the reality of their experiences but rather represent a later interpretation. A second limitation is that the study is confined to one city in Australia with a small number of participants. The results therefore may not reflect the opinions of all veterinarians, suggesting that further research should be conducted. However, these are common limitations of in-depth interviews where the goal is to identify and describe the experiences and perspectives of practitioners in detail, rather than to claim representativeness or generalizability that explore past experience.46
Although this was a small qualitative study, the findings resonate with current literature that veterinarians face frequent ethical challenges in companion animal practice, and that these challenges cause some individuals significant personal distress. This article shows that ethical challenges, and practitioners’ responses to those challenges, can be influenced by a range of extrinsic and intrinsic factors including the law, the presence or absence of peers and social networks, clinical uncertainty, different conceptions of professional responsibility (e.g., duties to the client and/or to the patient), the practitioners’ intuition and gut instinct, and exposure to previous veterinary ethics education. An important finding in this study is that some practitioners perceive that exchanging experiences and information with their peers and, more generally, having ongoing ethics discussions and ethics-based support would be valuable as a form of professional development in their daily veterinary work. Ethical support in the form of, for example, CECs, peer networks, and ethics education may give veterinarians the benefit of being exposed to other moral points of view and to clear ways of thinking through ethical challenges.
In the light of findings and reflections garnered from this small but in-depth study, we suggest that further research is needed to develop tools and strategies to support veterinarians in tackling ethical dilemmas and stresses. It would be helpful, for example, to know more about the value of different types of undergraduate ethics education, the usefulness of CECs in veterinary hospitals, and the benefits of fostering greater collegial dialogue and interaction in relation to ethical decision making.
Acknowledgments
We would like to thank the reviewers for their kind and constructive feedback to strengthen this article. Thank you to the participants and Professor Ted Whittem for his technical and moral support.
a Lort Smith Animal Hospital, https://www.lortsmith.com/.
| 1. | Batchelor C, McKeegan D. Survey of the frequency and perceived stressfulness of ethical dilemmas encountered in UK veterinary practice. Vet Rec. 2012;170(1):19. https://doi.org/10.1136/vr.100262. Medline:22084032 Medline, Google Scholar |
| 2. | Kipperman B, Morris P, Rollin B. Ethical dilemmas encountered by small animal veterinarians: characterisation, responses, consequences and beliefs regarding euthanasia. Vet Rec. 2018;182(19):548. https://doi.org/10.1136/vr.104619. Medline:29445010 Medline, Google Scholar |
| 3. | Moses L, Malowney MJ, Wesley Boyd J. Ethical conflict and moral distress in veterinary practice: a survey of North American veterinarians. J Vet Intern Med. 2018;32(6):2115–22. https://doi.org/10.1111/jvim.15315. Medline:30320478 Medline, Google Scholar |
| 4. | Wiseman-Orr ML, Stuart SA, McKeegan D. Ethical dilemmas in practice. Disc-Learn Teach Philos Relig Stud. 2009;8(2):187–96. https://doi.org/10.5840/discourse20098235. Google Scholar |
| 5. | Yeates JW, Main DCJ. Veterinary opinions on refusing euthanasia: justifications and philosophical frameworks. Vet Rec. 2011;168(10):263. https://doi.org/10.1136/vr.c6352. Medline:21498175 Medline, Google Scholar |
| 6. | Verrinder JM, Phillips CJ. Assessing veterinary and animal science students’ moral judgment development on animal ethics issues. J Vet Med Educ. 2015;42(3): 206–16. https://doi.org/10.3138/jvme.0215-022R. Medline:26200702 Link, Google Scholar |
| 7. | Batchelor C, Creed A, McKeegan D. A preliminary investigation into the moral reasoning abilities of UK veterinarians. Vet Rec. 2015;177(5):124. https://doi.org/10.1136/vr.102775. Medline:26109285 Medline, Google Scholar |
| 8. | Paul E, Podberscek A. Veterinary education and students’ attitudes towards animal welfare. Vet Rec. 2000;146(10):269–72. https://doi.org/10.1136/vr.146.10.269. Medline:10749039 Medline, Google Scholar |
| 9. | Hazel SJ, Signal TD, Taylor N. Can teaching veterinary and animal-science students about animal welfare affect their attitude toward animals and human-related empathy? J Vet Med Educ. 2011;38(1):74–83. https://doi.org/10.3138/jvme.38.1.74. Medline:21805938 Link, Google Scholar |
| 10. | Mullan SM. Ethical decision-making in veterinary practice: using the head and the heart. Vet Rec. 2012;171(18):443–4. https://doi.org/10.1136/vr.e7344. Medline:23125264 Medline, Google Scholar |
| 11. | Berry J. Ethical practice. Canadian Vet J. 2014;55(1): 1187–90. Medline:24381336 Medline, Google Scholar |
| 12. | Groenewald T. A phenomenological research design illustrated. Int J Qual Meth. 2004;3(1):42–55. https://doi.org/10.1177/160940690400300104. Google Scholar |
| 13. | Lee N-I. Phenomenology and qualitative research method. Grenzgänge: Studien zur interdisziplinären und interkulturellen Phänomenologie; 2011. Google Scholar |
| 14. | Creswell JW, Hanson WE, Clark Plano VL, Morales A. Qualitative research designs: selection and implementation. Couns Psychol. 2007;35(2):236–64. https://doi.org/10.1177/0011000006287390. Google Scholar |
| 15. | Ponterotto JG. Qualitative research in counseling psychology: a primer on research paradigms and philosophy of science. J Couns Psychol. 2005;52(2):126–36. https://doi.org/10.1037/0022-0167.52.2.126. Google Scholar |
| 16. | Braun V, Clarke V. Successful qualitative research: a practical guide for beginners. London, UK: Sage; 2013. Google Scholar |
| 17. | Bell J. Doing your research project: a guide for first-time researchers. McGraw-Hill Education; Berkshire, UK: 2014. Google Scholar |
| 18. | Titchen A, McIntyre D. A phenomenological approach to qualitative data analysis in nursing research. In Titchen A, editor. Changing nursing practice through action research. Oxford: National Institute for Nursing; 1993 p. 29–48. Google Scholar |
| 19. | Coghlan S. Euthanasing treatable patients. In Practice. 2017;39(4):190–1. https://doi.org/10.1136/inp.j1256. Google Scholar |
| 20. | Rollin BE. An introduction to veterinary medical ethics: theory and cases. John Wiley & Sons; Oxford, UK: 2013. Google Scholar |
| 21. | Yeates JW, Main DC. The ethics of influencing clients. J Am Vet Med Assoc. 2010;237(3):263–7. https://doi.org/10.2460/javma.237.3.263. Medline:20673104 Medline, Google Scholar |
| 22. | Morgan CA, McDonald M. Ethical dilemmas in veterinary medicine. Vet Clin N Am-Small. 2007;37(1):165–79. https://doi.org/10.1016/j.cvsm.2006.09.008. Medline:17162119 Google Scholar |
| 23. | Mullan S, Fawcett A. Veterinary ethics: navigating tough cases. 5M Publishing; Sheffield, UK: 2017. Google Scholar |
| 24. | Mossop L. Novice to expert? Teaching and development of moral reasoning skills. Vet Rec. 2015;177(5):122–3. https://doi.org/10.1136/vr.h4033. Medline:26231875 Medline, Google Scholar |
| 25. | Kinnison T. When veterinary teams are faced with clients who can’t afford to pay. Vet Rec. 2016;179(23):594–5. https://doi.org/10.1136/vr.i6436. Medline:27932719 Medline, Google Scholar |
| 26. | Jameton A. Nursing practice: the ethical issues. New Jersey, 1984. Google Scholar |
| 27. | Morley G. Perspective: the moral distress debate. J Res Nurs. 2016;21(7):570–5. https://doi.org/10.1177/1744987116666701. Google Scholar |
| 28. | Rollin BE. Euthanasia and moral stress. Loss Grief Care. 1987;1(1–2):115–26. https://doi.org/10.1300/J132v01n01_14. Google Scholar |
| 29. | Rollin BE. Euthanasia, moral stress, and chronic illness in veterinary medicine. Vet Clin N Am-Small. 2011;41(3):651–9. https://doi.org/10.1016/j.cvsm.2011.03.005. Medline:21601753 Google Scholar |
| 30. | Gillam L, Delany C, Guillemin M, Warmington S. The role of emotions in health professional ethics teaching. J Med Ethics. 2014;40(5):331–5. https://doi.org/10.1136/medethics-2012-101278. Medline:23760728 Medline, Google Scholar |
| 31. | Burbules N, Rice S. Dialogue across differences: continuing the conversation. Harvard Educ Rev. 1991;61(4):393–417. https://doi.org/10.17763/haer.61.4.yr0404360n31j418. Google Scholar |
| 32. | Delany C, Hall G. “I just love these sessions”: should physician satisfaction matter in clinical ethics consultations? Clin Ethics. 2012;7(3):116–21. https://doi.org/10.1258/ce.2011.012010. Google Scholar |
| 33. | Molewijk B, Kleinlugtenbelt D, Pugh SM, Widdershoven G. Emotions and clinical ethics support. A moral inquiry into emotions in moral case deliberation. HEC Forum. 2011;23(4)257–68.https://doi.org/10.1007/s10730-011-9162-9. Medline:21918811 Google Scholar |
| 34. | de Boo J, Knight A. “Concepts in animal welfare”: a syllabus in animal welfare science and ethics for veterinary schools. J Vet Med Educ. 2005;32(4):451–3. https://doi.org/10.3138/jvme.32.4.451. Medline:16421827 Link, Google Scholar |
| 35. | Magalhães-Sant’Ana M. A theoretical framework for human and veterinary medical ethics education. Adv Health Sci Educ. 2015;21(5):1123–36. https://doi.org/10.1007/s10459-015-9658-1. Medline, Google Scholar |
| 36. | Magalhães-Sant’Ana M. Ethics teaching in European veterinary schools: a qualitative case study. Vet Rec. 2014;175(23):592–7. https://doi.org/10.1136/vr.102553. Medline:25185106 Medline, Google Scholar |
| 37. | Gray C. Similar but not the same: the teaching of veterinary and medical ethics. Vet Rec. 2014;175(23):590–1. https://doi.org/10.1136/vr.g7451. Medline:25501523 Medline, Google Scholar |
| 38. | Mossop LH, Cobb K. Teaching and assessing veterinary professionalism. J Vet Med Educ. 2013;40(3):223–32. https://doi.org/10.3138/jvme.0113-016R. Medline: 23975066 Link, Google Scholar |
| 39. | Magalhães-Sant’Ana M, More SJ, Morton DB, Hanlon A. Ethical challenges facing veterinary professionals in Ireland: results from Policy Delphi with vignette methodology. Vet Rec. 2016;179(17):437. https://doi.org/10.1136/vr.103786. Medline:27613779 Medline, Google Scholar |
| 40. | Lave J, Wenger E. Situated learning: legitimate peripheral participation. Cambridge: Cambridge University Press; 1991. Google Scholar |
| 41. | Ehrich LC, Hansford B, Tennent L. Formal mentoring programs in education and other professions: a review of the literature. Educ Admin Quart. 2004;40(4):518–40. https://doi.org/10.1177/0013161X04267118. Google Scholar |
| 42. | Rosoff PM, Moga J, Keene B, et al. Resolving ethical dilemmas in a tertiary care veterinary specialty hospital: adaptation of the human clinical consultation committee model. The Am J Bioethics. 2018;18(2):41–53. https://doi.org/10.1080/15265161.2017.1409824. Medline:29393799 Medline, Google Scholar |
| 43. | Delany C, Molloy E. Learning and teaching in clinical contexts: a practical guide. Elsevier Health Sciences; Chatswood, N.S.W, Australia: 2018. Google Scholar |
| 44. | Delany C. The role of clinical ethics consultations for physical therapy practice. Phys Ther Rev. 2012;17(3):176–83. https://doi.org/10.1179/1743288X12Y.0000000009. Google Scholar |
| 45. | Magalhães-Sant’Ana M, Hanlon AJ. Straight from the horse’s mouth: using vignettes to support student learning in veterinary ethics. J Vet Med Educ. 2016;43(3):321–30. https://doi.org/10.3138/jvme.0815-137R1. Medline:27295118 Link, Google Scholar |
| 46. | Rubin HJ, Rubin IS. Qualitative interviewing: the art of hearing data. California. USA : Sage; 2011. Google Scholar |
