Reconciling Autonomy and Beneficence in Treatment Decision-Making for Companion Animal Patients

Opinions of Turkish veterinarians on the termination of unwanted pregnancies in dogs

BACKGROUND

No time constraints exist in Turkish veterinary law regarding the termination of unwanted pregnancies in dogs. Having undergone limited ethical debate, opinions on this issue vary among veterinarians. This study aimed to determine appropriate indications accepted by veterinary practitioners for the termination of unwanted pregnancies in dogs and the cut-off point preferred by these professionals for performing this medical and surgical intervention.

METHODS

A qualitative methodology was used for the collection of the data. Interviews were conducted with 40 veterinarians (13 practitioners and 27 academics).

RESULTS

The main reasons for performing pregnancy termination were 'institutional obligations' and 'demand of the animal owner'. Meanwhile, the cut-off points for veterinarians were 'possibility of pregnancy', 'implantation/diagnosability/visibility', 'heartbeat' and 'viability'.

LIMITATIONS

The inclusion of ethics experts among the authors may have caused bias in the comments of the participants on ethical issues.

CONCLUSION

The fact that animals are legally relegated to the custody of humans not only adds a unique character to the veterinary ethical debate but also creates a comfort zone for veterinarians not willing to examine compelling ethical issues.

The autonomy principle in companion veterinary medicine: A critique

Following developments in human medical ethics, veterinary ethics has similarly shifted from a historic paternalistic approach, toward greater respect for autonomy. Veterinarians operate within a tripartite system where there is separation of doctor/patient dyad by animal owners. As such there are fundamental differences between veterinary and human medical sectors regarding application of the autonomy principle—specifically, to whom is autonomy afforded? This paper argues that the accepted transference of autonomy to owners constitutes a corruption of the principle. Privileges owners exercise over animal treatment decisions relate to their rights over property use, rather than application of self-rule over one's own person as described in bioethics literature. To highlight issues with the status quo, this paper outlines the negative consequences of “owner autonomy” on animal (patient) welfare, integrity of the veterinary profession's social contract and professional autonomy. A way forward is proposed that places greater emphasis on animal (patient) welfare being explicitly at the center of veterinary treatment decision-making via recognition that all such decisions are made by a proxy, and therefore more appropriate frameworks ought to be engaged, such as a best interests paradigm.

When research animals become pets and pets become research animals: care, death, and animal classification

This paper explores what happens to care, and decisions about ending and extending life, when research animals become pets and pets become research animals. To do this, we draw on in-depth qualitative research on (i) rehoming of laboratory animals, (ii) veterinary clinical research, and (iii) the role of the Named Veterinary Surgeon (NVS) in UK animal research. We begin by exploring how (in theory and practice) the ethical, affective, and practical elements of care are split in the research laboratory. We then investigate arguments for and against ending and extending animal life via clinical research and rehoming, highlighting how these activities bring norms and dilemmas around animal death in the laboratory and veterinary clinic to the fore. We conclude by demonstrating the value of investigating borders between animal categories for understanding dilemmas around care and death, and for contributing to emerging literatures within geography around animal care, death, and categorisation. Key contributions of our work include highlighting: how care roles can be split; the importance of considering speculative and in-practice elements of care; the context-dependency and multiplicity of practices of killing in the veterinary clinic and laboratory; and the flexibility and changing nature of animal categories.

Researching consent in veterinary practice: The use of interpretive description as a multidisciplinary methodology

Informed consent in the veterinary sphere has been surprisingly under-researched, despite it being a professional ethical requirement. As consent is given by animal owners on behalf of patients who are unable to consent for themselves, its underpinning ethical basis cannot exactly mirror consent given by adult human patients with capacity. Any attempt to research consent in the veterinary context requires consideration of its legal, ethical and practical applications. This investigation of consent practices in veterinary settings in the United Kingdom was undertaken using interpretation of medicolegal cases, together with three discrete empirical studies comprising the textual analysis of consent forms, consent discussions for the elective neutering of companion animal patients, and interviews with key participants in the consent process. The chosen approach required a methodology that would facilitate triangulation between empirical data analysis and doctrinal legal research. Here, I describe the first use of interpretive description as a methodology of veterinary socio-legal studies, in the context of practice-based research. With foundations in traditional social science methodologies such as hermeneutics, grounded theory, ethnography and symbolic interactionism, interpretive description provided a multi-disciplinary methodological perspective. Its underpinning methodologies informed the methods that were used for data collection, and for subsequent analysis. I combined interpretation of legal decisions and professional ethical guidance with thematic surveys of empirical data to reach higher levels of analysis. The resulting conceptual description of consent in veterinary practice enabled the production of normative guidance appropriate for those in practice, thus fulfilling the methodological aims of interpretive description. Specifically, the key findings were that the consent form should act as a fuller record of the consent discussion, that attention should be paid to achieving an appropriate balance between client autonomy and patient ‘best interests’ and that consent should provide protection to all three parties (client, patient and veterinary professional).

Legal and Ethical Aspects of 'Best Interests' Decision-Making for Medical Treatment of Companion Animals in the UK

Simple Summary

Making decisions about medical treatment for animal patients involves two key decision-makers, the animal owner and the veterinary surgeon. We aim to show that these decisions should and can be based on the ‘best interests’ of the animal, with both human decision-makers acting as advocates for the animal requiring treatment. We suggest that the role of the animal owner is similar to that of a parent in making decisions for a child, drawing on legal cases to demonstrate the limits of parental (and owner) decision-making. To provide a firmer basis for ‘best interests’ decision-making, we adapt the factors included in the United Nations Convention on the Rights of the Child and demonstrate how these could be used with a typical clinical situation. Finally, we analyse the decisions from an ethical point of view.

Abstract

Medical decisions for young children are made by those with parental responsibility, with legal involvement only if the decision is potentially detrimental to the child’s welfare. While legally classified as property, some argue that animals are in a similar position to children; treatment decisions are made by their owners, posing a legal challenge only if the proposed treatment has the potential to cause harm or unnecessary suffering, as defined by animal protection legislation. This paper formulates the approach to a ‘best interests’ calculation, utilising the factors included in the United Nations Convention on the Rights of the Child and relying on exchange of information between the human parties involved. Although this form of decision-making must primarily protect the animal from unnecessary suffering, it recognises that the information provided by the owner is critical in articulating the animal’s non-medical interests, and hence in formulating what is in the animal’s best overall welfare interests. While statute law does not mandate consideration of ‘best interests’ for animals, this approach might reasonably be expected as a professional imperative for veterinary surgeons. Importantly, this version of a ‘best interests’ calculation can be incorporated into existing ethical frameworks for medical decision-making and the humane treatment of animals.

Animals, veterinarians and the sociology of diagnosis

While sociologists of medicine have focused their efforts on understanding human health, illness, and medicine, veterinary medical practice has not yet caught their attention in any sustained way. In this critical review article, we use insights from the sociology of diagnosis literature to explore veterinary practice, and aim to demonstrate the importance of animals to sociological understandings of health, illness and disease. As in human medicine, our analysis shows the importance of diagnosis in creating and maintaining the power and authority of the veterinary professional. However, we then explore how diagnosis operates as a kind of dance, where professional authority can be challenged, particularly in light of the complex ethical responsibilities and clinical interactions that result from the triad of professional/owner/animal patient. Finally, we consider diagnosis via the precept of entanglement, and raise the intriguing possibility of interspecies health relations, whereby decision-making in human health care may be influenced by experiences in animal health care and vice-versa. In our conclusion, we argue that this analysis provides opportunities to scholars researching diagnosis in human health care, particularly around the impact of commercial drivers; has implications for veterinary and public health practitioners; and should help animate the emerging sociology of veterinary medicine.