Perpetration-induced traumatic stress — A risk for veterinarians involved in the destruction of healthy animals

An article in this issue of the Journal (Whiting et al) describes operational logistics of mass killing of healthy, surplus to market, piglets. Our animal welfare team in Manitoba have, on a regular occasion, also experienced the need to deliver mass killing of large numbers of severely starved livestock and euthanasia to large numbers of companion animals, primarily unsocialized cats in hoarding situations (1). The killing of domestic animals is an unpleasant experience and recognized as a moral issue (2).

An accumulated body of research demonstrates that psychosocial health and the risk of suicide varies between occupational groups. The delivery of euthanasia and the negative effect it may have on the mental health of veterinarians and staff delivering humane killing has been a concern for many years (3,4). Recently, two rigorous systematic reviews on prevalence of suicide in veterinarians (5) and the prevalence of non-fatal suicidal behavior in veterinarians (6) have been published. The better quality research indicates that in the UK, the rate of suicide in the veterinary profession is at least three times the general population rate (5). Some studies suggest that young female veterinarians are at the greatest risk of negative mental health outcomes such as suicidal ideation, other mental health difficulties, and job dissatisfaction (6).

Post Traumatic Stress Disorder (PTSD) has entered the lexicon of the average North American citizen since the Vietnam war. A new variant, “Perpetration-Induced Traumatic Stress (PITS)” entered the scientific literature in 2002 when it was clearly identified that American veterans of the Vietnam war who actually killed humans or believed their actions resulted in human death, were significantly more likely to experience PTSD than matched individuals who had not directly participated in human killing but only witnessed such violence (7). This additional mental stress and negative mental health outcome, related to the actual perpetration of lethal violence have also been confirmed in veterans of the Iraq war (8).

Perpetration-Induced Traumatic Stress (PITS) has also been identified in individuals who participate in the killing of healthy animals (9). Rollin’s earlier description of “moral stress” in animal care workers where the job demands individuals to kill healthy animals is in many ways similar to PITS (10). Theoretical causal elements of PITS in veterinary work differs from classical PTSD in the fact that PTSD often occurs subsequent to a personal life-threatening experience; the life of the veterinarian is never directly threatened by the killing of animals, what is threatened is their identity as a veterinarian.

Many small animal practices refuse to euthanize healthy animals, or reluctantly provide the service for a variety of reasons (11). Most veterinarians would require significant neutralization techniques (moral justifications) to avoid the accusation of “occupational deviance” (12) if they were required to participate in the killing of thousands of healthy animals. In this current market collapse example, where several thousand piglets were killed; there were several recognized and articulated neutralization techniques (moral rationalizations) used by the organizers and participants: 1. The “defense of necessity;” no producer could afford to feed these pigs and predictably recover the cost of feed, killing the pigs avoided human financial injury; 2. “lack of viable alternatives,” there are no specific Government programs that provide aid for this particular situation. (Agriculture and Agri-food Canada oversees a comprehensive crop insurance program, but there is no livestock equivalent.); 3. The “denial of injury,” most of society concurs with the opinion that an animal killed humanely without suffering is not injured by killing (13), as is the case in humane slaughter of animals in the manufacturing of food for human consumption; 4. The “appeal to higher loyalties” was a strong justification framed in: “what responsible government would, by inaction, force a farmer to kill their own pigs, especially with the clear scientific evidence of risk of PITS, and in the current cases of global economic downturn, the farmer is not at fault for market collapse?” and, 5. The “denial of responsibility,” that is, the active choice to do nothing when assistance was sought, was not considered a viable option. For governments represented by their veterinary infrastructure to say this particular situation is an economic fluctuation and not a larger concern of society, would be an act that informed society would consider consistent with “bystander guilt” (14).

What came as a surprise to the participants, who both individually and collectively had many years of abattoir and animal welfare disaster experience, was that all the rational justifications and, the firm belief that this “dirty work” (15) had to be done, was not sufficient to prevent significant mental health challenges to some perpetrators. One member of our team experienced hospitalization and a period of sick leave associated DSM IV Criteria for major depressive episode (16) in temporal association with this and an additional animal welfare case of pig starvation requiring the humane killing by free bullet of about 400 emaciated market pigs.

The eradication of foreign animal disease (FAD) is often framed in government policy decisions and in the media as a “war” (17) and the war metaphor justifies the use of violent means to achieve victory. In 2010 the small province of Manitoba with just over 1 million people, exported 3 494 196 live pigs to the United States, which was significantly down from a peak of 6 146 465 live pigs exported in 2007 (18).

An outbreak of foot-and-mouth disease (FAD) or hog cholera in North America would undoubtedly trigger the immediate closure of the US-Canada border. This immediate border closure would result in an immediate requirement in Manitoba alone, to humanely kill about 10 000 pigs/day, 7 days a week at the 2010 production level. Border closure results in limited alternate housing options and no future market for the pork. This surplus animal killing would be in addition to the contemporaneous pigs scheduled for slaughter in Manitoba and intended for export as pork. No export market would exist for Canadian pigs post-FAD declaration. Although this inevitability has been widely identified in the scientific literature (19–21), currently it is not considered in any national animal emergency programs of Canada or the USA.

It may be appropriate that the veterinary profession itself plan for a foreign animal disease incursion into Canada or a similar event such as the closing of the US-Canada border to live animal trade. The Canadian Veterinary Reserve (CVR) would most certainly be mobilized in this type of situation, even though it is still a relatively young entity. Current CVR training is limited to the mandate of the Canadian Food Inspection Agency of identifying and controlling infected animals, and does not include welfare slaughter. Active preemptive planning would hopefully mitigate the injury to the profession of such a disaster.

The Canadian veterinary profession has taken a societal lead in promoting the welfare of animals and we will not be a by-stander in any disaster involving animals.

Known or highly probable negative impacts of a national or provincial farm animal movement restriction or closure of the US border to live animal movement on the veterinary profession will be loss of income to rural practices, alienation of our farm clients, loss of societal status as a profession (for although we will be held accountable for the humane destruction of animals, society and the media will also assign some culpability and stigma to this dirty work), and finally, individual members will probably leave the profession or otherwise suffer from complications related to PITS. Evidence to support this is scant in the English literature, perhaps because of the residual stigma associated with mental illness. There are reports of PTSD, and other mental ill health in farmers post FMD crisis of 2001 (22,23). Veterinary mental health subsequent to an FAD incursion has been more openly discussed in the Dutch veterinary literature (24,25).

For veterinarians currently working in animal welfare enforcement and shelter medicine, research has shown only limited efficacy of debriefing, and peer support as a stress management tool for first responders. Recently various forms of resilience training have demonstrated much better efficacy in stress management and in maintaining professional skill delivery in street level policing (26). It is unclear how we could assist veterinarians to be more resilient to the negative effects of delivering humane killing of livestock and euthanasia of companion species in times of animal management crisis. Identifying that there is a problem is a good place to start in looking for a solution.