Drawing the line in clinical treatment of companion animals: recommendations from an ethics working party
Grimm, H. et al. (2018) Drawing the line in clinical treatment of companion animals: recommendations from an ethics working party. Veterinary Record, 182 (23), p. 664
Technological developments, the increasing range of treatment options available in companion animal medicine and the owner’s willingness to pay for treatment mean that veterinary surgeons are regularly confronted with ethical challenges when treating their patients.
This paper describes the research and recommendations of a working party of the European College of Veterinary Anaesthesia and Analgesia (ECVAA) set up to discuss these issues. The working party, which was made up of six experts in the field, considered the available literature, explored the issues of veterinary ethics in companion animal medicine, and the options for dealing with ethically challenging cases via a series of open question discussions carried out by telephone, email and face-to-face. Following on from this the working party developed a list of core ethical problems and identified the key stakeholders and criteria in ethical decision making within companion animal practice.
The working party identified the principal of acting ‘in the animal’s best interest’ as the moral foundation of ethical decision making which could be expressed in two norms: (1) to restore the animal’s health and (2) to respect the animal’s quality of life (QOL). The relationship between these two norms is where the justification for treatment lies.
The motivations for the behaviour of the key stakeholders was considered; from this, a set of questions was developed to help explore the relationships between the various stakeholders.
A prototype veterinary ethical tool (VET) was created by the working party to help practitioners incorporate clinical ethical decision making in their day-to-day work and to facilitate discussions in this area within the veterinary team.
The VET framework consists of a set of analytical questions exploring the relationships, and corresponding factors, for consideration in the clinical ethical decision-making process. The framework gives practical guidance to veterinary clinicians on how to draw the line on treatment for companion animals. It is hoped that the framework will help veterinary clinicians determine whether the motivation behind the clinical decision is in the ‘best interest of the patient’ (justifications) or based on secondary factors which lack moral justification (explanations). A clinical decision based primarily on ‘explanations’ without a focus on patient-centred factors is questionable and loses its moral justification. Explanations can influence decisions but should not have priority over the justifications.
A study to assess the usefulness of VET in the clinical setting is in development.
Limitations of this paper are the small number involved in the working party, and the fact that the recommendations are primarily based on their experience and views.
The VET framework could potentially be a useful tool in enabling veterinary professionals to take account of all the relevant issues when deciding on a course of treatment in companion animal practice. Work to validate its use in a clinical setting is encouraged.