SVME ON-LINE ETHICS COURSE
CLASS TWO
CONTEMPORARY ETHICAL ISSUES IN VETERINARY PRACTICE TODAY
JOHN B. MCCARTHY, DVM, MBA
Ethical Challenges to Veterinary Medicine. The following is a partial list of a series of
real-life situations being faced today by veterinarians and veterinary practices, and the
public that they serve, which have the ability to have significant impact on the practice and
those involved with it. The situations listed here should give you an idea of why ethics is
important and why we need to know more about it and understand it. In each kind of
ethical issue listed there will not be an attempt to give answers to these challenges but
rather to identify them. Regarding each of these issues there can and will be those who
feel differently about the subject, even among veterinary colleagues. Most of these items
have questions included for the consideration of the reader. Many of the answers to these
questions will depend on the Normative Ethics of the individual. In many cases there may
be no right or wrong answers. These topics are for discussion purposes and are not meant to
represent right or wrong answers to these difficult ethical dilemmas.
1. Convenience Euthanasia of Companion Animals – Requests by animal owners to
have their animals euthanized because they cannot, or do not want to, continue to care for
them is among the most contentious of issues facing veterinarians and veterinary hospital
staff members today. As was noted in Class One, the AVMA Principles of Veterinary
Ethics states Humane euthanasia of animals is an ethical veterinary procedure. In spite of
lengthy efforts by veterinarians and organized groups dedicated to eliminating the causes of
overpopulation of pet animals, there are still many unwanted and homeless animals.
Increasingly, veterinarians, veterinary practices in general and shelters created to house
them are refusing to euthanize these “unwanted animals”. Instead these animals may
languish in the shelters, are left to fend for themselves in the wild or are “killed” by owners
taking matters into their own hands. What if any responsibility does veterinary medicine
have to help solve this problem? What happens to the unwanted animals that veterinarians
refuse to euthanize?
Reference: Principles of Veterinary Medical Ethics of the AVMA, Section XI
2. Changing the Legal Status of Companion Animals – At least one state, and several
U.S. cities and municipalities in recent years have adopted laws that makes use of the term
"guardian" instead of "owner" to describe a person's relationship with pets. Proponents of
the movement say it's the first step toward elevating pets to human status. It should be
made clear, however, that at this point, the only thing that has changed is the terminology
used in legal documents, not the legal status of the pet. The American Veterinary Medical
Association (AVMA) feels that “any change in terminology describing the relationship
between animals and owners, including "guardian," does not strengthen this relationship
and may, in fact, harm it. They warn that such changes in terminology may adversely
affect the ability of society to obtain and deliver animal services and, ultimately, result in
animal suffering”. For more information on AVMA policy go to:
www.avma.org/advocacy/state/issues/ownership.asp
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3. Importance of the Human Side of the Human Animal Bond - It is of extreme
importance that veterinarians and others working in veterinary practices understand the
human issues well as the issues related to animal care. These issues surface often but
especially whenever a beloved pet is in a critical or end-of-life condition as well as with
situations like the many animals that had to be abandoned after hurricane Katrina and
other similar disasters because there were no arrangements for them in the shelters. A
future class will examine this challenge in detail.
4. Advent of High Tech Advances – There continues to be an increase in the number of
veterinary specialists and specialty practices. These practices have the expertise and the
technical abilities to perform procedures such as MRI, radiation therapy, dialysis, nuclear
medicine that are rarely available in some. However, these specialty practices will, often
require fees beyond what many animal owners can afford. Should veterinarians
recommend these high tech practices? Should they consider the owner’s ability to pay?
Will that involve judging the owners or asking them? We know that veterinary medicine
has the ability to provide these procedures that may save an animal’s life but what is the
veterinarian’s responsibility to an owner who does not have the ability to pay for them?
When situations such as this are involved, is our responsibility only to the animal or also
to the owner? We have seen newspaper headlines such as Nine Lives With Bills to Match
and Owners Face Higher Bills - More Medical Options and Tough Decisions –How Much
is Too Much (Washington DC Post April 27, 2008 and June 1, 2008). Do we allow
headlines such as these to affect our decisions when they question the quality of the
medicine we are providing? Initiatives, such as one recently announced in Fairfield
County, CT, which primarily aims to give financial help to eligible owners of cancerstricken pets so they can provide their animals with the best possible treatment, will
provide some assistance. Initiatives such as this may prove helpful, but there is a need for
more such programs. Bernard Rollin in his book Veterinary Medical Ethics describes
Aesculpian Authority which is “ a unique authority that accrues to medical professionals”
allowing them to convince their patients and, in the case of veterinary medicine, the
animal owners to do whatever the medical professional wants them to do. Would it be an
abuse of Aesculpian Authority if a veterinarian convinced an owner to provide a treatment
or service to their animal that the veterinarian knew they were unable to pay for? Is the
veterinarian’s role simply to provide the owner with the diagnosis, prognosis, alternatives
for treatment and costs? If the veterinarian, because of their normative ethics, is unable to
accept euthanasia as an acceptable alternative when the owner has announced that they are
unable or unwilling, to pay for the service, does the veterinarian have any additional
responsibility to the animal or to the owner? What is the veterinarian’s ethical
responsibility? There are many questions but no easy answers.
Reference: “Veterinary Medical Ethics – Second Edition” (Blackwell Publishing 2006)
Bernard E, Rollin, PhD pgs 83-93
5. The Emergence of Animal Welfare Science. – What animals ought or ought not to be
forced experience. Questions pertaining to this topic are among the most contentious
ethical issues in veterinary medicine today and involve all species. Confinement rearing
of veal calves, swine and chickens have become very important issues that veterinary
medicine has become deeply involved in. The AVMA has developed an Animal Welfare
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Division, with a specialty group, to determine ways for our profession to address these
issues. The American Kennel Club has created a canine welfare advisory board and the
School of Veterinary Medicine at the University of California-Davis recently launched the
International Animal Welfare Training Institute, an animal welfare advocacy organization.
Its intent is to take into account the animal welfare concerns of both consumers and
farmers. A future SVME on-line class will be dedicated to the subject of Animal Welfare.
References: www.avma.org/issues/animal_welfare/default.asp
www.akc.org/news/index.cfm?article_id=3909
http://www.vetmed.ucdavis.edu/iawti/default.cfm
6. The Role of Sport and Entertainment Animal Practice- Society is besieged by
people who feel that animals should not be used for sport or entertainment. Rodeos, horse
racing, horse riding events, circuses, zoos, aquariums, even dog shows and other similar
uses of animals are increasingly coming under attack. Veterinarians and others
responsible for the care of these animals will be expected to give testimony as to why
these practices are not harmful to the animals. Bull fighting, dog fighting and cockrooster fighting, once the “sports of kings” have been ruled by society as in-humane and
outlawed in most countries. Will these other “sporting events” follow? How will
veterinary medicine respond to these questions?
7. The Ethics of Pain in Animals – In his book Veterinary Medical Ethics, Dr. Bernard
Rollin notes that before the 1980’s veterinary medicine did not consider pain control an
issue. Even with humans, safe anesthesia was in its infancy. There was little if any
concern in veterinary medicine about pain experienced by animals receiving veterinary
care. Veterinary students were taught that pain was a self inhibiting factor and was “good”
because it kept the animal quiet and without doing harm to itself after painful procedures.
It wasn’t until 1985 that the Federal Government enacted the 1985 Amendments to the
Animal Welfare Act, also known as the Improved Standards of Laboratory Animals. This
required research facilities using animals to set standards for the minimization of pain and
distress; the use of anesthetics and analgesics; and the consideration of using alternatives to
painful procedures. Perhaps because of the scarcity of safe and easily acquired medication
(and this is still true today) veterinary medical practice was slow to meet the standards
being used in Laboratory Animal Medicine. In 2001, the AVMA adopted the following
position on managing pain in animals:
"The AVMA believes that animal pain and suffering are clinically important
conditions that adversely affect an animal's quality of life. Drugs, techniques, or
husbandry methods used to prevent and control pain must be tailored to individual
animals and should be based, in part, on the species, breed, age, procedure
performed, degree of tissue trauma, individual behavioral characteristics, degree of
pain, and health status." (The Journal of the American Veterinary Medical
Association - June 1, 2001)
Most veterinary schools and veterinary practices today emphasize the importance of pre
and post surgical pain control in companion animal patients. The concern over pain control
being practiced in farm/food animals, where many veterinary procedures such as treating
feet, castration and dehorning are still being performed by lay people without anesthesia or
analgesia, is still of great concern. . In addition to physical pain, a subject increasingly
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discussed today refers to the psychological pain or stress experienced by all animals during
the course of their interaction with veterinary medicine. Can animals experience
psychological pain and stress? Would these conditions be similar in all species of animals?
Time, more research and, most importantly, better pain control will help us better
understand and answer these questions.
References: “Veterinary Medical Ethics – Second Edition”(Blackwell Publishing 2006)
Bernard E, Rollin, PhD
AAHA/AAFP Pain Management Guidelines for Dogs and Cats - published by the American
Animal Hospital Association (AAHA) and the American Association of Feline
Practitioners (AAFP) – Journal of the American Animal Hospital Association Sep – Oct
2007 Vol 43 Pgs 235-238
There is also an International Veterinary Academy of Pain Management. (IVAPM)
8.. The Ethics of Cosmetic Surgery – Ear cropping and tail docking are procedures that
most veterinarians would agree have no medical benefits to animals that experience them.
Most would also agree that both procedures have health risks and the potential to cause
these animals pain. Therefore, there is a moral dilemma between the wishes and desires of
dog breeders and owners, represented by breed clubs and the American Kennel Club
(AKC), who continue to request and require that these procedures be performed and the
animal welfare principles of veterinary medicine. Non-therapeutic ear cropping is illegal
in the United Kingdom but continues to be legal in the United States. Can this be
explained ethically? For many years ago both the American Veterinary Medical
Association (AVMA) and the American Animal Hospital Association (AAHA) publicly
opposed ear cropping. At its July 1999 meeting the AVMA House of Delegates
developed a policy that stated “Ear cropping and tail docking for cosmetic reasons are not
medically indicated nor of benefit to the patient”. The AAHA Animal Welfare Position
Statements, approved October 2003, stated “The American Animal Hospital Association
opposes both the cropping of ears and the docking of tails when done solely for cosmetic
reasons”. The AVMA revised its policy in November 2008 to state“ The AVMA opposes
ear cropping and tail docking of dogs when done solely for cosmetic reasons. The AVMA
encourages the elimination of ear cropping and tail docking from breed standards”. An
attempt, which was supported by the AKC, to soften this statement, was turned down by
the AVMA House of Delegates. The Banfield Company, owner of over 400 animal
hospitals in the US, has recently announced that it will no longer offer tail docking or ear
trimming in their hospitals. Veterinarians who continue to provide this service to their
clients may rationalize that if they don’t, the client will either do it themselves or, have it
done by non-veterinarians causing more pain and danger to the animals. It would seem
that as long as those controlling how the dogs look, or are supposed to look, do not agree
that the procedure is inhumane and not necessary, ear cropping and tail docking are likely
to continue.
Reference: Veterinary Ethics- Animal Welfare, Client Relations, Competition and
Collegiality, Second Edition by Jerrold Tannenbaum, Mosby 1995 pg 366
9. Animal Activism - The debate concerning “rights” of animals goes on with a small
number of activists carrying out criminal activities to fight for so-called animal rights
while most, including many members of the veterinary profession, seek answers to the
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questions concerning an animal’s basic right to live free of pain and discomfort. For many
years there were thousands of veterinarians and veterinary students who were members of
American Veterinarians for Animal Rights (AVAR). In early 2008 AVAR and the
Humane Society of the US, an organization once considered by the veterinary profession
as an “animal rights” group, formed a new organization named the Humane Society
Veterinary Medical Association, whose stated mission is “To protect and advocate for
animals while providing leadership and service opportunities that support a humane
veterinary profession”. Tannenbaum states that, “The concept of animal rights is
essential in the proper identification and weighing of animal issues”. Conversation and
determination over the semantics and rightful meaning of the term “animal rights” will
surely continue to evolve within the profession. This question will certainly be discussed
in the new AVMA Animal Welfare Division and Animal Welfare specialty group (See
item 4). There will also be continued discussion in the SVME on-line class on Animal
Welfare.
References: Humane Society Veterinary Medical Association - www.HSVMA.org
Veterinary Ethics- Animal Welfare, Client Relations, Competition and Collegiality,
Second Edition - Jerrold Tannenbaum, Mosby 1995
10. Horse Slaughter – The U.S. Congress has been considering a ban on slaughter of
horses for human consumption for several years (The Prevention of Equine Cruelty Act—
H.R. 503/S. 727). Previously unwanted horses were slaughtered in the United States and
the large majority of the meat derived from the slaughter was shipped to Europe and other
places where horse meat is considered a delicacy. This Act has never been enacted but, at
the present time, all three horse slaughter operations in the United States are closed and
the number of unwanted horses transported to Mexico for slaughter has increased over
300% in recent years. Both the AVMA and American Association of Equine Practitioners
(AAEP) feel that humane slaughter is a preferable method to handle the horses that are no
longer wanted by their current owners rather than allow them to be the subject of abuse,
neglect and abandonment. It is estimated that over 100,000 unwanted horses annually
would need to find alternative care or euthanasia and disposal if horse slaughter operations
were not available somewhere. However, some states recently have indicated that would
support the presence of privately owned equine slaughterhouse and several states have
passed or proposed laws urging members of Congress to oppose legislation that interferes
with a state's ability to direct the transport or processing of horses and to support horse
processing facilities. This discussion is ongoing with strong feelings on both sides of the
issue related to the normative ethics of the individuals involved.
References and More Information on this issue see:
Equine Slaughter Debate, Society of Veterinary Medical Ethics (SVME) Newsletter, Vol.13
Issue 2, 2007.
U.S. horse slaughter exports to Mexico increase 312%, JAVMA, January 15, 2008.
Unwanted horse survey sheds light on issue’s causes, extent, JAVMA, August 15, 2009.
11. Competing models of practice – Within the last several years for-profit corporations
have purchased or created new animal hospitals and hired veterinarians to operate them
under the corporate structure. The majority ownership in most of these businesses has
been non-veterinarian. An immediate ethical concern was, would these new entities
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operate in an ethical manner as was expected of animal hospitals with veterinary
ownership? An addition to the AVMA Principles of Veterinary Medical Ethics was
created and passed by the AVMA leadership. It states “Regardless of practice ownership,
the interests of the patient, client, and public require that all decisions that affect
diagnosis, care, and treatment of patients are made by veterinarians”. Currently, this
premise has been agreed on and, as far as we can tell, followed by all of the nonveterinarian owners of the corporate practices as well as the state licensing boards, which
have legal jurisdiction over the veterinarians who provide the veterinary services in these
practices. Vigilance on the part of these licensing boards will be key in assuring that the
AVMA Principle is maintained.
Reference: Principles of Veterinary Medical Ethics of the AVMA – Section II G.
12. Changing Demographics – The demographics of the veterinary profession has
changed drastically in the last 40 years. In 1970 women comprised just 10% of veterinary
practitioners. Today female practitioners outnumber men and the AVMA predicts that by
2015 women will comprise 67% of veterinary professionals. In addition, the veterinary
practice support staff is predominately female. What does that have to do with ethics?
There are recognized gender linked differences in moral philosophy. Men and women tend
to think and speak differently when confronting ethical dilemmas. Men tend to operate
under the ethics of a justice orientation concerning themselves with issues of fairness,
rights and adherence to standards and principals while women align themselves more with
the ethics of a care orientation concerning themselves with the complexities of sustained
relationships, compassion, forgiveness and avoiding doing harm to others. It is the
author’s opinion that these differences can have a profound effect on the normative ethics
of the individuals and because of the changing demographics may create, over time, a
totally different voice of the veterinary profession regarding many of the issues being
recognized here making it extremely important that those individuals working in
veterinary practices be aware of these differences to avoid conflicts.
Reference: Demographics, moral orientation, and veterinary shortages in food animal
and laboratory animal medicine – Heather Lyons Narver, VMD, JAVMA, Vol. 230, No 12,
June 15, 2007, p 1798–1803.
13. The Ethics of Alternative Medicine - There are few legitimate certification bodies or
identifiable standards of care for alternative or so called non-evidence based veterinary
medicine such as acupuncture and chiropractic. The popularity and success of these
modalities in human medicine makes it difficult for veterinary practitioners to refuse to
offer, or at least consider offering, alternative medicine for their animal patients. In
addition many veterinary practitioners may be convinced of the effectiveness of these
modalities and offer them as part of their practice. State laws can be different but
practicing acupuncture or other alternative modalities on an animal would be determined
to be malpractice in most states if the practitioner did not have some amount of acceptable
training. There are a number of satisfactory courses to support this training. However,
the most important consideration is to properly inform the client that the service has not
been adequately studied in veterinary medicine and then getting the animal owner’s
consent to proceed under those circumstances.
Reference:
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Veterinary Medical Ethics, Second Edition, Bernard E, Rollin, PhD., Blackwell
Publishing, 2006.
14. Ethical Conflicts between General Practitioners and Board Certified SpecialistsOver the last 20 years there has been a dramatic increase in the number of specialty and
referral practices in the United States. Over 10% of the veterinarians in the U.S are board
certified and there are over 800 Specialty Practices. Certainly the quality of veterinary care
available to animals has been greatly improved because of this. However, conflicts between
the general practitioners and the board certified veterinarians are inevitable. There are
certainly different standards of care within the two types of practice. There can be conflicts
over costs of services. Are general practitioners guilty of poor ethical judgment by not
referring a case to a specialty hospital because they are concerned that their client can’t
afford the costs? Could they be guilty of malpractice if the patient died in their care if they
didn’t use their access to the specialist? Clients should be informed of the availability of
these practices by the general practitioner and be allowed to decide if they want to use the
service. After accepting the client on a referral basis, the specialist should communicate
with the general practitioner concerning the case and then gladly send the client back to the
referring practitioner for follow-up care.
The American Animal Hospital Association (AAHA) has developed Referral Guidelines
for veterinarians making the referrals and for those receiving the referral.
References: Ethical Conflicts Between General Practitioners and Board Certified
Specialist in Veterinary Medicine, Gary Block, DVM, MS, DACVIM, Proceedings 144th
AVMA Annual Meeting, Washington DC, July 2007.
Referral Guidelines – American Animal Hospital Association – Denver, CO
15. Veterinary Medicine as a Business – Veterinarians must be aware of the need to be
successful as businesses. In many places, only the successful business will survive. This
means that promotion, advertising, marketing and, most important gaining profit will be
necessary. Before the 1970s AVMA ethical guidelines determined that advertising was
unethical. Soon after that, the U.S. Federal Trade Commission challenged this and other
AVMA ethical guidelines. Now the AVMA Principles of Veterinary Medical Ethics states
“Advertising by veterinarians is ethical when there are no false, deceptive, or misleading
statements or claims”. Other sections of the AVMA Principles of Veterinary Medical
Ethics pertaining to the business of veterinary medicine will be covered in a future class.
Reference: Principles of Veterinary Medical Ethics of the AVMA Section X, B.
16. Promotion and Collegiality – Are veterinarians colleagues or competitors? Veterinary
medicine has become a large and competitive business. Will the collegiality fostered in
veterinary school and within our professional associations continue or will the ethics of
the business world where, too often, the Means Ends Ethic, which Machiavelli wrote in
1513, which states Worthwhile ends justify efficient means, that when ends are of
overriding importance or virtue, unscrupulous means may be employed to reach them,
become part of the veterinary profession? In his book Veterinary Ethics, Second Edition,
Jerold Tannenbaum writes “I believe that I can state with confidence that the ethical area
most troublesome to veterinarians relates to competition.” Although this statement was
published in 1995, today, fifteen years later, with a recession economy; increased
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competition from and between specialty practices; and non-veterinarian owned corporate
veterinary practices, the ethics of competition it is still a major concern. Tannenbaum has
provided a full chapter (Chapter 19) in his book on this subject.
Reference: Veterinary Ethics- Animal Welfare, Client Relations, Competition and
Collegiality, Second Edition, Jerrold Tannenbaum, Mosby 1995, p 274.
What has been provided here is no more than a sampling of the many issues involved in
the provision of veterinary care today that has ethical roots or consequences. Anyone
involved in that care should understand these, and other issues, as well as understand how
their normative ethics and those of others involved in the care will and can differ.
Final Class Evaluation - To complete this class, write an essay of 500 words or more
based on what is given here, as well as additional research, on any one of the sixteen
subjects listed above. Your essay should result in a conclusion on your part but should
contain both pro and con arguments determining how you reached your conclusion. Email
your essay, prepared in MS Word or Adobe to jmccarthy1952@cs.com.
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