Moral distress in veterinarians

Survey on Psychosocial Conditions of Official Veterinarians in Germany: Comparison with Other Professions and Differences between Age Groups, Gender, and Workplace Characteristics

BACKGROUND

Even though the mental health of veterinarians has raised concerns, little is known about the wellbeing of official veterinarians ensuring animal welfare, food safety, and control of infectious diseases and performing other tasks for veterinary public health. Therefore, the aim of this study was to assess the psychosocial conditions of official German veterinarians and to compare them with those of other employees.

METHODS

An online survey was conducted including 82 items of the Copenhagen Psychosocial Questionnaire (COPSOQ III) and additional questions on workplace and demographics.

RESULTS

The answers of 838 respondents were analyzed, representing 26% of the target population. The average values for the dimensions Quantitative Demands, Emotional Demands, and Burnout Symptoms were substantially higher than those for German employees in other professions. Official veterinarians mainly working in animal welfare frequently experienced physical violence (6.7%) or threats of violence (53%). However, the profession also provides advantages: official veterinarians reported higher average values concerning the dimensions Control over Working Time and Influence at Work than other employees. Most participants stated that they experienced their work as meaningful, and the Job Insecurity dimension was low.

CONCLUSIONS

Official veterinarians frequently experience offensive behavior and high-level demands. Therefore, measures to support and protect official veterinarians are needed. The positive aspects of this job should be emphasized to recruit and retain veterinarians in this field of the profession.

Life tables of annual life expectancy and risk factors for mortality in cats in the UK

OBJECTIVES

The aims of the present study were to generate the first life tables for the UK companion cat population overall as well as broken down by sex and breed status, and to quantify associations between mortality and traits such as sex, neuter status, breed status and body weight in relation to mortality.

METHODS

Life table construction and modelling included data on 7936 confirmed deaths in cats under primary veterinary care at clinics participating in the VetCompass Programme in 2019. The life tables were built for cats overall, female and male cats, and crossbred and purebred cats. Multivariable generalised linear regression models were generated to explore the risk factors for a shortened lifespan.

RESULTS

Life expectancy at age 0 for UK companion cats overall was 11.74 years (95% confidence interval [CI] 11.61-11.87). The probability of death at each year interval increased with age from year interval 3-4, with the probability value not exceeding 0.05 before year 9. Female cats (12.51 years; 95% CI 12.32-12.69) had a 1.33-year longer life expectancy than male cats (11.18 years; 95% CI 11.01-11.38) at age 0. Among the 12 breeds (including crossbred) analysed, Burmese and Birman had the longest life expectancy at year 0, showing 14.42 years (95% CI 12.91-15.93) and 14.39 years (95% CI 12.87-15.91), respectively. Sphynx had the shortest life expectancy at year 0 among the analysed breeds at 6.68 years (95% CI 4.53-8.83). Being entire, purebred and with a non-ideal body weight were significantly linked to a decreased lifespan.

CONCLUSIONS AND RELEVANCE

The life tables presented here for companion cats in the UK overall, by sex, and by crossbred and purebred cats can contribute to a better understanding of the life trajectory of cats, helping with evidence-based decision-making for cat owners and the veterinary profession. We have also provided an updated life expectancy at age 0 for various cat breeds for 2019 and showed evidence of the association between non-ideal weight and a decreased lifespan.

Moral distress measurement in animal care workers: a systematic review

OBJECTIVES

The mental health of veterinary and other animal health professionals is significantly impacted by the psychological stressors they encounter, such as euthanasia, witnessing animal suffering and moral distress. Moral distress, initially identified in nursing, arises when individuals are aware of the right action but are hindered by institutional constraints. We aimed to review existing research on moral distress scales among animal care workers by focusing on the identification and psychometric validity of its measurement.

DESIGN

Two-step systematic review. First, we identified all moral distress scales used in animal care research in the eligible original studies. Second, we evaluated their psychometric validity, emphasising content validity, which is a critical aspect of patient-reported outcome measures (PROMs). This evaluation adhered to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). The results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

DATA SOURCES

PubMed, EMBASE and PsycINFO to search for eligible studies published between January 1984 and April 2023.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included original (primary) studies that (1) were conducted in animal care workers; (2) describing either the development of a moral distress scale, or validation of a moral distress scale in its original or modified version, to assess at least one of the psychometric properties mentioned in COSMIN guidelines.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers used standardised methods to search, screen and code included studies. We considered the following information relevant for extraction: study reference, name and reference of the moral distress scale used, psychometric properties assessed and methods and results of their assessments. The collected information was then summarised in a narrative synthesis.

RESULTS

The review identified only one PROM specifically adapted for veterinary contexts: the Measure of Moral Distress for Animal Professionals (MMD-AP), derived from the Measure of Moral Distress for Healthcare Professionals (MMD-HP). Both MMD-HP and MMD-AP were evaluated for the quality of development and content validity. The development quality of both measures was deemed doubtful. According to COSMIN, MMD-HP's content validity was rated as sufficient, whereas MMD-AP's was inconsistent. However, the evidence quality for both PROMs was rated low.

CONCLUSION

This is the first systematic review focused on moral distress measurement in animal care workers. It shows that moral distress is rarely measured using standardised and evidence-based methods and that such methods should be developed and validated in the context of animal care.

PROSPERO REGISTRATION NUMBER

CRD42023422259.

Exploring the role of personality, perfectionism, and self-compassion on the relationship between clinical decision-making and nurses' wellbeing

BACKGROUND

Clinical decision-making is a core competency of the nursing role, with nurses having to make decisions surrounding patient care and patient safety daily. With decision-making being linked to psychological outcomes, it is important to consider potential areas that may support or hinder nurses' wellbeing whilst navigating clinical decisions.

AIM

The present study sought to investigate the relationship between clinical decision-making and moral distress, and further explore the role of personality, perfectionism, philotimo (a virtue describing the desire to do right by oneself and others, aligning with one's sense of morality), and self-compassion.

DESIGN

An online cross-sectional survey was conducted using Qualtrics. Associations between clinical decision-making and moral distress, burnout, personality, perfectionism, philotimo, and self-compassion were examined using univariate and multivariate statistics.

METHODS

One hundred and forty-three nurses from the United Kingdom completed an online questionnaire. Eligibility criteria included individuals who had practised in the nursing profession for a minimum of six months. To ensure that all participants were practising across the United Kingdom, the eligibility criteria was made clear in the study advertisement, and the consent form. The consent form required participants to confirm that they reached these criteria to proceed with the study.

RESULTS

Results revealed that clinical decision-making was associated with moral distress experience, and that both openness to experience, and philotimo mediated this relationship, independently. In addition to this, self-compassion was significantly associated with clinical decision-making across senior banded nursing roles, but this was non-significant for junior banded nursing roles.

CONCLUSION

Findings highlight the role of individual differences when looking at the impact of clinical decision-making upon nurses' wellbeing and offers explanation for any variance in moral distress experience across nursing professionals. This research identifies fundamental differences between junior and senior nurses in relation to clinical decision-making and self-compassion that should be considered in future research.

Veterinarian-Chasing A Dream Job? A Comparative Survey on Wellbeing and Stress Levels among European Veterinarians between 2018 and 2023

Whilst recognizing the abundantly positive aspects within the different domains of the veterinary profession, the challenging socio-economic and cultural working climate has been identified as a source of veterinary mental wellbeing issues. This mixed methods study provides an overview of the mental state of veterinarians across Europe via two cross-sectional surveys in 2018/2019 (n = 14,559 veterinarians) and in 2022/2023 (n = 12,393 veterinarians). Mental wellbeing was assessed using 3 indicators: self-reported stress levels, the need for medical leave due to reduced mental wellbeing (22% and 23%, resp., in 2018/2019 and 2022/2023) and the seven-question Warwick-Edinburgh Mental Wellbeing Scale (2018/2019: 25, 2022/2023: 24.8). In both surveys, important differences were spotlighted between countries, but early-career veterinarians and female veterinarians were most at risk of decreased mental wellbeing all over Europe for all indicators. In conclusion, stress levels and need for medical leave due to reduced mental wellbeing remained at comparatively high levels across the two surveys and standardized mental wellbeing scores remained equally low. Notwithstanding the increased attention given to veterinary wellbeing in the last decade, our results underline that major efforts remain necessary, by creating more supportive and attractive workplaces that prioritize wellbeing, a good work/life balance, and providing job satisfaction.

Attending veterinarians improve the research capability and psychological well-being of researchers in animal research institutes

The use of laboratory animals in biomedical research has significantly advanced scientific understanding, yet it raises ethical concerns about animal welfare and the mental health of researchers Recent research has highlighted the potential for stress and compassion fatigue among researchers working with distressed animals. Attending veterinarians (AVs) are crucial in mitigating the pain and stress experienced by animals and, by extension, researchers. However, the impact of AVs on researchers' psychological well-being remains understudied. This study explores how AVs contribute to researchers' research capability and psychological well-being in animal research institutions. AVs oversee animal housing, health, and welfare; their involvement is mandated or strongly recommended in developed countries. AVs enhance animal welfare by ensuring proper housing, nutrition, and social interaction. They monitor animal health, educate researchers on pain assessment, and promote compliance with post-surgical care. AVs also contribute to researchers' well-being by addressing euthanasia procedures, which can be emotionally challenging. Programs for rehoming animals after experiments offer an alternative to euthanasia and positively impact researchers' psychological well-being. Moreover, AVs promote workplace well-being by fostering positive workplace cultures, offering peer counseling, and providing social support. Programs considering animal welfare and researchers' emotions are crucial for a healthy research environment. In conclusion, AVs are essential in balancing scientific progress with animal welfare and researchers' psychological well-being. Therefore, their role should be recognized as vital in achieving social equity that considers the welfare of humans and laboratory animals.

Euthanasia of animals - association with veterinarians' suicidal thoughts and attitudes towards assisted dying in humans: a nationwide cross-sectional survey (the NORVET study)

BACKGROUND

Veterinarians are an occupational group with an increased suicide risk. Euthanasing animals may influence both veterinarians' views on assisted dying in humans and their suicide risk. We investigated (I) attitudes towards assisted dying, (II) whether the field of work and the frequency of euthanasing animals were associated with positive attitudes towards human euthanasia, and (III) whether frequently euthanasing animals was associated with serious suicidal thoughts.

METHODS

We conducted a nationwide cross-sectional study among veterinarians in Norway (response rate: 75%). Logistic regression models were used to calculate the odds ratios for both positive attitudes towards human euthanasia and serious suicidal thoughts. The analyses were adjusted for socio-demographic and work-related factors.

RESULTS

Fifty-five percent of the veterinarians agreed that euthanasia should be permitted for humans with a fatal disease and short life expectancy. Working with companion animals was independently associated with positive attitudes towards human euthanasia (OR = 1.66 (95% CI: 1.23-2.23)), while veterinarians' frequency of euthanasing animals was not. Frequency of euthanasing animals was independently associated with serious suicidal thoughts, OR = 2.56 (95% CI: 1.35-4.87).

CONCLUSIONS

Veterinarians' attitudes towards assisted dying in humans did not differ from those of the general population. Veterinarians' frequency of euthanasing animals was not associated with positive attitudes towards euthanasia in humans. However, veterinarians working in companion animal practices were more likely to have positive attitudes towards euthanasia in humans. Moreover, euthanising animals five times or more a week was associated with serious suicidal thoughts. We need more research to infer about causality in these findings.

Hong Kong veterinarians' encounters with client-related stress - a qualitative study

Aims

Limited research has explored the stressors experienced by veterinarians in East Asia. Metropolitan cities like Hong Kong may have overlooked factors that significantly contribute to veterinarians' stress. This paper examines how client-related stressors and contextual factors contribute to the stress levels of Hong Kong-based veterinarians.

Methods

Veterinarians from small domestic animal practices in Hong Kong were recruited using purposive and targeted snowball samplings until thematic saturation was achieved. Semi-structured in-depth interviews were conducted, audio-recorded, transcribed, coded, and analysed using reflexive thematic analysis with an interpretivist paradigm based on Heidegger's phenomenological approach.

Results

A total of 18 participating veterinarians described the expectations of and communication with the animal-health enthusiast (AHE) community, including clients, pet owners, and animal lovers, as their primary source of stress. Discrepant expectations and miscommunication between the AHE and veterinary communities, along with contextual factors, such as convenience in clinic switching, negative online reviews, and the relatively short history of the veterinary profession in the multilingual city, were identified as contributing factors to their stress. Recent socio-political events and the pandemic further intensified societal emotions, leading some clients to project frustrations onto perceived authority figures, including health professionals.

Conclusion

The study highlights that client-related stress extends beyond the health of animal patients, encompassing the expectations of the AHE community, which requires professional-level communication skills to build a mutually respectful three-party relationship. Besides, Hong Kong's unique contextual and historical factors subtly but chronically impact veterinary practices, which can be easily overlooked. Recognising these influences and how they interact is crucial for collaboration, within and beyond the profession, at the policy level to improve veterinary training and practices.

Implications

Our findings highlight the importance of expectation management and improving communication quality to foster healthy relationships among animals, the AHE community, and veterinary professionals. These efforts are believed to alleviate veterinarians' stress and enhance the well-being of all parties involved. We recommend incorporating effective communication and self-care discussions into the veterinary curriculum and advocating ongoing training for practising veterinarians. At the community level, encouraging open dialogues between animal caregivers and veterinary professionals can help address expectation discrepancies.

The moral deliberation pathway in veterinary practice: a qualitative study

BACKGROUND

Veterinarians may face various ethical decisions and potential moral conflicts in clinical practice. The ethical decision-making process often leads to a satisfying resolution. However, when such a process is accompanied by a perceived inability to act according to a person's values, it can lead to psychological distress that characterises moral distress. Theoretical models in professions such as nursing attempt to explain the evolution of moral conflict into moral distress. In veterinary professionals, a model has been proposed to explain this pathway (the moral deliberation pathway). However, empirical data are still lacking on whether veterinary clinicians experience a moral deliberation pathway as hypothesised.

METHODS

Using thematic analysis, this qualitative study investigates veterinary clinicians' experiences with moral distress and aims to explain the moral deliberation pathway in these veterinarians.

RESULTS

The results suggest that veterinarians' experiences with moral distress follow a deliberation process that can be explained by the proposed moral deliberation pathway. Experiencing a moral conflict leads to moral stress, then either to moral distress or resolution into moral comfort.

LIMITATIONS

Self-selection of participants and possible recollection bias may have biased the findings.

CONCLUSIONS

The empirical data provided by this study can inform future research and intervention strategies to identify, measure and manage moral distress in the veterinary context.

A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors

Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.

Suicide in veterinary medicine: A literature review

Veterinarians are commonly exposed to occupational stressors, including excessive workload and financial constraints. These stressors can lead to psychological distress, which typically results in mental health disorders such as depression, anxiety, and burnout and can even culminate in suicide attempts or suicide deaths. Risk factors associated with poor mental health and high rates of suicide in veterinary practitioners include continuous exposure to challenging scenarios, such as interpersonal conflicts, performing euthanasia, and easy access to lethal means of suicide, such as opioids and anesthetics. The previous studies highlight the urgent need for a better understanding of predisposing factors, mental health-related improvements in the professional environment, and the subsequent establishment of primary mental health-related care policies. Effective ways to promote mental health and prevent suicide may include social support, resilience, developing coping skills, promoting a healthy work environment, and discouraging perfectionist behaviors. This review aimed to summarize findings in studies that have investigated mental health and suicide in veterinarians and veterinary students and highlight measures that could be implemented as options for mental health promotion and suicide prevention.

"What If It Was Your Dog?" Resource Shortages and Decision-Making in Veterinary Medicine-A Vignette Study with German Veterinary Students

The here presented vignette study was part of a survey on ethical judgement skills among advanced veterinary students at the University of Veterinary Medicine Hannover, Foundation. The vignette describes a fictitious dilemma in veterinary practice due to medication supply shortages. First, the students should make an ethically justified decision: who of the two patients in the waiting room gets the last dosage of a medication. Important factors were the animal patients' characteristics (age, state of health, life expectancy), the patient owners' wellbeing, and context-related criteria. Second, the students were asked for decisional changes if one of the patients was their own dog. They reacted in four different ways: (1) for a professional, this should not make a difference; (2) most likely being "egoistic" and preferring their own dog; (3) giving the medication to the other dog; and (4) avoiding a decision. Finally, the students judged a list of possible solutions to the dilemma on a 9-point scale. They preferred patient-related criteria to patient-owner-related criteria in this task. In the overall results, it became obvious that no "gold standard" or guidelines for situations of medication shortages exist, yet, which presents an important subject for future research and veterinary ethics teaching.

Moral distress in rural veterinarians as an outcome of the Mycoplasma bovis incursion in southern New Zealand

AIMS

To gain insight into the world of rural veterinarians during the Mycoplasma bovis incursion within southern Aotearoa New Zealand by exploring their experiences during the incursion, and to understand the consequences, positive and negative, of these experiences.

METHODS

A qualitative social science research methodology, guided by the philosophical paradigm of pragmatism, was used to collect data from an information-rich sample (n = 6) of rural veterinarians from Otago and Southland. Interview and focus group techniques were used, both guided by a semi-structured interview guide. Veterinarians were asked a range of questions, including their role within the incursion; whether their involvement had any positive or negative impact for them; and their experience of conflicting demands. Analysis of the narrative data collected was guided by Braun and Clarke's approach to reflexive thematic analysis.

RESULTS AND FINDINGS

All six participants approached agreed to participate. Analysis of the data provided an understanding of the trauma they experienced during the incursion. An overarching theme of psychological distress was underpinned by four sub-themes, with epistemic injustice and bearing witness the two sub-themes reported to be associated with the greatest experience of psychological distress. These, along with the other two identified stressors, led to the experience of moral distress, with moral residue and moral injury also experienced by some participants.

CONCLUSIONS

Eradication programmes for exotic diseases in production animals inevitably have an impact on rural veterinarians, in their role working closely with farmers. Potentially, these impacts could be positive, recognising and utilising veterinarians' experience, skills and knowledge base. This study, however, illustrates the significant negative impacts for some rural veterinarians exposed to the recent M. bovis eradication programme in New Zealand, including experiences of moral distress and moral injury. Consequently, this eradication programme resulted in increased stress for study participants. There is a need to consider how the system addresses future exotic disease incursions to better incorporate and utilise the knowledge and skills of the expert workforce of rural veterinarians and to minimise the negative impacts on them.

CLINICAL RELEVANCE

To date, the experience of moral distress by rural veterinarians during exotic disease incursions has been under-reported globally and unexplored in New Zealand. The findings from this study contribute further insights to the existing limited literature and provide guidance on how to reduce the adverse experiences on rural veterinarians during future incursions.

ABBREVIATIONS

MPI: Ministry for Primary Industries; PITS: Perpetration-induced traumatic stress; PTSD: Post-traumatic stress disorder.

Mass Depopulation of Swine during COVID-19: An Exploration of Swine Veterinarians' Perspectives

Simple Summary

This study was designed to better understand the mental health of U.S. swine veterinarians who were involved in the mass depopulation events related to COVID-19. A total of 25 swine veterinarians, participants from a larger quantitative study, volunteered to be interviewed about their experiences related to the COVID-19 mass depopulation event. The themes that arose from these interviews included: (1) the need to be better prepared for crisis events; (2) lack of public understanding; (3) moral distress; (4) empathy for others, especially young veterinarians; (5) sources of support; (6) pride, honor and gratitude; and (7) an overarching theme of emotional distancing and detachment—concerns external to one’s own mental health. Based on these results, we recommend additional training and supportive services for those who might be involved in future depopulation efforts.

Abstract

This qualitative study (n = 25) was created to better understand the mental health of U.S. swine veterinarians who were involved in the mass depopulation events related to COVID-19. A total of 25 swine veterinarians, participants in a previous larger quantitative study, volunteered to be interviewed about their experiences related to the COVID-19 mass depopulation event. Themes that emerged from these interviews included: (1) the need to be better prepared for crisis events; (2) lack of public understanding; (3) moral distress; (4) empathy for others, especially young veterinarians; (5) sources of support; (6) pride, honor and gratitude; and (7) an overarching theme of emotional distancing and detachment—concerns external to one’s own mental health. Based on our results, we recommend additional training and supportive services for those who might be involved in future depopulation efforts. Additionally, we suggest that the veterinary profession prioritize public education campaigns to help the public better understand the need for depopulation.

“There Was a Sense That Our Load Had Been Lightened”: Evaluating Outcomes of Virtual Ethics Rounds for Veterinary Team Members

Clinical ethics support services (CESS) are employed in healthcare to improve patient care and help team members develop skills to recognize and navigate ethically challenging situations (ECS). The objective of this study was to evaluate the impact of ethics rounds, one form of CESS, on veterinary team members. An anonymous, online mixed-methods survey incorporating a 15-item instrument designed to assess the outcomes of moral case deliberation originally developed for human healthcare workers (the Euro-MCD 2.0), was developed. The survey was administered to veterinary team members prior to and following participation in a 90-min virtual ethics rounds session. A total of 23 sessions of virtual ethics rounds were held. In total, 213 individuals participated, and 89 completed both surveys (response rate 41.8%). Most respondents were female (n = 70, 81%). Most were veterinarians (n = 51, 59%), followed by other veterinary team members (practice manager, animal attendant) (n = 18, 21%), veterinary nurses or animal health technicians (n = 10, 12%) and veterinary students (n = 8, 9%). Age ranged from 20 to 73 (median 41, IQR 32–52, n = 87). While there was no statistically significant difference between overall modified Euro-MCD 2.0 scores between T1 and T2, there were statistically significant changes in 7 out of 15 Euro-MCD 2.0 items in the domains of moral competence and moral teamwork. Reflexive thematic analysis of free-text responses identified themes including the types, impact and barriers to resolving ECS, the impacts of ethics rounds on veterinary team members and constraints preventing veterinary team members from speaking up in the face of ECS. While participants largely described the impact of ethics rounds as beneficial (for example, by facilitating clarification of thinking about ECS, allowing participants to see ECS from the perspective of others and providing a safe space for discussion), reflecting on ECS could be stressful for participants. Active participation in ethics rounds may be inhibited in the context of power imbalance, or in settings where bullying occurs. Overall, carefully facilitated ethics rounds has the potential to improve the ability of veterinary team members to identify and navigate ECS, and potentially mitigate moral distress.

Medical futility is commonly encountered in small animal clinical practice

OBJECTIVE

To document veterinarians' perceptions and understanding of medical futility and determine the frequency with which medical futility occurs in small animal practice.

SAMPLE

477 veterinarians in small animal general and specialty veterinary practice.

PROCEDURES

A cross-sectional study was performed with a 25-question, web-based, confidential, anonymous survey distributed through various professional veterinary specialty associations.

RESULTS

Nearly all respondents (469/474 [99.0%]) believed that futile care occurs in veterinary medicine, and 42.4% (201/474) felt it occurred commonly (> 6 times/y). A similar percentage (471/475 [99.2%]) reported encountering futile care within their careers, and 85.0% (402/476) reported encountering it within the past year. A majority (293/477 [61.4%]) reported witnessing futile care occurring in both inpatient and outpatient settings. Most respondents disagreed or strongly disagreed (320/463 [69.1%]) with a statement that providing futile care is always wrong, and only 38 (8.2%) agreed or strongly agreed. Over 70% (329/464 [70.9%]) of respondents agreed that there are situations in which provision of futile care is appropriate.

CLINICAL RELEVANCE

The importance of reaching a consensus definition for medical futility in veterinary medicine is evident given the frequency with which such care is being provided. Most small animal specialist veterinarians will encounter futile care, and the establishment of an ethical framework to navigate questions surrounding medical futility may help reduce moral distress.

Applied Animal Ethics in Industrial Food Animal Production: Exploring the Role of the Veterinarian

Industrial food animal production practices are efficient for producing large quantities of milk, meat, and eggs for a growing global population, but often result in the need to alter animals to fit a more restricted environment, as well as creating new animal welfare and health problems related to animal confinement in high densities. These practices and methods have become normalized, to the extent that veterinarians and others embedded in these industries rarely question the ethical challenges associated with raising animals in this fashion. Moral ‘lock-in’ is common with those working in food animal industries, as is the feeling that it is impossible to effect meaningful change. Animal welfare issues associated with the industrialization of food animal production are ‘wicked problems’ that require a multi- and transdisciplinary approach. We argue that veterinarians, as expert animal health and welfare advocates, should be critical stakeholders and leaders in discussions with producers and the food animal sector, to look for innovative solutions and technology that will address current and future global sustainability and food security needs. Solutions will necessarily be different in different countries and regions, but ethical issues associated with industrial food animal production practices are universal.

Assessing Moral Judgements in Veterinary Students: An Exploratory Mixed-Methods Study from Germany

Simple Summary

On the one hand, veterinary ethics is a required part of veterinary education. On the other hand, the success of ethics teaching and the students’ skills concerning judgements in morally demanding situations are hardly evaluated systematically. This article presents an innovative tool to evaluate those skills in veterinary students in a first case of application. One group of students in this case had taken ethics classes, the other had not. The participants were asked to fill in a questionnaire with different scenarios from veterinary practice and answer additional free-text questions. Students who had taken ethics classes did not answer generally different from those students who had not taken ethics classes. However, there were many overall differences between the students’ answers, decisions, attitudes, and explanations. The tool is therefore suggested for further evaluations of ethics teaching and moral judgement skills in veterinary students.

Abstract

Although veterinary ethics is required in veterinary curricula and part of the competencies expected of a trained veterinary surgeon according to the European Association of Establishments for Veterinary Education (EAEVE), knowledge concerning the effects of ethics teaching and tools evaluating moral judgement are scarce. To address this lack of tools with a mixed-methods approach, a questionnaire with three case scenarios presenting typical ethical conflicts of veterinary practice was administered to two groups of veterinary students (one had taken ethics classes, one did not). The questionnaire contained both open-ended and closed questions and was analysed qualitatively and quantitatively. The qualitative part aimed at revealing different argumentation patterns between the two groups, whereas the quantitative part focused on the students’ approval of different roles and attitudes possibly relating to veterinarians. The results showed no major differences between both groups. However, answering patterns suggest a clear diversity among the students in their perception of morally relevant factors and the veterinary profession. Awareness of morally challenging elements of their profession was presented by students of both groups. With this exploratory study, the application of an innovative mixed-methods tool for evaluating the moral judgement of veterinary medical students is demonstrated.

Low and No-Contact Euthanasia: Associated Ethical Challenges Experienced by Veterinary Team Members during the Early Months of the COVID-19 Pandemic

Simple Summary

During the COVID-19 pandemic, many veterinary practices have been required to move to a low or no-contact consultation model to minimise the risk of SARS-CoV-2. Utilising data from a global survey, we explored the experiences of veterinary team members performing low and no-contact euthanasia during the early months of the COVID-19 pandemic. We found that low and no-contact euthanasia were encountered as common and/or stressful ethical challenges in the pandemic. In order to minimise the potential negative impacts of low and no-contact euthanasia on veterinary team members, clients and animal patients, there is a need for a toolkit of protocols to assist veterinary team members in provision of low-contact euthanasia, and avoidance of no-contact euthanasia wherever possible.

Abstract

Background: During the ongoing COVID-19 pandemic, many veterinary practices around the world have shifted to a low or no-contact consultation model to ensure the safety of their team members and clients, and comply with public health orders, while continuing to provide veterinary care. Methods: We performed reflexive thematic analysis on a subset of data collected using a mixed-methods survey of veterinary team members globally. Results: There were 540 valid responses available for analysis. Low and no-contact euthanasia we raised as a common and/or stressful ethical challenge for 22.8% of respondents. We identified five key themes: no-contact euthanasia as a unique ethical challenge; balancing veterinary team safety with the emotional needs of clients; low and no-contact protocols may cause or exacerbate fear, anxiety and distress in veterinary patients; physical distancing was more challenging during euthanasia consultations; and biosecurity measures complicated communication around euthanasia and end-of-life decision making. Recommendations: In light of concerns highlighted by respondents, we recommend the development of a toolkit of protocols that will assist veterinary team members in performing low-contact euthanasia in a range of circumstances, in alignment with their values and professional ethical codes. Professional bodies may be involved in developing, updating and disseminating this information, and ensuring a continuous supply chain of PPE.

What Would You Do? Types of Ethical Challenging Situations Depicted in Vignettes Published in the Veterinary Literature from 1990 to 2020

Veterinary team members encounter a wide range of ethically challenging situations (ECS) in their work. Inability to resolve ECS in accordance with their values may negatively impact the wellbeing of veterinary team members. We sought to determine the types of ECS described in published ethical vignettes in the veterinary literature. We performed a strategic literature search, followed by a thematic analysis of vignettes published in the veterinary literature from 1990–2020. We identified 567 published vignettes in 544 publications. In the majority of vignettes, the protagonist was a veterinarian (61.6%) and the most common categories of animal involved were dogs (28.0%), livestock in general (10.8%), and cattle (10.6%). The primary type of ECS was coded for each scenario, generating 29 themes. These findings extend knowledge about types of ECS that may be encountered by veterinary team members. These themes can help to inform curricula and better prepare veterinary team members to navigate ECS. They may also highlight factors that contribute to ECS that can be addressed on a broad scale, such as through regulation, continuing professional development, or stakeholder education. Knowing that others may experience similar ECS may help veterinary team members feel part of a moral community.

Social Workers in Animal Shelters: A Strategy Toward Reducing Occupational Stress Among Animal Shelter Workers

Animal shelter workers (ASWs) are at disproportionate risk of moral injury, secondary trauma, compassion fatigue, and burn-out. While there is an emerging body of literature developing on understanding the nuances of these experiences for ASWs, little work has been done on developing strategies to ameliorate occupational stressors and the negative effects of such for ASWs. Within this paper, occupational risks and protective factors for ASWs are summarized, and the emergence of social work within animal shelter settings as one strategy for helping to ameliorate the occupational stress experienced by ASWs is delineated.

Risk Factors Associated With Increased Ethically Challenging Situations Encountered by Veterinary Team Members During the COVID-19 Pandemic

Ethically challenging situations (ECS) are commonly encountered in veterinary settings. The number of ECS encountered by some veterinary team members may increase during a crisis, such as the COVID-19 pandemic. This study aimed to determine the risk factors for experiencing an increase in the frequency of ECS in the months following the beginning of the COVID-19 pandemic, utilizing data from a global survey of veterinarians, veterinary nurses and animal health technicians collected from May to July 2020. In this study, descriptive analyses were performed to characterize veterinary team members who responded to the survey (n = 540). Binomial logistic regression analyses were performed to determine factors associated with an increase in ECS encountered since the beginning of the COVID-19 pandemic. Being a veterinary nurse or animal health technician, working with companion animals, working in the USA or Canada, and being not confident or underconfident in dealing with ECS in the workplace were factors associated with an increase in ECS encountered since the beginning of the COVID-19 pandemic. Results suggest a need to explore the ECS encountered by veterinary team members, particularly veterinary nurses and animal health technicians working in companion animal practice, in depth. Identification of risk factors may facilitate better preparation of veterinary team members for managing ECS, and minimizing the negative impact of ECS on the well-being of those who care for animals.

Compassion Fatigue: Understanding Empathy

In clinical medicine, empathy is considered a central feature of holistic caretaking and successful patient interaction. It is unclear whether characteristics of empathy are innate, learned, or a combination of both. The means to evaluate clinical empathy are ill-defined, but perception of empathy has been shown to influence patient outcomes as well as professional well-being. This article reviews what is known about empathy in a medical setting and how it relates to negative mental health outcomes, such as compassion fatigue.

Frequency, Stressfulness and Type of Ethically Challenging Situations Encountered by Veterinary Team Members During the COVID-19 Pandemic

Ethically challenging situations (ECS) are common in veterinary settings and can lead to moral stress. However, there is no published information about how a global pandemic affects the frequency and types of ECS encountered by veterinary team members. An online mixed methods survey was developed to determine the frequency, stressfulness and types of ECS experienced by veterinarians, animal health technicians and veterinary nurses since the advent of the global COVID-19 pandemic in March 2020. Responses from 540 veterinary team members from 22 countries were analyzed. With the advent of the COVID-19 pandemic, the median frequency of ECS encountered by respondents increased from several times per month to several times per week (Spearman Rank Correlation 0.619, P < 0.0001). The most common ECS (encountered at least several times per week) were: challenging decisions about how to proceed when clients have limited finances (64.4%), conflict between personal well-being and professional role (64.3%), conflict between the interests of clients and the interests of their animals (59.6%). These were followed by challenging decisions about what counts as an essential veterinary service (48.1%); conflict between well-being of family/household members and professional role (46.3%); and challenging decisions about whether to perform non-contact veterinary visits (46.3%). The most stressful ECS (reported to be very or maximally stressful) were: conflicts between the interests of clients and the interests of their animals (50.2%), other (42.9%), conflicts between the interests of my employer and my own interests (42.5%), challenging decisions about how to proceed when clients have limited finances (39.4%), conflict between personal well-being and professional role (38.0%), and conflict between well-being of family/household members and professional role (33.6%). Thematic analysis of free-text responses revealed biosecurity, client financial limitations, animal welfare, working conditions, and client relations as prominent themes. This is, to the best of our knowledge, the first study to describe the impacts of the pandemic on ECS experienced by veterinary teams globally. It identifies an increase in the frequency of ECS associated with the COVID-19 pandemic, and a number of stressors unique to the pandemic. We identified a number of resources and strategies that may help veterinary team members navigate ethical challenges that may emerge in their daily work, as well as in the context of global crises.

Strengthening Workplace Well-Being in Research Animal Facilities

In recent years, there has been an increased recognition of the potential cost of caring on the mental well-being of research animal facility personnel. While this issue is considered a normal consequence of caring for others, these stressors must be acknowledged and managed to ensure that the workplace culture remains positive and that employees are engaged. Factors that can contribute to these feelings in those working with animals in research include compassion and moral stress, issues related to staffing and scheduling of work, insufficient communication in the workplace, and public ambivalence toward the use of animals in science. The first step in developing a program is to survey facility personnel about their concerns, either formally (e.g., using a needs analysis) or informally. Two examples are provided to demonstrate different institutional approaches to assessing personnel needs and developing an internal compassion-resiliency program. The best programs are based on the needs and wants of personnel and these can be cost effective and geared at a grassroots level. Social support in the workplace, for example, through peer counseling, can be a highly effective means of helping personnel to build compassion-resiliency. Addressing mental well-being of research animal facility personnel is an important component of ensuring a positive culture of care in the workplace.

Am I actually a veterinarian or an economist? Understanding the moral challenges for farm veterinarians in Germany on the basis of a qualitative online survey

This qualitative online survey (n = 123) investigated what farm veterinarians in Germany perceive as morally challenging situations. Vital moral challenges can be described as conflicts between different actors who make demands on the veterinarians, like (a) animals, (b) farmers, (c) politics, (d) society, (e) veterinary offices (f) colleagues, supervisors, employees and competitors and (g) the veterinarian himself/herself. Or they can be described as the conflict between different roles of veterinarians who describe themselves as (a) advocates for the animals, (b) entrepreneurs, (c) social workers, (d) part of agriculture, (e) colleagues, supervisors, employees and competitors and (f) private persons. It can be deduced that at least some study participants find the described moral challenges a cause for moral distress. The key moral challenge for farm veterinarians, from their own viewpoint, are not so much open ethical questions, ethical dilemmas or "duty vs. inclination" conflicts, but rather situations in which their personal moral convictions are conflicting with external obstacles. Accordingly, a feeling of powerlessness appears in their answers. The extremely limited financial scope of animal owners could be identified as the key external obstacle.

Establishing Animal Welfare Rules of Conduct for the Portuguese Veterinary Profession-Results from a Policy Delphi with Vignettes

Promoting animal welfare is one of the basic tenets of the veterinary profession and, in doing so, veterinarians are expected to abide to the highest legal and professional standards. However, the Portuguese veterinary code of conduct, established in 1994, largely overlooks animal welfare and fails to address issues such as the euthanasia or humane killing of animals. As part of a wider research aiming to revise the Portuguese veterinary code of conduct, a Policy Delphi study was conducted in late 2018, using a pre-validated three-round structure and vignette methodology, to explore the range of opinions and the level of agreement on end-of-life dilemmas and animal welfare rules of conduct of a purposeful sample of forty-one (out of seventy) Portuguese veterinarians. When faced with ethical vignettes involving end-of-life dilemmas, veterinarians were shown to privilege personal moral agency over legal obligations in order to defend the interests of stakeholders, namely of the animals. Most participants agreed that the suggested animal welfare rules of conduct reflected their own views on the subject (88%), in addition to representing a significant improvement in terms of regulatory standards (93%). We expect that this study will support regulation and policy-making by the Portuguese Veterinary Order and by veterinary representative bodies elsewhere.

Exposure to animal suffering, adult attachment styles, and professional quality of life in a sample of Italian veterinarians

Contextual and individual risk factors of veterinarians’ professional quality of life are being debated. Research suggests that attachment styles are relevant predictors of professional quality of life; however, their role in work-related well-being of veterinarians is yet to be ascertained. In the present study, self-report measures on exposure to animal suffering, adult attachment styles, and professional quality of life were administered to 1,445 Italian veterinarians (70% females) aged 24 to 74 years old; sociodemographic information and information on workload were also collected. Female gender, higher levels of ordinary workload, on-call hours per week, exposure to animal suffering, together with fearful and preoccupied attachment styles were significantly associated with lower levels of veterinarians’ quality of life. This suggests that work-related factors may combine with individual psychological features in promoting or disadvantaging the professional quality of life of veterinarians. Implications of these findings for promoting veterinarians’ quality of life and directions for future research are discussed.

Determination of Dairy Cattle Euthanasia Criteria and Analysis of Barriers to Humane Euthanasia in the United States: The Veterinarian Perspective

Simple Summary

Making and carrying out euthanasia decisions on dairy farms is complex and decisions are often challenging and multi-factorial. Training caretakers to be confident in their abilities to make timely decisions about euthanasia is critical. Veterinarians are often asked to serve in the role of training caretakers on euthanasia. Given the valuable role veterinarians play regarding dairy cattle euthanasia, the objective of this two-part study was to evaluate the main factors influencing euthanasia practices on dairy farms across the United States (US) by recruiting experienced dairy cattle veterinarians to participate in either an online survey (Part I) or in-person focus groups (Part II). Survey results indicated variability in health condition management amongst dairy cattle veterinarians, and only 60% of serviced facilities have a written euthanasia protocol in place. Three main themes of euthanasia decision-making were identified across focus group discussions and included logistical, animal, and human Factors. In addition, participants frequently expressed frustration with protocol limitations and requirements. These results suggest the need for the development and implementation of science-based standards to improve cattle welfare on-farm by promoting consistency in euthanasia decision-making across the US dairy industry.

Abstract

When dairy cattle become ill or injured to the extent that recovery is unlikely or impossible, on-farm euthanasia should be used as a tool to eliminate pain and suffering. Our study aimed to identify decision-making criteria and the most common factors considered by veterinarians when making and carrying out euthanasia decisions. Dairy cattle veterinarians were recruited to participate in an online survey (Part I, 61 surveys collected) or in one of three focus groups (Part II, 4–10 veterinarians/group, n = 22). Part I (survey): Surveyed veterinarians varied regarding health condition management and demonstrated a strong proclivity to treat compromised cattle, mirroring trends amongst dairy producers identified in previous research. Sixty percent of respondents indicated that most facilities for which they serve as the primary veterinarian have a written euthanasia protocol in place. Part II (focus groups): Three main themes about euthanasia decision-making (logistical, animal, and human) were identified from focus group discussions. Discussions focused primarily on logistical factors such as financial considerations and client/public perceptions. Development of specific standards for euthanasia, alongside interactive training programs for dairy veterinarians and producers are vital next steps to improving cattle welfare and consistency in euthanasia decision-making across the United States dairy industry.