Clinicians and researchers from North Carolina State University and Duke University have developed a first-of-its-kind veterinary medical ethics committee to aid care providers in navigating complex situations and difficult questions about care goals and quality of life. “Even though everyone involved in an animal’s case is trying to act in the animal’s best interest, determining the best course moving forward can lead to conflicts and that can be distressing for the people involved,” said Jeannine Moga, a veterinary social worker at NC State. “I wanted to find an ethics-based way to help our hospital staff address differences and form consensus in these cases.” Moga contacted Philip Rosoff, MD, MA, for guidance and advice on how to proceed. Rosoff, pediatric oncologist and director of the clinical ethics program at Duke University Hospital, is corresponding author of a new paper describing the committee’s formation. “The establishment and growth of veterinary specialty hospitals for very sick animals is a relatively recent phenomenon,” Dr. Rosoff said. “It’s not surprising that veterinary hospitals also now see the need for ethics committees to mediate and adjudicate disputes about care.” Together, Rosoff, Moga, and Bruce Keene, DVM, MSc, DACVIM, Jane Lewis Seaks Distinguished Professor of Companion Animal Medicine at NC State, set out to adapt human ethics committee guidelines currently in use to address issues in a veterinary hospital, creating NC State’s first Clinical Ethics Committee (CEC). “The pediatric model works very well for our situation in veterinary medicine,” Dr. Keene said. “In both cases, you’re dealing with a patient who cannot advocate for him or herself, and a decision-maker who is very involved in the process. However, we do deal with some thorny issues—such as euthanasia—that human hospitals do not.” The CEC consists of three doctors, three veterinary technicians, and a social worker. When cases arise, as many as four or as few as two members of the committee meet with the veterinary patient’s care team to serve as a resource or a sounding board. The entire process operates independently from the academic and business aspects of the NC State veterinary hospital to avoid conflicts of interest. As of December 2017, the CEC has worked on seven cases. While the CEC currently serves veterinary clinicians, staff and students, Moga said she hopes to expand its availability to hospital clients in the near future. “Our job is not to make treatment recommendations,” she said. “We are there to make sure that any ethical issues raised are dealt with openly and fairly. Sometimes it’s as simple as just getting everyone in the same room to hash things out. “Figuring out which medical options are feasible and ethical in a way that also respects client autonomy can be difficult, but dealing with ethical issues pre-emptively rather than reactively is in everyone’s best interest.” The research appears in the American Journal of Bioethics.
