I am pleased to recommend "An Introduction to Veterinary Medical Ethics, Theory and Cases" by Bernard E. Rollin, Ph.D. This second edition by Blackwell Publishing discusses the rising public concern for farm animal welfare in confinement agriculture, the demands for increasing the legal status and economic value of companion animals, the social concern for animal pain, distress and quality of life, the increase in specialization and the public interest and veterinary involvement in complementary and alternative therapies. Ethics 1 and 2 The first 100 pages of Rollin's book highlight the richness and complexity of theoretical and moral issues found in veterinary medicine. He points out that the transformation in veterinary medicine from a more rigid, male-dominated profession to a more flexible, compassionate profession, soon to be dominated by women, reflects the changes in our society and social ethics. Rollin discusses aspects of basic ethics as Ethics 1 the set of principles that governs people's views of right and wrong, good and bad, fair and unfair, just and unjust. This involves social consensus ethics, personal ethics and professional ethics. He then introduces the secondary sense of ethics as Ethics 2. It is the logical, rational study and examination of Ethics 1. Ethics 2 is a branch of philosophy that looks for justifications, inconsistencies, omissions, conclusions and the consideration that all societies might embrace the same Ethics 1. The remainder of Rollin's insightful book presents 104 real-life ethically charged case scenarios from his column in the Canadian Veterinary Journal. Facing Untreated Pain In my recent travels, I had the pleasure of visiting a number of households with very old animals. It amazes me how lovingly geriatric pets are regarded by their family members, friends and neighbors. Each family wanted me to look at their aging pets. Some of these pets hadn't seen a veterinarian in quite a while, but most were under routine veterinary care. More than half of the old dogs exhibited lameness because of osteoarthritis. One 16-year-old Aussie had diabetes and glaucoma. One 14-year-old yellow lab had canine cognitive syndrome, deafness and arthritis. Another 15-year-old Aussie had a thyroid mass, a large testicular tumor, a swollen front leg and lameness. Yet all of these old dogs greeted me, were interested in their environments, ate well and followed us around. Several old cats had chronic renal failure, one had hyperthyroidism and one had asthma. Most of these geriatric pets had some level of dental disease. While these elderly pets were treasured by their families, it was obvious that some of them had untreated pain. Rollin states that people make their own decisions as to what constitutes sickness, wellness and normal aging. People make decisions about their animals based on factors relevant to their own values, cultural backgrounds, financial philosophies, knowledge and the intensity of their human-animal bond. A person's concept of an older pet's health or level of pain is often based on how the pet functions in the household, despite warning signs that might indicate pain, dental disease, arthritis, illness or cancer. If an elderly pet is able to follow the family pack, eat and eliminate in an acceptable fashion, the family may be inclined to feel that there is nothing to worry about. Our profession is obliged to educate caregivers, be the pet's advocate and bring attention to unnoticed discomfort and pain that many older pets endure ever so stoically. Professional Obligations Veterinarians need the ability to effectively communicate the fundamentals of aging and age-related disabilities, pain and illnesses to all pet caregivers in a kind, comforting and supportive fashion. More than ever, veterinarians need to be skilled in their approach to deeply-bonded clients. Veterinary students and practitioners should strive to become proficient at applying the basic principles of psychology, sociology and medical ethics to discuss issues with pet owners. In this way, the attending doctor can communicate the diagnosis, therapy and quality of life issues in a way that enlightens clients so they will want to use pain management for arthritis, elect to treat cognitive syndrome, dental disease, responsive cancers and so on. The attending doctor and staff should discuss options and quality-of-life issues without prompting fear or anxiety. When clients are upset about their pet's illness, I like to congratulate them and acknowledge my respect for their ability to have pets that reach old age. I point out that having older pets is an achievement. Old pets validate that the caregivers created a good loving home. It is our professional duty to comfort upset clients and help them to understand that illness and cancer happen as part of the aging process. We are obliged to inform clients if their pet's condition is preventable or has contributing environmental factors such as solar exposure for skin cancer, hormone exposure for breast cancer, obesity for diabetes, environmental smoke for feline oral and intestinal cancer or vaccine associated sarcoma. Moral Stress One contributing factor to the moral stress placed on veterinarians is that our profession is asked to skillfully operate within the crosshairs of the arbitrary opinion of our clients. Our diagnosis may inadvertently create a dilemma that winds up with the client suggesting immediate euthanasia of a treatable condition. Rollin states that going against one's own moral commitments or personal ethics invites moral stress, which erodes physical and mental well-being and job satisfaction. Rollin points out that veterinary medicine is the only profession where the diagnosis of treatable disease may instigate the premature euthanasia of the patient at the request of the owner. The patient may be a working animal. The owner may lack a bond with the animal. Treatment may cause economic hardship. The owner may have cultural, philosophical or religious constraints to allowing medical care or euthanasia for their animal. These complex situations place emotional and ethical pressure on veterinarians and staff. Most of us entered the field with high ideals and we acquired detailed scientific training to heal and combat disease. This "heal or kill" dilemma clobbers many veterinarians with frustration and guilt that may precipitate ambivalence or aversion to their chosen career. The process of working up a patient, making a diagnosis and providing therapy creates a unique doctor-client-pet relationship. When veterinarians are asked to end the pet's life, it can also end the doctor-client relationship as well. Euthanasia can cause some veterinarians and staff to be at odds with their inner nature and precipitate burnout, career crisis and compassion fatigue. There is a need for more training in veterinary medicine so students and practitioners can know how to adjust while juggling the incongruent roles of healer and executioner. It is germane to be grateful that our profession has the ability, social sanction and privilege to provide a good death for our animal patients when they are suffering and can't be helped. The power of the human-animal bond is the glue that binds our profession to the greater community of pet caregivers. The bond fortifies and guides decision-making, which should ultimately be aimed for the best interest and comfort of our patients, especially as they age. Dr. Villalobos is president of the American Assn. of Human-Animal Bond Veterinarians and is on the editorial review board of the Society for Veterinary Medical Ethics. She may be contacted at dralicev@aol.com. <HOME>
