Why ethical debates are necessary

THIS article aims to give an introduction to veterinary and animal ethics and will try to explain its relevance today. As animal advocates, it is of paramount importance that any professional working with animals is familiar with exigent aspects of this challenging melting pot of differing thoughts and principles, widely relating to matters of morality and philosophy. In a series of articles, I will look into issues of veterinary and animal ethics of interest to the veterinary professional, and give examples of ethical dilemmas that may be encountered on a daily basis. Challenging cases in veterinary medical ethics and how best to resolve them will also be presented and discussed. Because veterinary (medical) ethics is concerned with all aspects of animal issues, excursions into topics of animal rights, animal welfare and their respective philosophical backgrounds relating to these closely related subjects are necessary, and will be touched upon for a better understanding of the relevant issues.

14 POINT-OF-VIEW ETHICS

Veterinary Times

FRANK BUSCH
PhD, MRCVS

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examines the ethical conflicts inherent to the profession in the first of a series of articles
publicised, and more journals are willing to devote column space to debating these issues, many of which continue to be controversial and are yet to be fully answered. In this and forthcoming articles, a discussion of the differing ideas and viewpoints surrounding animals and, consequently, the treatments they receive is not only intended to explore and improve animal understanding and, consequently, animal welfare, but also aim to increase the understanding of philosophical matters that impact on the moral and ethical values on display in our society. Having become almost fashionable, ethical topics have sprung up everywhere in journalism. Ethics, our moral points of view, are constantly changing. Not only have ethical issues and products become big business, but it is also en vogue to be socially conscious. What is called by Fairtrade Foundation director Harriet Lamb a social phenomenon and here to stay1, is merely one account of societies constant change of thought and action boycotts of companies because of consumers concerns about sweatshop labour or animal welfare are rising all the time (Hall, 2006). In line with a power-tothe-people mindset are other

Ethical issues seem to come up more and more these days how do they affect the veterinary community and its working practices, and can one lie to save an animal?

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examples of fairly recent social changes, such as the continued rise of public suspicion of science and technology, and the demand for green-fingered politics, coupled with the acceptance of environmentalism and mass questioning of animal use in science and industry. As a society, other social concerns are reflected by societal changes of attitudes. What has been accepted or not been questioned in the past possibly because it had not been in the public domain may not be acceptable today, and is now under scrutiny. As we have recently marked the bicentenary of the abolition of the slave trade, we should be reminded that the driving force behind Wilberforce and other anti-slave trade campaigners was not only their religious beliefs (they often saw their personal battle against slavery as a divinely ordained crusade), but also their conviction that slavery was immoral and a blight upon humanity. Even DirectGov, the website of the UK Government, explicitly mentions morality by remarking that: The 1807 Act marked an important point in this countrys development towards the nation it is today a critical step into the modern world and into a new, and more just, moral universe, (DirectGov, 2007). The general application of ethics in veterinary medicine is to define a code of conduct for our professional activities. The issue of animal rights, for example, has questioned not our professional conduct as vets, but also our personal value system as it relates to animals. As the

veterinary profession covers a Rollin (1978, 1981) calls the full spectrum of animal uses, from fundamental question of vetpets to the livestock industry, it erinary ethics to whom does is unavoidable that, at points, the veterinarian owe primary an animal rights philosophy may obligation: the animal or the come into direct conflict with owner? Are animals moral our charge as veterinarians that objects in themselves or are of care providers and animal they of moral concern only as welfare proponents. someones animals? Another main issue is the Another stumbling block is the mandate for moral concern for lack of a clear consensus about living things and how to deter- how society values animals in mine the moral obligation we general. Arkow (1998) comhave to living things through ments that the status of animals some assessment of the moral is inconsistent and remarks that: status of the animal concerned. Some are doted upon and The need to balance patient spared no expense by their care and welfare, client needs owners. Some are abandoned and means, public protection by owners and by society and and welfare, and will be euthanised self interest, try- Are animals moral in animal shelters. ing to avoid what Some are highly objects in themselves Rollin (1986) calls prized economic moral stress2, is or are they of moral investments. And concern only as a complex process some will wind and requires con- someones animals? up on someones stant discussion, dinner plate. As a not only within, but also outside, result, veterinarians frequently the veterinary profession. find their values conflicting with others who also care about Unresolved issues animal well-being. In short, ethical debates are Other questions that divide necessary because there are still opinions include: too many unresolved issues that l Can one lie to a client to save impact directly, and all too often an animal? negatively, on animals we swore l Do animals have an intrinsic an oath to protect. value? These issues will not go away, l Are all animals equal? unless each and every individual l Are animals sentient? working professionally with and l Is it better to have a painful life for animals has gone through or no life at all? some active detailed analysis of l Should one support or be the problems at hand. Unre- involved in activities such as greysolved issues, such as those hound or horse racing, which surrounding convenience eutha- may cause animal suffering? nasia, will undoubtedly impact on l Like all other animal advocates, practitioners daily performance shouldnt veterinary professionals and quality of life. play a role in raising the moral Another issue at hand is what status of animals?

Table 1. Distinction of Ethics I and Ethics II (after Rollin, 2006)

Ethics I Moral rules that one believes ought to bind society or oneself; a set of principles that governs peoples views of right and wrong, good or bad, fair and unfair and just and unjust. Social ethic, personal ethic and professional ethic. Ethics II The logical, rational study and examination of Ethics I. Ethics II is a branch of philosophy.

Definition

Further distinction and explanation

Attempting to justify the principles of Ethics I; seeking out inconsistencies in the principles of Ethics I.

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February 4, 2008
What roles are practice team members to play in raising the moral status of animals, and what input are they allowed to have in the process?3 l Are we able to identify the most pressing current social concern about animals and animal treatment? l Arent we confused by the individual values we assign to life, suffering and science? l What are the current social attitudes towards animals, in the context of modernisation and technology? l What is the moral status of animals other than humans? What roles do animals play in human society?4 l What role should, and can, veterinarians play with regard to humane education and humane understanding of the animal world? l Does every practitioner truly understand the intricacies of the human-animal bond? Although important questions such as these will be addressed within this series, it is disheartening that these issues are not sufficiently debated at university level. Is the veterinary nurse, the veterinary student or the practitioner to acquire such knowledge on a learning by doing basis?5 Arkow (1986) points out that it is becoming increasingly imperative that veterinarians not only apply ethics especially as they impact on animal welfare to their practices, but that they also assume leadership roles and take the moral high ground proactively, rather than respond defensively to pressing social concerns. The veterinary profession continues to be increasingly drawn into ethical debates as society explores, and redefines, many of its values regarding animals. Arkow also says a failure to debate these issues as animal advocates will damage the veterinarians credibility in society. The emerging social consensus ethic is concerned with ensuring that the animals we use live decent and happy lives hence, as vets, we are well placed to take the lead on animal welfare and animal rights issues as well.
l

POINT-OF-VIEW ETHICS 15
he calls Ethics I) and Ethics II. Eth- erinarians face unique dilemmas ics I is defined by Rollin as a set of with few comparative analogies principles that governs peoples in human medicine. views of right and wrong, good This is particularly true with and bad, fair and unfair, and just regard to the widespread and unjust. Ethics necessity for II, on the other Compared to the animal euthanhand, is defined asia. It may be as examining the standards in some a r g u e d t h a t logic of Ethics I, veterinary schools implementation of which includes ethical principles in the USA, the important quesis easier in human UK efforts seem tions as to medicine than whether all socie- wholly insufficient. i n v e t e r i n a r y ties ought to have medicine, because the same Ethics I and, hence, human medicine assumes that all branches very much into the human life is equally valuable. realm of philosophy (Table I). However, in comparison, the Rollin (2006) comments that physician, confronted by distresswhereas we in society learn ing ethical dilemmas in human Ethics I from parents, teachers, medicine, is frequently guided churches, movies, books, peers, by externally imposed guidelines magazines, newspapers and (laws), which dictate what is mass media, we rarely learn to culturally acceptable. engage in Ethics II. Rollin is of To date, the legal obligations the opinion that, as a general of veterinarians are rarely as rule, veterinarians are ill-prepared to confront ethical debates and adds that the practitioner may be excused if he or she finds moral dilemmas uncomfortably troubling. Trained first in science, veterinarians may be frustrated by philosophical questions which are not amenable to empirical resolution (Rollin, 1991). He adds that as business owners, veterinarians may believe there is little economic pay-off in basing decisions solely on issues of morality. codified as are those of human health care professionals (Rosenberg, 1990). As already mentioned, euthanasia raises disturbing questions regarding the value of life, the freedom of choice, and the nature of trust among patient, practitioner and client. When all these moral values are integrated, an extremely complex model emerges (Quackenbush, 1988). Veterinary medicine is unique in that it has twin heritages of medicine and agriculture (Loew, 1992). The former has an ethical basis representing the patient; the latter has an economic purpose and represents the client. This dualism inevitably leads to misunderstandings by those outside the profession and conflicts of interest for those within. As an example, Arkow (1986) asks us to consider a common sceFRANK BUSCH currently works in mixed practice. Frank has a predominantly small animal background and his main interests are physiotherapy, acupuncture and animal welfare. He primarily writes on veterinary ethics and animal assisted therapy.

nario from small animal practice. A client asks the veterinarian to euthanise a physically healthy dog for the sake of the owners convenience. Perhaps the client lacks the patience to solve the dogs behavioural problem; perhaps the client is moving and cannot find new housing that will accept the animal. For the veterinarian to satisfy

the clients needs demeans the patients interests to protect the patient risks losing the client. The veterinarian is in conflict. To euthanise the animal, for arguments sake, is justifiable, but to do so accepts four uncomfortable premises: l that the dog has no inherent right to live;
continued overleaf

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Training
As students, veterinarians have traditionally received little or no formal training in resolving veterinary ethical dilemmas, although teaching ethics and welfare at some veterinary schools, such as Glasgow and Liverpool, seems to be on the horizon (Teaching ethics and welfare, The Veterinary Record, May 26, 2007). Compared to the standards in some veterinary schools in the USA, the UK efforts seem wholly insufficient. For example, students at the Cummings School of Veterinary Medicine at Tufts University are expected to study ethics in their first year with a mandatory course in human-animal relations. Formal instruction in professional ethics begins with their third year with the compulsory course, Jurisprudence and Ethics. The school states that the combination of law and ethics has encouraged students to consider ethical questions inherent in legal ones, and vice versa. In their fourth year, all students must present an ethics case as part of their clinical work in small animal medicine. The students select a case that they themselves have handled or observed, and present a case work-up similar to the required report of a medical case. An oral presentation is also undertaken. Students are taught to realise early on that ethics is not apart from medicine but is, in fact, intertwined with daily practice6. As medical practitioners, vet-

Theoretical framework
Ethics is the study of moral issues (Broom, 2006), the practical application into daily living of those beliefs that we strongly value as individuals and as a culture. Whereas Tannenbaum (1995) differentiates between normative veterinary ethics (what should I do?), descriptive veterinary ethics (what do other practitioners think ought to be done?), administrative veterinary ethics (what does the government body think is appropriate?) and official veterinary ethics (what does the organised profession think is appropriate?), Rollin (2006) makes a distinction between social, personal and professional ethics (which encompasses what

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16 POINT-OF-VIEW ETHICS
n WHY
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Veterinary Times
fessional ethics and states that this responsibility would fall upon the RCVS10. However, a search conducted on the RCVS website returns no useful information or links to resources in veterinary or professional ethics, and a search for ethics on the BSAVA website returns no results. It is hoped that these omissions will be urgently addressed. l A full reference list will be published with the final article in this series. However, comprehensive details of references from this article are available by contacting the editor.
Footnotes 1. The Fairtrade Foundation says British sales rose by 46 per cent last year to 290m (www.telegraph. co.uk/money/main.jhtml?xml=/ money/2006/02/12/ccfash12.xml, last accessed on 13/08/2007). 2. Rollin (1986) distinguishes between professional/occupational stress and moral stress. He comments that: The stress and pain of killing healthy animals (or being asked to kill them even if one refuses to do so) is, in my experience, the most demoralising part of companion animal practice I have called it moral stress because it arises out of a fundamental conflict between ones reasons for going into animal work and what one is in fact doing or being asked to do. 3. This is a particularly important point, not only for busy veterinary hospitals where support staff often are left in limbo as to which veteri-

ETHICAL DEBATES ARE NECESSARY from page 15

tioned euthanasia conflict is there a right or wrong way to deal with this admittedly simplistic scenario? It is troubling that the profession is undivided on the issue 7 and that there are no guidelines for the veterinary practitioner whatsoever. Especially for new graduates, this scenario must be overwhelming (bearing in mind that in a busy practice, support on these issues may not always available) and, ultimately, will lead to moral stress8. There is a pressing need for guidelines and, ideally, a legal framework concerning these and other troublesome ethical dilemmas faced by veterinarians on a daily basis. The BMA, for example, has a medical ethics department, which advises BMA committees on medicoethical issues and offers guidance9. The BVA, at least, has the Ethics and Welfare Group for its members to access (for nonmembers and members of the public, a search on the BVA website returns no results). The BVA states that the committee considers the ethical issues relating to societys use of animals. It prioritises the issues that the profession should address and recommends policy developments where necessary. It stresses that it is not concerned with pro-

that the client is an owner with an incontrovertible right to dictate what to do with his or her property; l that the most expedient way to resolve an inconvenience is to eliminate it, rather than to solve the problem and prevent it from recurring; and l that the veterinarian is obliged to follow the exact instructions of the client. Obviously, there are solutions other than euthanasia. Obedience training or educational interventions can teach the client to correct the animals behaviour. Assistance can be secured to help the client and the patient with the move. Adoption services can be arranged and, finally as we all know too well many animals that were destined to be destroyed due to owner ignorance, short sightedness, or just a cannot-be-bothered attitude, often find a new home with a compassionate member of staff. But back to the above-men-

What is more important? The clients wishes, or the welfare of the patient?

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nary surgeon is responsible for which patient, the result being that, all too often, care plans have not been issued to veterinary nurses, which in turns impacts negatively or even catastrophically on the care (and/or welfare) of the animal. Also, what role should the veterinary nurse play in voicing concerns on behalf of the animal? Should nurses or colleagues accept instructions from a colleague, for example, as to withhold water from a patient for a great length of time?Is it ethical and/or essential to conduct, for example, the water deprivation test? 4. In Poetic Animals and Animal Souls Malamud refers to contemporary western society as the box, suggesting it is a neatly packaged, pleasingly wrapped set of assumptions about humans and animals in particular. In the content of societys box, humans are central to everything. Everything outside the box (animals, wilderness, cultures with other stories) is considered empty of value.

5. The author recognises that at least two universities in England, courses in ethics (often taught in combination with animal welfare) either have been or are about to be introduced see discussion within the theoretical framework chapter. 6. www.tufts.edu/vet/signature/ ethics.html (last accessed 10.10.2007). 7. At the moment, it is at the discretion of the veterinarian confronted with the issue. He or she will make a decision based on personal experience and personal moral values. At the moment society still respects our (personal) judgement as professionals. If a veterinarian performs convenience euthanasia, he or she will go unpunished because the veterinarian acts outside any legal framework. In comparison, punishment for killing a protected species often results in imprisonment. 8. See footnote two. 9. The BMA produces reports, codes of practice and discussion documents

on topical and often controversial issues. These include genetic technology, euthanasia, and organ donation. The Medical Ethics Committee debates issues of principle in medical ethics, medical law, ethical matters concerning the relationship between the medical profession, the public and the state. The committee comprises 18 members doctors, philosophers, lawyers, theologians and lay people. It debates issues of principle in medical ethics, medical law, ethical matters concerning the relationship between the medical profession, the public and the state. The Medical Ethics Department answers ethical enquiries from doctors and produces guidelines and books. Enquiries from members of the public or press are handled by the public affairs department. www.bma. org.uk/ap.nsf/Content/LIBEthics?Ope nDocument&Highlight=2,ethics (last accessed 10.10.2007). 10. www.bva.co.uk/members/committees/ethics.asp (last accessed 10.10.2007). n

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