Conceptualization of convenience euthanasia as an ethical dilemma for veterinarians in Quebec

Abstract

Companion animal welfare in our society has become increasingly important, yet many healthy animals are euthanized in veterinary facilities. How is it possible to explain the simultaneous presence of these opposing views of obligation toward animals? The goal of this study was to describe convenience euthanasia of companion animals as experienced by veterinarians in order to understand their thought processes. A qualitative study was undertaken to analyze the results of interviews of 14 veterinarians. The study showed that veterinarians interviewed assessed convenience euthanasia based mainly on their subjective evaluation of the owner-animal bond. As most owner-animal bonds stem from an anthropocentric point of view, decisions on convenience euthanasia were taken mostly by considering the veterinarian’s and the client/owner’s interests.

Introduction

Ethical dilemmas in the practice of veterinary medicine represent a situation in which 2 or more values are in conflict and a decision is difficult to make (1,2). Core values are associated with perception of actions toward animals particularly in cases of convenience euthanasia (defined as euthanasia of a physically and psychologically healthy animal) (3). Two models have been described in the literature, the anthropocentric- biocentric model and the pediatrician-mechanic model (1,4). In the anthropocentric model, the animal is fundamentally described by the owner-animal bond. The interests and needs of animals are not directly taken into consideration. In fact, an animal has to belong to a caring human in order to receive attention for its specific interests and needs. This last point illustrates the importance of the owner-animal bond. Rollin’s garage mechanic model (4) similarly describes the service orientation of the veterinarian to his client. In the biocentric model, animals are viewed as moral beings just like humans. Animals are described as complete entities and the interests and needs of the animal are then considered a priority. The biocentric vision of animals shows an egalitarian position between the interests and needs of animals and humans. Veterinarians perceiving animals in a biocentric model tend to act like pediatricians (4). Veterinarians are no longer neutral professional service providers. They are medical professionals acting as advocates to protect their patients.

The present study focused on the animal’s status in veterinary medicine as well as the moral duties of veterinarians toward animals. The role and consideration of each major stakeholder (owner, veterinarian, animal) regarding decisions about convenience euthanasia are core elements necessary for a better understanding of the dilemma. To date, there is little published on the topic (5–7). The Quebec licensing body for veterinarians (OMVQ: RLRQ c M-8, r 4) clearly defines and regulates duties concerning physical suffering and methods of euthanasia based on species (8). Unfortunately, moral duties of veterinarians with regard to convenience euthanasia are not clearly defined within the profession even though the American Veterinary Medical Association (AVMA) has published euthanasia guidelines (8). The most recent version (2013) now includes an algorithm to evaluate the morality of the decision. If animals belong to the sphere of moral beings as described by several authors (4,9,10) and the animal is taken into consideration, what thought processes do veterinarians rely on to make daily decisions regarding convenience euthanasia? In order to answer this question, a qualitative study on the subject of convenience euthanasia was undertaken. The goal of this study was to describe convenience euthanasia of companion animals as experienced by veterinarians.

Materials and methods

Methodological approach

A qualitative methodology (inductive approach) was best suited to obtain the most data. Semi-structured interviews of veterinarians were conducted to explore their perspective in depth. The interviews consisted of open-ended questions followed by a scheduled period of discussion on convenience euthanasia. The interview questions are available from the first author on request. The interview guide was pre-tested and no modification was necessary. This method allowed an exploration of the issues at the heart of the dilemma (11). This study was approved by the research ethical committee of the Faculty of Medicine at the University of Montreal. All participants signed written consent forms.

Population studied and sampling

This research on the perception of the dilemma of convenience euthanasia was limited to veterinarians in Quebec. Companion animal practitioners are confronted with this dilemma and thus were selected for this study. No distinction was made between general practitioners and specialists. The sample included 1 specialist and 13 general practitioners, and involved a wide range of clinical experience (2 to 32 y), men, women, owners, employees, and rural and urban practices in 5 regions in Quebec. The purpose of this qualitative research was to take a wide range of possible opinions into consideration (divergent or not), to achieve data “saturation.” Veterinarians who accepted or refused to practice convenience euthanasia were invited to participate. Only veterinarians refusing to practice convenience euthanasia for ethical reasons were classified in the group of veterinarians not practicing convenience euthanasia.

Probabilistic sampling would most likely unintentionally exclude veterinarians who were not practicing convenience euthanasia, due to their low number. This sampling method could therefore create a risk of obtaining incomplete results. A non-probabilistic sampling method was therefore chosen. Veterinarians known to not practice convenience euthanasia were solicited first, followed by veterinarians performing convenience euthanasia. This purposeful sampling (12) would likely result in a more efficient collection of in-depth information about the dilemma. A snowball method was used to find participants (13). The snowball method was initiated with 4 veterinarians from different backgrounds to ensure diversity and representativeness of the data.

Initially, no limit on the number of participants was established. Data analysis was done throughout the period of data collection. This procedure allowed the researchers to evaluate, on an on-going basis, if saturation of information had been reached and to decide if additional interviews were needed. “Saturation achieves 2 main functions: from an operational standpoint, it tells the researcher when to stop data collection to avoid useless collection of data and waste of time or money. From a methodological standpoint, it allows generalization of results to the given population” (11). Fourteen 30- to 45-minute interviews were completed. This sample size matched information in the literature about the average number of interviews usually required in non-probabilistic studies to reach saturation of information (14). Interviews were initiated on May 18, 2010 and concluded on November 18, 2011.

Data analysis

Interviews were recorded and transcribed (MSWord; Microsoft, Redmond, Washington, USA). First, manual coding of the text (verbatim) was done to establish a preliminary list of codes (15,16). For example, if a veterinarian described her pet as equal to a human, this section of text was coded “equal to human.” Once the manual coding of the first 4 interviews was completed, the software program QDA MINER (Provalis Research, Montreal, Quebec) was used for coding management of all interviews. The coding list was continuously adjusted during the entire data collection period. Next, 2 methods were performed to ensure internal validity and accuracy of the coding technique (11). The first consisted of counter-coding by an independent research assistant. Consistency level (percentage agreement) was 89% (15,16). The second was inverse coding. Use of inverse coding ensures that all interview excerpts represented by a code are appropriately categorized. These 2 methods of verification showed that the coding results were accurate.

A thematic analysis of the interviews was done to draw an initial portrait of the current situation. Thematic analysis was achieved by grouping codes to represent the main ideas expressed (17).

Results

Three primary/overarching themes emerged from the data: i) influence of the veterinarian’s personal and professional perceptions of the animal on clinical decisions concerning convenience euthanasia; ii) origin of the convenience euthanasia dilemma; and iii) veterinary involvement in this dilemma.

Theme 1: Influence of the veterinarian’s personal and professional perceptions of the animal on clinical decisions concerning convenience euthanasia

Veterinarian’s perception of the companion animal in his/her personal life

Veterinarians were asked to discuss their perception of animals in their personal life. Ten veterinarians gave enough information about this topic to be assessed. Responses were classified in 5 categories which were not mutually exclusive: i) being different from humans, ii) companion, iii) family member, iv) living being, and v) equal to humans.

Some veterinarians believed that animals were different from humans (illustrated by all the previously listed categories except the category equal to humans). These veterinarians were not able to qualify this difference or to establish a comparison plan. They mostly thought that animals and humans belonged in separate categories and therefore were impossible to compare:

“Yes, completely different. I think that we do enjoy their presence, probably as they enjoy ours. But we must be careful. This does not mean that they owe us something. Yes, we feed them and take care of them, but they would be able to do it without us. They are not subordinate to us; it is different.”

None of the veterinarians agreed when confronted with a classification that puts the animal at a lower level than humans. However, when the veterinarians thought of a familiar context in which the interest of their animal was in conflict with the interest of a family member, the animal’s interest was always considered after the family member’s interest:

“But my animal would never be considered ahead of a person that I love (…), there is a special place for my animal but it is not absolute.”

Some veterinarians clearly defined their animal as their equal. They justified their position by the absence of valid arguments to allow a distinction to be made between humans and animals. This point of view is illustrated by the following comment:

“It always depends on what we base ourselves. If we take life, then I think that we are all equal. We consider ourselves superior as humans, but I am not sure that we deserve it. We may be superior in terms of cognitive capabilities, but with regards to life and welfare, I am not sure.”

Veterinarian’s perceptions of the client owner-animal bond

An evaluation of the veterinarian’s perception of the animal during professional activities was possible through responses obtained from direct questioning. Thirteen veterinarians gave sufficient information about the topic. The responses were all related to the veterinarian’s perception of the owner-animal bond. As an illustration, here is the response of one veterinarian:

“I think that the animal does more now than before. For some people the animal can be a companion, we see this really often, but for others, the animal would always be seen as a utility animal. If we look only at companion animals, an example would be the garage dog and he is a utility animal not really a companion. When we talk to those owners, they are telling us that the dog is only a garage dog kept outside and that they would not invest a lot of money for his healthcare. As said before, for them the dog is only a utility animal. For most of the clients seen in clinic, animals are more than that; they are a companion for different reasons. They are a companion because the owner is lonely, because they want their children to have a friend, because the dog is always there to play with them.”

The responses were divided into 6 categories which were not mutually exclusive: i) member of the family equivalent to a human member, ii) companion, iii) social crutch, iv) tangible personal property, v) subordinate, and vi) utility.

Data analysis showed that within their professional context, veterinarians perceived animals in 2 distinct ways. Either, veterinarians presented a vision of the animal by describing the place of animals in a utility role in the relationship with the owner (all categories except “member of the family equivalent to human member”) or the animal was described as a family member equivalent to human member.

Evaluation of the relationship between the owner, animal, and veterinarian in cases of convenience euthanasia

Veterinarians were asked to describe their perception of the relationship of the owner, animal, and veterinarian in the context of convenience euthanasia. Since not all convenience euthanasia situations were identical, a veterinarian could express diametrically opposite opinions on the topic:

“I do my physical exam of the animal first and I talk with the client as if the animal was a young child unable to talk on its own. Depending on the client’s reaction, I change my way of dealing with the case.”

Thirteen veterinarians gave enough information about this topic to be assessed. The veterinarians were not questioned on a specific situation. They chose their own context to define their vision. Veterinarians were invited to describe the situation in order to explain the priority of attention that they gave to the animal’s needs and those of the owner. Some veterinarians said that they prioritized and respected the animal’s interests when they decided about euthanasia.

“I decided to persist in the fact that I am here to do the best that I can for the animals and I will always do what is best for them. I stay polite and diplomatic with clients, but I studied to be able to treat animals, not to deal with human psychology. And it will stay like that.”

Of those, some systematically refused to proceed with convenience euthanasia. Some veterinarians, however, gave priority to respecting the owner’s interest. These veterinarians always decided to proceed with convenience euthanasia.

“At that moment, when people are here for euthanasia, the importance should be put on them. The animal doesn’t matter anymore.”

Some veterinarians explained that they tried to find a balance between the animal’s interests and those of the owner. Data obtained did not reveal an imperative scheme on how veterinarians consider the animal’s interests nor how they prioritize each stakeholder’s interest when requested to perform convenience euthanasia. In fact, depending on the situation described, prioritization of the interests fluctuated with the circumstances. For example, one veterinarian described a situation in which he had prioritized the animal’s interests and then described a different situation in which he had prioritized the owner’s interests. Few veterinarians were consistent in every situation and they always prioritized the animal’s interests by refusing to proceed with convenience euthanasia.

Theme 2: Origin of the convenience euthanasia dilemma

Veterinarians commented spontaneously about this topic without direct questioning

Some veterinarians provided information on the correlation between the various motivations to adopt a companion animal and the type of perceived owner-animal bond. Some motivations were more likely to result in a request for convenience euthanasia. The owners did not reflect sufficiently on the implications involved prior to the adoption of the animal, which seemed to prevent strong bonding between the owner and animal. Examples included situations such as adopting the animal because it is pretty, on the spur of the moment, or due to pressure from children. These situations failed to create the active involvement necessary from the owner concerning his obligation toward the animal.

Some veterinarians believed that the legal social status of a companion animal in society was at the core of the convenience euthanasia dilemma. The lack of consideration of the animal’s interests or needs within Quebec’s legislation did not encourage companion animal owners to view their animal differently from the status of property. This situation, therefore, also contributed to minimization of the animal’s needs and interests.

The overabundance of companion animals in Quebec is illustrated by the high occupancy rate of animal shelters. Some veterinarians referred to this situation in order to explain the origin of the dilemma. They saw a clear link between society’s consumption habits and the low value bestowed on animals. The animal’s individual value was low because the number of animals waiting for a new home was always more important than the number of owners searching for a new companion animal. This overabundance of companion animals made them easily replaceable objects. Veterinarians expressed themselves on the overabundance effect and the loss in value within society:

“There are two types of clients. The first type loves animals, they care for them. The second is an animal consumer. We are a consumption society and this is the problem. People are consumers of animals as if they were simple objects. I think it is within society and it will not change soon, it is too deeply rooted within us. It is too large. Convenience euthanasia is normal because animals are seen as objects.”

Veterinarians also felt that consumers had higher expectations of their animals and the overabundance of available animals was amplifying the problem. Owner expectations were becoming more and more superficial and unrealistic. These owners became easily frustrated because they had an illusionary vision of what their animal should be and do. They then rejected their animal easily knowing that it would be simple to find another one that perhaps met their expectations.

“Our level of satisfaction is so difficult to reach and our values about satisfactory criteria for beauty and other superficial topics are so difficult to address because there are so many choices available. It is the same thing with animals. He was pretty and young, but now he is older and bigger and we are less attached to him. We need to take care of him and it was initially okay but now he has become annoying. It is the same thing with the different breeds. I think that if we do not have consideration about living beings, it is easier to discard them. I think it is the circle of influence of our times. Did we have something to do with it? Yes, we did!”

Some veterinarians saw convenience euthanasia as a humane way to help the situation of animal overabundance created in part by the consumption habits of society.

One veterinarian identified the general public’s ignorance of convenience euthanasia to explain the origin of the dilemma:

“The first week of work here was “moving week” and I performed 21 procedures of convenience euthanasia. I did an average of three daily. At the end of the week 1 was asking myself why was I doing this job? I can understand if you have to move, that it can be difficult to find a place accepting companion animals, you cannot be picky about the choice of apartment. But the client does not know that it is your fifth case of the day. They think it is always easy for you, that you just have to administer the injection, put the animal in a bag and bring him to the freezer. Yes, we try to create a barrier and detach ourselves from the situation because it is not our animal. But, the dog is there, he is watching you, he wags his tail, he looks nice and you do not want to do it. He could die old after a nice life, but you have to kill him because of his owner’s decision, he is not attached to him anymore, he is tired of his animal, he is not cute anymore.”

Ignorance may be a loophole in the general public’s education with regard to responsibilities associated with the care of an animal. However, it is difficult for veterinarians to precisely and uniformly define this concept of responsibility.

Theme 3: Veterinary involvement in the dilemma

Veterinarians commented spontaneously about this topic without direct questioning. A few veterinarians discussed their own involvement in the dilemma. Some veterinarians refused to believe that they share responsibility in the dilemma of convenience euthanasia. They even doubted the existence of the dilemma in their professional activities. For them, the problem came from veterinarians who refused to perform convenience euthanasia. They thought that those veterinarians were against the practice of convenience euthanasia because they were uncomfortable with the general concept of death. In their opinion, the discomfort originated from a lack of emotional management because they were unable to create distance between the professional situation and their own emotions.

One veterinarian estimated that the profitability pressure of veterinary facilities amplified the dilemma. This veterinarian expressed himself on the subject by explaining that leaders of veterinary businesses were not able to imagine the situation differently and continued to profit from those cases. They were then automatically disengaging.

“By the same token, what can I do? It is on this that we need to work. What are the alternatives that I can offer and how can I do this? Is it possible to work differently? Am I sure that there are other ways to explore, are there other solutions to try? And why am I asking myself those questions? Is it because nobody else is trying to find a solution? I think that the profitability pressure has taken over within our facilities. And maybe it is up to institutions to work on the topic, because short-term evaluation is not profitable for veterinary businesses. Long-term evaluation will be profitable for society.”

Another veterinarian explained that it is easier for veterinarians to accept all requests of convenience euthanasia rather than defend the animal’s interests. Use of convenience euthanasia to get rid of unwanted companion animals is a widespread practice. This respondent believed that veterinarians performed euthanasia because they were now used to doing the procedure. The habit of performing convenience euthanasia trivialized the procedure and did not encourage veterinarians to reflect on the moral aspect of this act.

Discussion

Evaluation of veterinarians’ perception of animals illustrated the discrepancy between veterinarians’ moral value attributed to their own pets and the perceived strength of the owner-animal bond of their clients. In cases of convenience euthanasia, veterinarians’ responses predominantly reflected their perception concerning the lack of importance attributed to the animal’s moral value within society. The moral value attributed in relation to the owner-animal bond excluded the animal’s interests from the debate of convenience euthanasia. It is therefore possible to understand why most of the veterinarians interviewed would perform convenience euthanasia. Their view on the subject was influenced by their perception of the owner-animal bond during the appointment.

Morgan and McDonald (1) explored different visions of the animal’s value in dilemmas within the field of veterinary medicine. They described and classified those visions in either an anthropocentric or a biocentric model. Our results fit this model.

Veterinarians perceiving animals in an anthropocentric model corresponded to Rollin’s garage mechanic model (4). They were acting as service providers and were not getting personally involved in the dilemma. Veterinary medicine is a profitable activity and rarely are veterinarians willing to refuse client demands. Some saw convenience euthanasia as a conflict of interest and others saw it as a service.

Our study results also fit with the pediatrician (4) and biocentric models (1). Some veterinarians were systematically refusing to perform convenience euthanasia. They were medical professionals acting as advocates to protect their patients.

Convenience euthanasia is a sensitive topic within the profession and is recognized as a stress factor for practitioners (2,5). Paradoxically, veterinarians interviewed, although not specifically questioned, did not talk about themselves as active participants in convenience euthanasia decisions. However, they identified the context of companion animal adoption as a major contributor to the dilemma. The first theme of this article indicated that the owner-animal bond was a major factor in the decision process of convenience euthanasia. According to some participants in this study, the motivation to adopt a companion animal was very important for the identification of the dilemma’s origin. This motivation had a direct impact on the importance attributed to the animal by the owner. A weak bond led to an anthropocentric definition of the animal and the recognition of the animal’s interests was then poor. For some veterinarians, convenience euthanasia was considered a humane method to stabilize the situation of companion animal overabundance.

Finally, the results of this study cannot be extrapolated to represent the point of view of veterinarians in Quebec on convenience euthanasia because the sample size was small and there were limitations related to the qualitative research design. The purpose of qualitative research is to collect the widest range of opinions possible; therefore, data cannot be extrapolated to quantitatively represent the entire veterinary community. Research has not been done on the differences in veterinary practice from country to country or even from province to province in Canada. The goal of this research was to qualitatively describe the situation of convenience euthanasia and represents the perspectives of 14 veterinarians in Quebec.

The goal of this study was to describe veterinarians’ conceptualization and experience of convenience euthanasia. The analysis of responses brought to light many components of the dilemma and led to a better understanding of this issue. The veterinarians interviewed decide about convenience euthanasia based mainly on their analysis of the owner-animal bond. As most veterinarians in this study view animals in an anthropocentric way, the animal’s interests and needs are not necessarily taken into consideration. Some veterinarians believed that the origin of the dilemma came from social weakness (i.e., the owner’s inability to take responsibility). Further analysis of this dilemma is currently being done. Consequences resulting from the decision about convenience euthanasia on each stakeholder will be assessed.

This study provides a description of the issue of convenience euthanasia and is the first to highlight the absence of animal welfare discussion by all participants in this study in the context of convenience euthanasia. However, veterinarians were not directly questioned about animal welfare. Convenience euthanasia is a sensitive topic, but veterinarians did not describe themselves as major actors in the dilemma. These results did not assess the prevalence of responses reported within the entire population of veterinarians in Quebec. A second study involving a quantitative evaluation of the concepts reported in this article has already been undertaken.