Ethically challenging situations for veterinarians, veterinary nurses and animal health technicians due to the Covid-19 pandemic

The Covid-19 pandemic has raised additional and perhaps unforeseen ethically challenging situations for veterinary team members. Illustration (c) Sally Pope, spediting. 

The Covid-19 pandemic has raised additional and perhaps unforeseen ethically challenging situations (ECS) for those working in veterinary clinical settings. 

As part of my PhD study, I am conducting a survey to determine the frequency, stressfulness and nature of these ethical challenges.

The survey is open to veterinarians, animal health technicians and veterinary nurses around the world who are over the age of 18. It will take 15-20 minutes to complete.

To read the participant information statement and complete the survey, please copy and paste the following link into your browser: https://redcap.sydney.edu.au/surveys/?s=KDFEFHCKX3

This is an anonymous survey. You are welcome to share the link with colleagues anywhere in the world.

For further information about this study, contact Anne Fawcett: anne.fawcett [AT] sydney.edu.au

The survey will remain open until July 13, 2020.

My colleague and friend Sally Pope drew the above depiction of companion animal practice during the Covid-19 era. When she isn't drawing (she is a ridiculously talented artist) she is editing academic writing. 

George meets home schooling, updates on Covid-19 for vets and VALE Michele Cotton.

When George met home schooling...he was highlighted. (Courtesy of a colleague who, on top of being an incredible vet has had to learn how to home school).

Life is already challenging, but it seems like the Covid-19 pandemic has challenged everyone simultaneously. 

Among the most stressed are colleagues with elderly family members, and those who have been saddled – on top of everything else – with the responsibility of home-schooling kids. My brother, a human nurse, is one among those peeps. His family lives interstate, so there’s no chance to visit and help out and I am told that babysitting by Zoom isn’t a goer.

A drawing from an SAT reader. I especially love the depiction of Hero with his missing forelimb. I don't want to say too much but I think that I need to re-read The Trainable Cat this week.

Other colleagues have had to put their research on hold because of university shut-downs and social distancing measures. Colleagues in Italy and the UK are finding life especially tough at the moment, with very limited supplies of PPE. Two Italian colleagues have been diverted into human healthcare, so that is really happening. 

Last week we heard a little more about cats and Covid-19. For those who missed it, Mighty Vet streamed a webinar featuring feline infectious disease expert Professor Mike Lappin, which you can watch here. 

Dr Angela Willemsen, aka “The Clean Vet”, discussed her research on infection control in veterinary hospitals and provided some excellent tips. This is available on the Australian Veterinary Association’s coronavirus page.

One of the projects I am working on is a webinar for veterinary team members on ethical challenges for veterinary teams in the Covid-19 era. There are significant animal welfare implications associated with shut downs and movement restrictions, as well as issues relating to scarcity of resources and private vs professional interests, that are the source of much debate and moral stress. I am very interested in hearing anyone’s thoughts or experiences relating to these issues.

The webinar is being hosted by the Centre for Veterinary Education and is free to attend. For more info or to enrol visit this page.

In non-Covid-19 related news (and there is such a thing), earlier this year we lost an amazing colleague. She lived a remarkable and inspiring life, beautifully celebrated in a recent obituary published in the Sydney Morning Herald and written by two remarkable veterinarians, Jennie Churchill and Sandra Steele. Read here. It contains some incredible photos and is really a beautiful read.

Our veterinary ethics book is out

Veterinary Ethics: Navigating Tough Cases.

Veterinary practice can be confronting. There are life and death decisions to be made. The question of just because we can, does it mean we should is raised frequently. The fact that our patients never consent to invasive procedures. And the potential for conflict between the interests of the owner, the animal or animals, the vet and even their employer.

I am also very grateful to colleagues, friends and family whose animals are pictured in the book (with names changed).

For several years I had the privilege of working with Dr Siobhan Mullan, from the University of Bristol, and collaborators from around the world, on a textbook of veterinary ethics. This is for vets, vet students, nurses and those who work with animals. It is published by 5M.

Ellie May poses with the book.

There were many late nights, early mornings, two international meetings and some awesome typesetting involved, as well as support from a lot of colleagues. It was a major effort on the part of many people, and the final product weighs almost as much as Phil.

VETtalk Online interviewed me about the book, and you can watch the two-part interview here.

Part One.

Part Two.

Copies can be ordered via Amazon. 

Animal welfare science, ethics &law and behaviour conferences

I fell in love with this sculpture/ornament when I visited a colleague.

Today we’d like to share some fantastic opportunities for veterinarians and non-veterinarians to extend their knowledge about animal welfare and behaviour. We can always learn more!

If you’re heading to the UK later this year, or you’re able to do so, you can undertake a range of face to face courses on Animal Welfare Science, Ethics and Law at St Catharine’s College Cambridge, between September 10 and 22.

The courses include

• Welfare concepts and assessment, and zoo animal welfare (Sept 10-12)
• Law and companion animal and horse welfare (13-16 Sept)
• Principles of ethics in relation to animal use (18-20 Sept)
• Farm animal welfare (21-22 Sept).

For info visit www.cawsel.com

Human Behaviour Change for animals for animals is running several workshops in the UK for those who will be there over the next few months.

Please visit the website for details. 

Closer to home, the Delta Institute is hosting its Dog Behaviour Conference in Sydney from 7-9 April.

The Conference Consists of Two Programs:

Friday evening program: 'From a Dog's Point of Nose' with Dr Alexandra Horowitz - understanding and appreciating the dog's point of view.  

Who should attend?  Dog owners and anyone interested in the latest research on dog behaviour and perception.  
Two day weekend program (Saturday & Sunday): Hosted by comedian Kitty Flanagan and featuring Alexandra, as well as intensive presentations, interactive discussions and special guest speakers, this is not to be missed.  For the full agenda please click HERE.

Who should attend?  This program is intended for dog trainers, pet industry professionals, local and state government bodies and anyone interested in a deeper understanding of the latest research into dog behaviour, training and the importance to society of the human-animal bond.

Finally, if you’re interested in the topic of animal ethics, I’ve been working on a project for several years with Dr Siobhan Mullan and a team of incredible contributors. This has resulted in a textbook of veterinary ethics which you can now pre-order here.

What do clients think of consent forms in veterinary practice?

Getting consent in veterinary practice can be tricky for a number of reasons. Cartoon by Aileen Devine, conceived by Anne Fawcett.

Have you ever signed a consent form? Do you read the fine print? Do you feel like you’re signing over your rights? What goes through the mind of veterinary clients when they sign a consent form? These are really important questions to ask, and UK veterinarians have done just that.

Martin Whiting and colleagues surveyed 470 clients from the Queen Mother Hospital for Animals about the consent process and the findings are surprising.

To backtrack slightly, informed consent in medicine is a concept that was developed to ensure that patients have autonomous choice, and to protect their interests. In veterinary medicine consent is never obtained from the patient (another can of worms that I’m working on a paper about at the moment), but 

from the owner/guardian or client.

It usually also includes agreement about expected costs.

When asked about signing consent forms, most clients recalled signing forms (records indicated that 100 per cent signed a consent form – this was an inclusion criteria for the study).

But the majority of these found the process disempowering – the opposite of what it’s meant to be.

More than half did not read the form – 60 per cent “trusted their veterinarian”.

Most (71 per cent) felt that the consent process explained the proposed procedure/procedures in a way they could understand, and 77 per cent felt they could understand potential risks. Yet 33 per cent felt frightened by the process.

Only 15 per cent felt in control of their choices. Half (51 per cent) did not feel in control, nor reassured (51 per cent) by the consenting process.

Almost half (45 per cent) believed that consenting removed their right to compensation for negligence, while 31 per cent felt the veterinarian could do something different from the agreed procedure anyway.  More than one third of clients did not realise that they could change their mind. And 7 per cent did not understand what the consent form meant.

These findings are interesting. It’s not known whether similar findings apply in a general practice setting – animals attending referral hospitals like the Queen Mother Hospital for Animals may be undergoing advanced, invasive or higher risk procedures. The authors indicate that they may undertake further studies to determine if this is the case.

What can be done?

The study found that it wasn’t about time – 96 per cent of clients were satisfied with the amount of time offered to consider a procedure before consenting.

But better communication may be helpful. For example, some people dismissed the form as a standard agreement and therefore didn’t read it, others were too worried to read the form (suggesting scope to address further concerns), and some just preferred to listen to the vet’s explanation. The study found that clients want to hear about a few treatment options, risks of procedures and treatment, prognosis and an estimate of fees. They want the opportunity to ask questions about the treatment, and they want to be talked through the aftercare.

From a client’s point of view, what might help the process? Asking for more time to consider a process if needed, getting a second opinion (not always possible in the case of emergencies but possible for some procedures), and telling the vet what you are most concerned about (is it the anaesthetic? Is it the procedure itself? Do you feel that there’s something else you would like the vet to look at before proceeding? Is it the recovery or post-operative care?). As a consumer of health care services (including veterinary services) myself, I want to know as much about potential risks and benefits that the vet can impart, and I seek out a clinician who seems to genuinely care.

As the authors suggest, perhaps we also need two different consent forms – one regarding a fee estimate, and another regarding procedures. By combining the two, some clients may feel that the consent form is simply an instrument that the hospital uses to ensure it gets paid, i.e. to protect its own interests. By signing two different forms, it may be clearer that consent to procedures is about ensuring informed consent and protecting the interests of the client/patient. Of course, additional forms increase administrative load and may not be favourably perceived by clients.

It would be really interesting to find out and compare vet’s perceptions of the consent process.

You can read the paper here. 

Reference

Whiting M, Alexander A, Habiba M & Volk HA (2017) Survey of veterinary clients’ perceptions of informed consent at a referral hospital. Veterinary Record January 7, doi 10.1136/vr104039

Professor Bernard Rollin on the ethics of animal use

Bernard Rollin's newest book, A New Basis for Animal Ethics: Telos and Common Sense, set against a fantastic feature wall (alas, not mine).

When one considers the staggering amount of unnecessary suffering experienced by animals in all the multifarious uses we impose upon them, it is virtually impossible to remain unmoved” – Bernard Rollin, 2016.

There is no question that our society is predicated on animal use which is almost impossible to escape. The food we eat, the clothing we wear, the medications we rely on, are based to a large extent on animals. For philosopher and ethicist Bernard Rollin, the problem is not with animal use per se but the suffering that this causes in various contexts.

He's not the only person to raise concerns about the use of animals. Others like Peter Singer have argued that we have a moral duty to minimise (or eliminate, where possible) suffering. This reflects a utilitarian approach – seeking to maximise good, or pleasure, and minimise pain. Then there are people like Tom Regan who take a rights-based approach, arguing that we should respect the rights of animals just as we have learned to respect the rights of other groups in society, for example women.

Many ethicists get caught up in a debate about whether there are morally relevant differences between people and animals, which may or may not “compel us to withhold the full range of our moral machinery from animals,” Rollin writes in his latest book, A New Basis for Animal Ethics: Telos and Common Sense.

What we need to pay attention to, he argues, is the telos or nature of animals.

“As Aristotle pointed out, living beings have unique strategies for solving the problems inherent in living – sensing, moving, reproducing, nourishing themselves – the thwarting of which matters to them…Telos allows us to talk of animal interests…well beyond the narrow restrictions of pleasure and pain. In addition, it provides an excellent shield against the sorts of rationalisations that confinement agriculturalists, in particular, have given in defence of keeping animals in highly restrictive and impoverished environments. They tend to argue that in confinement systems, animals do not need to worry about finding food, extremes of climate, predators – all needs are supplied by the system. While there is certainly some truth in this argument, it neglects the fact that animals are built to, for example, find food in certain ways.” p55

According to Rollin, then, animals have needs and desires which flow from their natures or teloi, which – when thwarted, frustrated or unmet – lead to negative feelings or the experience of poor welfare.

Acceptable systems of animal use, Rollin argues, must accommodate the telos of the animals involved. In other words, to have a life worth living, animals must be able to express the full suite of natural behaviours. Rollin’s arguments are compelling and his examples – drawn from decades working with veterinarians and others trying to improve the lot of animals in contexts ranging from laboratory animal medicine to agriculture – are fascinating.

My interpretation is that Rollin calls for a return to more extensive, traditional husbandry systems (as opposed to intensive agriculture) and – where the benefits of experimentation are shown to outweigh the costs – laboratory animal housing that accommodates the specific needs of species and individuals involved. He doesn’t really discuss companion animals, but he does talk about domestication. He argues that domestication and in fact genetic engineering do not violate telos, because it is not the nature of animals that is sacred and inviolable – rather the interests flowing from it.

As he writes, “It is a better world in which husbandry and sustainability reign over productivity and profit at all costs. The animals live decent, natural lives. Animal welfare is integral to the system, not an afterthought to be politically imposed” (p128).

Though he concedes this will be challenging, Rollin argues we don’t have much choice.

“…we must consider that industrial agriculture is very likely living on borrowed time, not being inherently sustainable. If, for example, we lose cheap energy, the whole system collapses” (p129).

Rollin’s approach relies on us to observe, recognise, respect and protect the interests of animals. If we are going to use animals for our own ends, he argues, we must ensure they have a “good” life.

This book provides a good overview of Rollin’s work, a fascinating history of animal welfare science and the animal rights movement, and a good discussion of some of the limitations of traditional ethical approaches. Like all philosophy books, it raises many questions, including how we legislate protection of telos.

Definitely a must-read for those who are interested in the ethics of animal use.

Reference

Rollin BE (2016) A New Basis for Animal Ethics: Telos and Common Sense. University of Missouri Press, Columbia.