Monday, August 19, 2013

Interview with animal ethicist & veterinarian Dr James Yeates

An excellent guide for veterinarians.
SAT was fortunate enough to interview the talented, extremely busy Dr James Yeates. James Yeates graduated from Bristol University in 2004 as a veterinarian, where he also completed a biotethics degree, certificate, dipoma and PhD. He worked in Gloucestershire in private practice, then at an RSPCA branch. He became head of the RSPCA’s companion animals department in 2011 and their Chief Veterinary Officer in 2012. He is based at the RSPCA’s South Support Centre in Sussex.

He is also the author of Animal Welfare in Veterinary Practice, a practical and very accessible guide for veterinarians. (If you click the hyperlink you can download and read some excerpts). One common criticism of ethics teaching is that it tends to remain a little ivory tower. As a lecturer on this topic I am always trying to integrate case scenarios and give students a dose of reality. We expect diagnostic tests to yield black and white answers when this is often not the case. So do with ethical decision making. So its nice to have someone so practical, with their feet grounded in practice, writing about ethics in an accessible way.

When did you realise you wanted to devote your career to animal welfare?

It was after a forum run by the British Veterinary Association Animal Welfare Foundation charity for students to discuss animal welfare issues. I found the discussions could be made useful and practical, drawing on both the practical reflections of intelligent practitioners and the philosophical ideas that I had read as a student. It also made me think that there could be a career forged here, although I thoroughly loved full time GP practice too.

The forewords in your book both suggest that as a profession, vets can do better when it comes to animal welfare. In your opinion, what are the biggest failings and how do we address these?

Most vets are concerned about animal welfare but
  • Suffer the same distractions and barriers that everyone does, not least time and money
  • Feel somehow that doing “good” work for free is somehow letting the side down
  • Don’t think to “look up” at the wider issue (beyond complaining about it over coffee)

Addressing these can be mainly done by us reminding ourselves why we wanted to be vets, and that doing good is a legitimate “bottom line”.

You developed the concept of a welfare account - can you explain what this is and how it works?

This is the idea that you judge yourself on how much welfare improvements or problems you cause – all added up over time. This means that if you do cause some harms (and we cannot avoid it, especially in some ethical dilemmas such as whether to perform a caesarean without spaying) then you can compensate or “offset” those harms by doing more good (eg to educate people to avoid breeds that regularly need caesarians). [I posted on this topic earlier, to read more check out this link].

The gravid uterus of a chihuahua mated with a larger dog resulting in foetal oversize and necessitating a caesarian. There is much can do to prevent such scenarios (desexing for example - in this case the owners didn't intend to breed the dog but didn't consider that the dog might mate with another in spite of their wishes).
Throughout your book you use the metaphor of contagion - referring to both good and bad animal welfare. Why is animal welfare contagious and how do we harness the power for good?

We are all influenced by other people – consciously and subsconsiously. So how we treat animals can affect how others treat animals. This is especially true for vets. As a profession, we look to mirror what our colleagues to (indeed, that’s a basis of avoiding negligence in this country) and we have especial influence as authoritative role models for other people. This means we have enormous potential to influence – for good or bad.

One thing you raise which is interesting is the iatrogenic harm of hospitalisation. As vets we often assume that we are always helping animals. What sort of iatrogenic harms are common to many clinics and how to we ensure that we are aware of these as our practice develops?

Nearly all treatment causes some pain or fear. Most common iatrogenic harms are perfectly legitimate insofar as they are necessary to do good – the mild pinprick of a vaccination is needed to avoid the severe suffering of parvovirus infection etc.

It is easy to think of overtreatment as the big surgery but some overtreatment is from just doing slightly more tests than needed or asking for slightly more repeat consultations for an animal that hates coming to the vets. As vets we need to consider each individual animal – and, for example, decide how often to recheck a diabetic depending partly on its stress on coming to a vets (as well as how well it is doing on its glucose levels).
A puppy undergoes its first veterinary examination. This puppy was born with a (difficult to see in this photo) small hernia (easily repaired in surgery).
What is your impression about how responsive veterinarians are to positive animal welfare changes? 

All vets are keen to improve animal welfare. Often disagreement can be reduced to “philosophical” differences, eg sometimes we have different ideas about what is welfare or to psychology, eg some of us get defensive in public. Sometimes our philosophical points are ways to make our defensiveness sound more convincing! But I haven’t get met a vet who doesn’t care about animal welfare and, with the right discussions, is keen to make improvements. Then the main problem for vets trying to respond is owners who don’t respond…

You mention in the book that there is a possibility that reflection on welfare and education about welfare may be seen as more boring than surgery and medicine CE. Any ideas as to how that could be changed?

No clever ideas, really. Main thought is to make it as practical and non-theoretical as possible, but relating to the wider ideas. For example, we should
  • Drop the philosophical labels. Who cares really whether Kant or Hegel said something. Vets do love long words for medical conditions but not for metaethical theories.
  • Relate it to all cases, and ask students to actually make a decision.
  • Otherwise its just a matter of good teaching and using the range of methods – debates, role playing, case studies etc.

What changes would you like to see in relation to animal welfare in small animal practice in the future?

Greater recognition of it as a specialist subject, but that we all need to know something about as a central part of practice (like any veterinary specialty). Its not all “just a matter of opinion” or all “subjective” – there are ways to make better decisions.

Even hospitalisation can cause stress. Such iatrogenic "harms" can be minimised by providing a quiet, clean environment, soft bedding and a place to hide (esp for cats). Different wards or hospital areas for dogs, cats and exotic pets reduces stress (Phil simply posed in a cat ward here because I needed a photo. Hence he is looking at me with those "are you kidding?" eyes).
How can a single, ordinary veterinarian make a meaningful impact on animal welfare?
  • Enjoy doing the extra reflection and caring in day to day work
  • Try to improve welfare in the community – give free neutering, educational talks etc.
  • Use your veterinary authority to influence key people, not least your member of parliament and local authority.
Thank you James!

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