Veterinary Medical Ethics

Ethical question of the month — February 2019

When a pet shows signs of severe distress outside of regular business hours, clients are directed to an emergency clinic. It is common practice in such cases for the emergency clinic to request a down payment or guarantee of payment for the initial examination and treatment. Emergency care can be very costly and some owners request the emergency clinic do whatever necessary to save their pet without appreciating the costs involved and without the ability to pay. Animals in severe distress have been refused admission at emergency clinics if the clients are unable to provide proof that they can afford the emergency work. Is refusing to treat an animal in severe distress compatible with the Canadian Veterinary Oath to relieve animal suffering? How should practitioners balance their business and professional responsibilities?

An ethicist’s commentary on dealing with clients who cannot afford emergency treatment

Throughout his writings, Plato regularly makes the point that the function of a craftsman, be the person a goldsmith, carpenter, silversmith, veterinarian, or physician, is to add value to the material upon which he or she exercises their art. If one is a goldsmith, one turns a piece of raw gold into a work of art the value of which exceeds the value of the metal alone. Similarly with a medical professional, although one does not usually speak of augmenting the value of the sick person or animal. The fact is that any creature that is ill cannot perform its normal function or indeed, even live its normal life. When a physician or veterinarian restores the object of his or her art to health, they have essentially restored its value by allowing it to function as it should. Plato also points out that when a medical “craftsperson” collects a fee for such an activity, they are functioning not just as a craftsperson, but as a “wage earner.” The functions are clearly conceptually distinct.

When circumstances prohibit a healer from the function he or she is trained to do, a situation of considerable stress is created. I call such stress “moral stress,” because it arises out of what you are committed to doing ethically and philosophically, and what you are actually asked to do. An excellent example can be found in situations in which an owner does not wish to pay the money required to fix the animal, even though you, the veterinarian, may have doctored the animal for its entire life and exerted Herculean efforts to save it. As I predicted in 1987, this is not stress that you manage by such techniques as deep breathing or yoga. This sort of stress tears at your core. It is now well-known that the suicide rate among young veterinarians is far greater than that of other professionals, and I am convinced that a good part of the cause is moral stress.

It follows from what we have been saying that a veterinarian should avoid moral stress at all costs, for the sake of both their physical and psychological well-being. And an obvious and major source of moral stress occurs when an owner desperately wants an animal treated but cannot afford the treatment. Nor can veterinarians do their work without compensation. So how is this major obstacle to be surmounted? Over the years, many of the best veterinarians I know have shared with me their solutions to this vexatious dilemma.

Very often, wealthy people express considerable gratitude to veterinarians for healing their animals, especially when the veterinarian has gone to great lengths to accomplish this goal, for example staying up all night. Such clients offer the veterinarian additional payment under such circumstances. When this occurs, one of my colleagues asks the grateful client to contribute the money to a fund to help indigent clients as described above. Given what they themselves have just gone through, clients possessing the means to do so are glad to be able to share the joy they have experienced at their animals being healed. On other occasions, resourceful veterinarians will arrange fundraisers for this express purpose. Anyone who values their own animal can empathize with poor people who cannot afford treatment. Other veterinarians are willing to barter so that instead of cash, an indigent client can trade such work as painting, gardening, auto repair, snow removal, or some other sort of manual labor for what they owe. No veterinarian should be forced to euthanize an animal because of a client’s lack of funds — that is the stuff of nightmares.

In these sorts of ways, veterinarians can circumvent moral stress, abide by their oath, and, above all, do what their life’s work and their heart has committed them to do — care for animals to the best of their ability.

Ethical question of the month — May 2019

To improve the efficiency of swine production, genetics companies have increased the number of pigs born per litter. As litter size has increased the birth weights of the individual pigs in a litter have decreased. On average, pigs with lower birth weights have lower viability. This is supported by several large databases documenting a steady year over year increase in pre-weaning mortality that follows the trend of increasing litter size. Nevertheless, the net outcome is that producers are weaning more pigs per litter than previously despite losing more pigs in each litter. Pigs that are low birth weight/low viability at birth are humanely destroyed soon after farrowing or die “naturally.” Some producers see the net outcome as increased productivity. However, stock people who must deal with the high mortality in low birth weight pigs see primarily poor welfare for the pigs. Genetics companies say they are supplying producers a competitive edge. Does the net benefit (more pigs weaned) justify the cost (more pigs dying)?

Responses to the case presented are welcome. Please limit your reply to approximately 50 words and forward along with your name and address to: Ethical Choices, c/o Dr. Tim Blackwell, 6486 E. Garafraxa, Townline, Belwood, Ontario N0B 1J0; telephone: (519) 846-3413; fax: (519) 846-8178; e-mail: tim.e.blackwell@gmail.com

Suggested ethical questions of the month are also welcome! All ethical questions or scenarios in the ethics column are based on actual events, which are changed, including names, locations, species, etc., to protect the confidentiality of the parties involved.