Veterinary Ethics Flipped Learning Material PDF

VMS1002 VETERINARY ETHICS FLIPPED LEARNING MATERIAL RETHA QUEENAN MRCVS LEARNING OBJECTIVES Discuss the major categories of ethical frameworks Discuss the relationship between professionalism, ethics and the law. Discuss the relevance of ethics to the Veterinary Profession...

VMS1002 VETERINARY ETHICS FLIPPED LEARNING MATERIAL RETHA QUEENAN MRCVS LEARNING OBJECTIVES Discuss the major categories of ethical frameworks Discuss the relationship between professionalism, ethics and the law. Discuss the relevance of ethics to the Veterinary Profession Define moral distress and discuss strategies for coping with and preventing moral distress. 2  P R E S E N TAT I O N R O A D M A P RCVS Day 1 (D1) competences What is ethics? Why does ethics matter? Ethical frameworks - general Some ethical frameworks relevant to veterinary science Pause to consider case studies An Ethical Matrix (Mepham matrix) Professionalism, Ethics and law What about euthanasia? Final thoughts – some strategies for navigating ethical dilemmas and moral distress, including ‘Contemporary Tools’ 3 RCVS D1 COMPETENCIES Personal Leadership – Professionalism #1 - Act professionally, as informed by the RCVS Code of Professional Conduct. #2 – Act in a way that shows understanding of ethical and legal responsibilities, appropriately balancing competing interests. 4  D1 COMPETENCY Act in a way that shows understanding of ethical and legal responsibilities, appropriately balancing competing interests. To abide by the principles in the Code of Professional Conduct, veterinary surgeons need to be able to make professional judgements based on sound principles. They must be able to think through the dilemmas they face when presented with conflicting priorities and be prepared to justify the decisions they make. As well as decisions relating to individual patients, animal groups, populations of animals and clients, veterinary surgeons must take account of the possible impact of their actions beyond the immediate workplace, for example, on public health, the environment and society more generally. 5 W H AT I S E T H I C S ? It is a branch of philosophy which, “in the broadest sense considers the question, ‘What should I do’? It assumes that there are, if not right and wrong answers to that question, better and worse answers. The word ‘ethics’ is an umbrella term for beliefs, principles and rules determining what is right and wrong” (Mullan & Fawcett, 2017, p1) 6 ETHICS1 VS ETHICS2 (ROLLIN ET AL, 2006) Ethics1 (morality) Ethics 2 (the study of ethics) Beliefs held by society (societal This is a branch of philosophy, the ethics), individuals (personal logical, rational analysis of ethics) or subgroups (professional Ethics1 and an exploration of how ethics) regarding right vs wrong, Ethics1 positions are justified. fair vs unfair, just vs unjust. 7 LEARNING OBJECTIVES Discuss the major categories of ethical frameworks Discuss the relationship between professionalism, ethics and the law. Discuss the relevance of ethics to the Veterinary Profession Define moral distress and discuss strategies for coping with and preventing moral distress. 8 W H Y I S E T H I C S I M P O R TA N T I N VETERINARY SCIENCE? “ Veterinary Professionals have the same general responsibilities to animals as other people, but are more accountable because we have more opportunities to cause greater harms and fewer excuses because of our greater knowledge” (Yeates, 2013) 9 W H Y I S E T H I C S I M P O R TA N T I N VETERINARY SCIENCE? Society places trust in us due to our perceived experience, expertise and judgement. We enjoy Aesculopian authority (“the powerful, almost mystical authority that healers enjoy in all cultures” (Rollin 2006, p79) Vets in the UK enjoy ‘self-determination’, through our governing body, the Royal College of Veterinary Surgeons (RCVS). The autonomy and trust that we enjoy must not be taken for granted and we must think deeply and systematically about the decisions that we make. 10 W H Y I S E T H I C S I M P O R TA N T I N VETERINARY SCIENCE? MORAL DISTRESS 11  W H Y I S E T H I C S I M P O R TA N T I N VETERINARY SCIENCE? RCVS Code of Conduct: protecting animal welfare is at the heart of our duty as vets in the UK However, additionally, there are multiple other stakeholders to consider Consequently, veterinarians face ethical challenges and complicated decision-making (Gibson et al, 2023) Veterinary ethical decision-making processes in the face of moral conflicts can result in satisfactory outcomes and ‘psychological comfort’. Often, however, it does not, resulting in stress (Arbe Montoya et al, 2023) In essence, stress in veterinary work is inevitable due to frequent ethical challenges as well as surgical or medical complications, adverse events and errors that can characterize veterinary work.  W H Y I S E T H I C S I M P O R TA N T I N VETERINARY SCIENCE? Moral distress “develops when individuals are constrained in their ability to act in line with their own morals” (Gibson et al, 2023, p2) “MD occurs when a professional cannot follow what they perceive to be the correct moral or ethical path in the workplace’ (Arbe Montoya et al, 2023, p1) It can happen when moral principles and institutional demands are not aligned. It can be the result of lack of agency or due to inadequate resources; it could be due to lack of training or time constraints. In human heathcare: MD can impact on patient safety. (Gibson et al, 2023) Moral injury- longer-term consequence of sustained moral distress- linked with more serious mental health problems ” (Gibson et al, 2023) LEARNING OBJECTIVES Discuss the major categories of ethical frameworks Discuss the relationship between professionalism, ethics and the law. Discuss the relevance of ethics to the Veterinary Profession Define moral distress and discuss strategies for coping with and preventing moral distress. 14 SOME ETHICAL FRAMEWORKS- GENERAL (1) Utilitarianism/ Consequentialist- (Jeremy Bentham, 1748-1832, John Stuart Mill, 1806- 1873 and Henry Sidgwick, 1838-1900). Aiming for “the greatest good for the greatest number”…, and “If the circumstances are such that there cannot be a good outcome, the aim is to seek the outcome that yields the least suffering…” (Mullan and Fawcett, 2017, p40). Often explained as: “the end justifies the means”. Kantian/ Deontology – (Immanuel Kant, 1724-1804) The end doesn’t necessarily justify the means; It is the action that counts. “We should aim to do the ‘right’ thing, rather than aiming for the most ‘good’…” and “…some choices are morally forbidden.“(Mullan and Fawcett, 2017, p44) 15 SOME ETHICAL FRAMEWORKS- GENERAL (2) Virtue ethics – (Aristotle, 384-322BC) Is the person good or bad; virtuous or not? This view “assumes that good decisions follow from having a virtuous character” (Mullan and Fawcett, 2017, p47) Divine command theory - follow your religion-not always clear cut. Situation ethics - no two situations the same, each requires a different decision. 16  ETHICS IN VETERINARY SCIENCE Rollin (2006), on p 17, cites his earlier work in asking: “To whom does the veterinarian owe primary obligation: animal or owner? Ought the model for the veterinarian be the paediatrician or the car mechanic?” He also outlines that vets have a duty towards animals, clients, the profession, society and themselves, and that “…the moral status of animals represents the fundamental question of veterinary medical ethics...” (p105) 17 SOME ETHICAL VIEWPOINTS IN THE CONTEXT OF ANIMALS Utilitarian View Relational View Animal Rights View Respect for Nature View Contractarian View 18 T H E U T I L I TA R I A N V I E W Greatest good for the greatest number. Animals deserve welfare consideration. Killing animals may be justified if is done humanely Strengths of this view include: Animals are considered as stakeholders ‘Impartial’ (all stakeholders morally equal) Accounts for the consequences of actions (e.g. breaking rules) Limitations include: Can be used to justify immoral actions Lack of access to all relevant information at the time of decision-making (e.g. whether a particular species can experience pain) Potential justification of inequality (e.g., as long as the majority of stakeholders are happy, some may be neglected or persecuted) (Mullen & Fawcett, 2017) 19  T H E C O N T R A C TA R I A N V I E W From Mullen & Fawcett (2017): This view flows from the belief of ‘Justice as fairness’ (p50). It is an “anthropocentric” approach (p425), and it assumes that ethical obligations result from contracts or arrangements between people, and that “obligations to those with whom we have ‘contracts’ are greater that those whom we don’t.” (p137) Whilst animals can’t make ‘contracts’, some may refer to “the ‘contract’ domesticated animals have entered into with the humans that domesticated them.” (p137) So, whilst non-humans, e.g. animals, cannot make agreements or contracts, they matter to other humans, and this, under the contractarian view, gives us an indirect obligation to them. 20  T H E R E L AT I O N A L V I E W This view recognises the importance of relationship between individuals. We have more responsibility for domestic animals as we have a closer relationship to them. Under this ethical view we have no duty towards vermin or “pest” animals, and this view may promote getting rid of vermin efficiently. This may raise some contradictions, because this view may lead someone to justify significantly different moral value to members of the same species, e.g. veterinary treatment for a pet rat vs. pest control measures for ‘pest’ rats. https://unsplash.com/photos/QxW15BmJxOQ 21 THE ANIMAL RIGHTS VIEW This contrasts to the utilitarian view. This view holds that good results for the greatest number (of people) do not justify inhumane treatment of animals. It holds that animals have rights just like humans have human rights. jorge-maya-Ovw4vkqciX8-unsplash 22 R E S P E C T F O R N AT U R E V I E W This belief promotes that we should respect not only animals, but all species. When a species becomes extinct, it is not the resources lost that is the issue, it is the species itself. Under this view, selective breeding may be challenged and viewed as unacceptable. adam-kool-ndN00KmbJ1c-unsplash 23 CONSIDER THIS CASE: Farmer sells known BVC shedders 24 CONSIDER THIS CASE: Farmer sells known BVC shedders: “You are working with a farmer to eradicate bovine viral diarrhoea from his herd. You identify several chronic shedders among some of his better cows and recommend that these be shipped to slaughter. Several days later you find that he has sold these cows to another of your clients without advising him that the cows have been identified as significant risks for transmitting bovine virus diarrhoea. Is it ethically correct to maintain client confidentiality in such a case? (Rollin, 2006, p113) 25 CONSIDER THIS CASE: “Ms G brings her new puppy, Bramble, to you for a check over. She is very clear that she doesn’t want Bramble to be vaccinated as she has heard (now discredited) scare stories about the human Measles, Mumps and Rubella (MMR) vaccination. You presume she could easily afford the vaccinations. In truth, you know the incidences of the diseases you vaccinate against are very low in your area, thanks partly to decades of vaccination of the pet population, although parvovirus is common in small pockets around the country where vaccination rates are lower. “What should you do?” (Mullan & Fawcett, 2017, p160) 26 E T H I C A L M AT R I X ( D E V I S E D B Y B E N M E P H A M , 1 9 9 6 ) Respect for: Wellbeing Autonomy Fairness Stakeholder 1 (E.g treated organism/ veterinary patient) Stakeholder 2 (E.g. client, such as farmer/ producer) Stakeholder 3 (E.g. consumer of product, such as meat/ milk) Stakeholder 4 (E.g society) Stakeholder 5 (E.g. biota) 27 E T H I C A L M AT R I X Mullan & Fawcett, 2017, p60 28 LEARNING OBJECTIVES Discuss the major categories of ethical frameworks Discuss the relationship between professionalism, ethics and the law. Discuss the relevance of ethics to the Veterinary Profession Define moral distress and discuss strategies for coping with and preventing moral distress. 29 PROFESSIONALISM, ETHICS AND THE LAW Professionalism Ethics The Law Behaviour Provides guidance to A set of rules and Governed by the help us understand regulations intended RCVS Code of what we should do to help govern Conduct Principles, beliefs and society ‘Professional ethics’ rules helping us In the UK, laws are Not always legally determine what is passed by Acts of binding, but right or wrong Parliament; ideally establishes duties Looks for better or agreed by majority. and obligations to worse answers and ‘Consensual ethics’ animals, to ourselves, helps people decide E.g. in the context of our clients, our how to behave in a our profession: The profession and particular situation Veterinary Surgeons’ society via a Not always clear-cut Act, 1966, The Professional Code of as people have Animal Welfare Act, Conduct. different views 2006 30 CONSIDER THIS CASE: It is a busy evening surgery, and you see a client, Mr Osmond, who is new to the clinic. He presents a young male Border Collie cross, ‘Chester’, which he acquired from a dog shelter around the time of the Covid-19 pandemic lockdown. The dog is excitable and difficult to control, and Mr Osmond describes how his family was initially very pleased to have a puppy to take out for walks during the lockdown. However, the dog’s boisterous nature made this increasingly challenging, and both his wife and the children have completely lost interest in the dog. Mr Osmond is due to start an overseas work contract, and he would like you to euthanase Chester, as he feels the family can no longer care for the dog, and he does not think that it would be possible to rehome Chester. “What should you do?” 31 IS IT RIGHT TO PERFORM EUTHANASIA OF A H E A LT H Y PAT I E N T B E C A U S E A N O W N E R REQUESTS IT? What does the RCVS say? Primary duty to relieve suffering Need to take into account owners wishes and circumstances To refuse may be deleterious to the welfare of the animal You can direct the owner to another source of advice » Section 8 Code of Conduct 32  WHY SHOULD YOU CHECK FOR A MICROCHIP? “There may be circumstances where a request is made by a client for the destruction of a dog, as above where in the clinical/professional judgement of the veterinary surgeon destruction of the dog is not necessary, for instance where there are no health or welfare reasons for the dog to be euthanised. In these circumstances, veterinary surgeons should scan the dog for a microchip and check the relevant database if a microchip is found before carrying out the request for euthanasia. Further, veterinary surgeons should note that where the dog in question has been rehomed from a shelter, clients may have a contract such that the dog can be returned to that shelter and so it may be appropriate to discuss this with the client prior to euthanasia. Alternatively, there may be another individual willing to take responsibility for the dog (who may be named on the microchip database), and this may also be discussed with the client” RCVS Code of Conduct Section 8.9 33  W H AT I F A N O W N E R W I L L N O T C O N S E N T T O EUTHANASIA WHEN THIS IS THE BEST O P T I O N T O TA K E I N T H E I N T E R E S T O F A N I M AL W E L FA R E ? 8.11 ” Where a veterinary surgeon is concerned about an owner's refusal to consent to euthanasia, veterinary surgeons can only advise their clients and act in accordance with their professional judgement. Where a veterinary surgeon is concerned that an animal's welfare is compromised because of an owner's refusal to allow euthanasia, a veterinary surgeon may take steps to resolve the situation, for example, an initial step could be to seek another veterinary opinion for the client, potentially by telephone”. RCVS Code of Conduct 8.11 34 LEARNING OBJECTIVES Discuss the major categories of ethical frameworks Discuss the relationship between professionalism, ethics and the law. Discuss the relevance of ethics to the Veterinary Profession Define moral distress and discuss strategies for coping with and preventing moral distress. 35 S T R AT E G I E S F O R D E A L I N G W I T H M O R A L DILEMMAS AND MORAL DISTRESS 36 CONTEMPORARY TOOLS- SARAH WOLFENSOHN 1. Identify all possible courses of action 2. Establish the interests of affected parties 3. Identify the ethical issues involved 4. Establish the legal position of the dilemma 5. Choose a logical course of action 6. Minimise the impact of the decision. (Personal communication with Prof Sarah Wolfensohn, OBE BSc MA VetMB CertLAS FRSB DipECLAM DipECAWBM(AWSEL) FRCVS) 37  S T R AT E G I E S F O R D E A L I N G W I T H M O R A L DILEMMAS AND MORAL DISTRESS Look for guidelines (e.g. legislation or RCVS guidelines) Write it down (this may provide clarification) Seek evidence (e.g. textbooks, “Everyday Ethics” in “In Practice” journal Seek professional advice (e.g. a senior colleague or veterinary board) Phone a friend Counselling (e.g. VetLife) Develop a self-care plan (to include a healthy work-life balance; adequate rest, nutrition, hobbies and social support) For employers/ managers: Develop an open and sharing workplace culture Adequate resources/ staffing/ time Streamline bureaucracy 38 HAVE WE MET THE LEARNING OBJECTIVES? Discuss the major categories of ethical frameworks Discuss the relationship between professionalism, ethics and the law. Discuss the relevance of ethics to the Veterinary Profession Define moral distress and discuss strategies for coping with and preventing moral distress. 39 40  REFERENCES AND ADDITIONAL READING (1) Allen, K. et al., 2024. Ethical issues concerning UK veterinary surgeons practicing in equine sports medicine. Equine veterinary journal. [Online] https://doi.org/10.1111/evj.14204 Arbe Montoya, A. I. et al., 2023. The moral deliberation pathway in veterinary practice: a qualitative study. Veterinary record. [Online] 193 (8), https://doi.org/10.1002/vetr.3173 Fawcett, A. and Mullan, S., 2018. Managing moral distress in practice. In Practice, 40: 34-36 Gibson, J. et al., 2023. Ethical challenges experienced by veterinary practitioners in relation to adverse events: Insights from a qualitative study. Veterinary Record. [Online] 193 https://doi.org/10.1002/vetr.3601 Moses, L. et al., 2018. Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. Journal of Veterinary Internal Medicine. [Online] 32 (6), 2115–2122. https://doi.org/10.1111/jvim.15315 41  REFERENCES AND ADDITIONAL READING (2) Mullan, S. & Fawcett, A., 2017. Veterinary Ethics: Navigating Tough Cases. Sheffield, UK, 5M Publishing. RCVS, 2022. Royal College of Veterinary Surgeons. RCVS. Advice and Guidance, Code of Professional Conduct for Veterinary Surgeons, Supporting Guidance. https://www.rcvs.org.uk/ (Accessed 6th November 2022) Richards L, Coghlan S, Delany C. 2020. “I had no idea that other people in the world thought differently to me”: Ethical challenges in small animal veterinary practice and implications for ethics support and education. Journal of Veterinary Medical Education 47, 728–736 Rollin, Bernard E., 2006. An Introduction to Veterinary Medical Ethics : Theory and Cases, John Wiley & Sons, Inc. Rollin, B. E., 2002. The use and abuse of Aesculapian authority in veterinary medicine. Journal of the American Veterinary Medical Association, 220, 1144-1149. RVC, 2024. https://www.rvc.ac.uk/research/projects/bovine-viral-diarrhoea Accessed 28/10/2024 Yeates, J., 2013. Animal welfare in veterinary practice. Oxford: Wiley-Blackwell. 42