Veterinarians and Humane Endings: When Is It the Right Time to Euthanize a Companion Animal?

Development and validation of a questionnaire to assess health-related quality-of-life in cats with hyperthyroidism

BACKGROUND

Health-related quality-of-life (HRQoL) assessment tools are becoming increasingly important for the assessment of diseases in veterinary medicine.

OBJECTIVES

To develop a tool to assess the HRQoL of hyperthyroid cats and their owners.

ANIMALS

Cats with hyperthyroidism (n = 229) and without hyperthyroidism (n = 322).

METHODS

Cross-sectional study design. A preliminary list of 28 questions relating to the HRQoL of hyperthyroid cats and the influence their cat's disease might have on owners was created. Each question consisted of 2 subquestions: (1) "how often does the item apply"; (2) "how strongly does the item affect HRQoL." The questionnaire was refined based on statistical analysis, including Mann-Whitney-U tests on each item, comparing the results from cats with and without hyperthyroidism. Internal consistency and reliability of the questions were measured by Cronbach's alpha (α). P < .05 was considered significant.

RESULTS

Overall, 25/28 questions were retained within the final HRQoL tool, which had an excellent internal consistency (α = .92). The tool produced a score between 0 and 382 (lower scores meaning better HRQoL). The median HRQoL score was 87.5 (range, 2-348) for cats with hyperthyroidism, and 27 (range, 0-249) for cats without (P < .001), suggesting the HRQoL was poorer in hyperthyroid cats.

CONCLUSIONS AND CLINICAL IMPORTANCE

This validated HRQoL tool is useful to reliably quantify the influence of hyperthyroidism on the quality-of-life of affected cats and their owners. In the future, it could be considered of assistance in the clinical assessment of cats with hyperthyroidism.

Cat and dog owners' expectations and attitudes towards advanced veterinary care (AVC) in the UK, Austria and Denmark

Modern veterinary medicine offers a level of care to cats and dogs similar to that available to their owners, including blood transfusions, chemotherapy and MRI scans. The potential benefits to the animals of owners who can afford such care are obvious, but there can also be negative consequences if owners with strong emotional attachments to their pets pursue treatments that significantly reduce the quality of the animal's life while attempting to prolong it. Moreover, caring for a chronically or seriously ill animal can lead to emotional distress and financial and practical challenges for the pet owner. A questionnaire was used to survey cat and dog owners from representative samples of citizens in the UK, Austria and Denmark, to investigate owners' expectations and attitudes towards advanced veterinary care, and the factors that might influence those views. Overall, 58.4% of the pet owners surveyed believed that their pets should have access to the same treatment options as humans, while 51.5% believed that they should have access to the same diagnostic tests as humans. Owners were most likely to be neutral on the question of whether advanced veterinary care has 'gone too far' (45.3%), and to disagree with the statement that advanced care is 'unnecessary' (40.1%). In all three countries, the level of attachment owners had to their pets was most strongly associated with attitudes towards advanced care, with owners scoring higher on Lexington Attachment to Pets Scale (LAPS) being more likely to expect advanced care to be available. Other factors such as owner age, living situation (alone or not), income or possession of pet insurance were less consistently with owner attitudes. Our findings will help inform veterinarians and other health care providers about pet owner expectations and attitudes towards advanced veterinary care, and contribute to the debate on increasing specialisation within the profession.

The Sun Also Rises: Tracing the evolution of humanistic values in anatomy pedagogy and research, including cadaveric acquisition practices

Anatomy has always been at the intersection of the socio-cultural and political landscape, where new ideas constantly replace older wisdom. From ancient Egyptians through the Greeks, and then the Romans, finally culminating into the European Renaissance-all the significant eras of human civilisation have left their insignia and distinct marks on the evolution of anatomical practices. Despite its utility as a tool for anatomy pedagogy and research that has proven its worth over millennia, cadaveric dissection has particularly been subject to political and social vicissitudes. A major debate about anatomical dissection lay with the ethical considerations, or its lack thereof, while acquiring corpses for demonstration in the dissection halls. From antiquity, anatomical dissection-often synonymous with medical studies-had typically been carried out on the dead bodies of executed criminals with certain laws, such as the Murder Act of 1752, facilitating such uses. Gradually, the uses of unclaimed bodies, resourced primarily from the impoverished sections of society, were also introduced. However, these body acquisition protocols often missed the crucial element of humanism and ethical considerations, while knowledge augmentation was taken as sufficient reasoning. Unfortunately, a gross disregard towards humanistic values promulgated heinous and illegal practices in acquiring corpses, including grave robbery and even murders like in the case of Burke and Hare murders of 1828. Follow-up legislation, such as the Anatomy Act of 1832, and comparable laws in other European nations were passed to curb the vile. What distils from such a historical discourse on humane values in anatomy dissection, or medical science in general, is that the growth and integration of humanism in anatomy have never been linear, but there were intermittent and, yet, significant disruptions in its timeline. For example, there were serious human rights violations in anatomical practices during the Third Reich in Germany that perpetrated the holocaust. The medical community has kept evolving and introducing new moral values and principles while using such egregious events as lessons, ultimately resulting in the Declaration of Helsinki in 1964. This article revisits the heterogeneous journey of integrating humanistic values in anatomy practice. Such humanistic traits that, like medical science, have also developed over centuries through the inputs of physicians, researchers, and philosophers-from Greece to modernity with an important stopgap at the Renaissance-are a fascinating lore that deserves to be re-envisioned through the lens of contemporary values and ethos. In parallel to human medicine, humanistic values continue to influence veterinary medicine, a welcome development, as our society condemns animal cruelty in any form. There are lessons to be learned from this historical journey of how humanism shaped many of the concepts that anatomists use now. Finally, and most importantly, it might prevent the medical community from repeating the same mistakes by cautioning against the traps that are there, and in a convoluted world where morality as such is eroding from our social fabric, will always be there. Such historical account acts as a righteous, ethical, and contextual compass to guide the existing and upcoming anatomists in discerning between light and dark, right and wrong, and roads-to be or not to be-taken.

Euthanasia of Cats by Australian Veterinarians: A Survey of Current Practices

We sought to document the contemporary feline euthanasia practices among Australian veterinarians and determine the factors associated with the administration of a premedication or sedation prior to euthanasia. Australian veterinarians who had euthanised at least one cat during the previous 12 months were invited to participate in an anonymous online survey. From 615 valid responses, 585 respondents (95.1%) had euthanised at least one cat in the last 12 months, of which 462 respondents (75.1%) had performed an emergency euthanasia. Intravenous (IV) injection (n = 536, 91.6%) of pentobarbitone sodium (n = 584, 99.8%) was the predominant primary method. Premedication or sedation was administered to cats by 415/585 (71.0%) and 242/462 (52.4%) of respondents in non-emergency and emergency euthanasia, respectively. In a multivariable logistic regression analysis, for non-emergency euthanasia, being female and working in a metropolitan area were significant predictors for administering a premedication or sedation (p < 0.001 and p = 0.037, respectively). For emergency euthanasia, working in an 'other' type of practice was a significant predictor for administering a premedication or sedation (p < 0.001). Australian veterinarians vary in their approach to feline euthanasia. There is scope for refinement of euthanasia techniques to maximise the welfare of cats, their owners or guardians, and veterinary team members.

Handling End-of-Life Situations in Small Animal Practice: What Strategies do Veterinarians Contemplate During their Decision-Making Process?

This study researched end-of-life (EoL) decision-making processes in small animal practices in the Netherlands, focusing on strategies veterinarians contemplate during this process. Fourteen veterinarians were interviewed about animal end-of-life decision-making. The results of these interviews show that the decision-making process consists of three steps. The first step is to assess the animal's health and welfare. During the second step, veterinarians consider the position of the owner. Based on steps 1 and 2, veterinarians decide in step 3 whether their advice is to a) euthanize or b) contemplate one or more strategies to come to a decision or potentially alter the decision. These results can support members of the veterinary profession to reflect on their decision-making process. If veterinarians know what strategies their peers use to deal with EoL situations, this can help to reduce the stress they experience in such situations. In addition, veterinarians may find inspiration for new strategies in the study results. For the veterinary profession itself, the current results can be used as a starting point for describing best practices for EoL decision-making in small animal practice.

Justifying Euthanasia: A Qualitative Study of Veterinarians' Ethical Boundary Work of "Good" Killing

(1) Veterinarians are regularly required to euthanize their "objects of care" as part of their work, which distinguishes them from other healthcare professionals. This paper examines how veterinarians navigate the ethical tensions inherent in euthanasia, particularly the collision between the routine practice of killing animals within their profession and the broader social and moral implications. (2) Using the sociological concept of ethical boundary work as a theoretical framework, this research observes how veterinarians draw boundaries by positioning their euthanasia practices on the ethical "good" spectrum. A grounded theory study of 17 qualitative interviews with veterinarians was conducted. (3) The findings highlight differences in ethical boundary work within veterinary medicine, particularly in the distinction between farm animals and companion animals. Economic and emotional reasoning play differing roles in explanation and justification. Ethical boundary work is a tool for distinguishing normative frameworks in different areas of veterinary medicine. (4) In conclusion, veterinarians grapple with the realities of an imperfect world and often rely on boundary work to assert diverse interests and navigate multiple contexts. By exploring the complexities of ethical boundary work, this study contributes to a more comprehensive understanding of the moral landscape within veterinary practice.

Euthanasia and the rehabilitation of wildlife casualties in Finland: decision-making varies depending on the background education of the caregivers

Caring for wildlife casualties is a common aspect of animal-protection work. The range of care options of wildlife in Finland vary from professional zoos to voluntary members of the public. There are complex ethical concerns to be considered in deciding whether an injured animal should be treated or euthanized. Differing opinions and poor communication may lead to unnecessary conflicts among caregivers. We investigated opinions behind the decision-making of caregivers related to wildlife casualties using a web-based questionnaire. We asked the respondents to rate their level of agreement with 27 statements on a seven-point Likert scale. Seventy-eight respondents were included in our analysis. Animal-related education was classified as veterinarian (n = 14), other (n = 18), and none (n = 49). The median (IQR) levels of age and work experience were 43 (17) and 5 (9) years, respectively, regardless of educational level. The groups were tested for differences level of agreement with the statements in Kruskall-Wallis tests (with Bonferroni-corrected pair-wise tests). Overall, the strongest disagreement was with statements proposing euthanasia on the grounds that the species was common [1 (2)], the treatment would be costly [1 (4)] or long-term [1 (4)], or there was no end-of-life-solution immediately available [1 (2)]. The highest agreement was with the statement advocating not euthanizing the animal if it could easily be returned to its natural habitat [7 (0)]. The respondents differed in their perceptions depending on their animal-related education. The cost and length of treatment, the prevalence of the species, and a known end-of-life solution influenced the euthanasia-related decisions of veterinarians more than of respondents in the other educational groups. Those with no animal-related education expressed the least willingness to euthanize an injured wild animal, even if it would be partly dependent on humans for the rest of its life or even if the treatment would be very stressful. We concluded that attitudes and practices related to euthanasia differ depending on the respondents' education, and that more discussion is needed on the ethical aspects behind the decision-making. This would help to increase mutual understanding among caregivers and facilitate the development of uniform standards that would potentially benefit animal welfare.

Euthanasia of Dogs by Australian Veterinarians: A Survey of Current Practices

Euthanasia techniques utilised by veterinarians impact the welfare of many dogs in their final moments. Despite euthanasia guidelines, little is known about euthanasia techniques used in practice. We administered an online survey of Australian veterinarians who had euthanised at least one dog in the previous 12 months. We found that 668 (96.8%) had euthanised a dog in the previous 12 months, almost all using intravenous pentobarbitone sodium (n = 651, 99.7%). For non-emergency euthanasia (n = 653), the majority (n = 442, 67.7%) administered a premedication or sedation prior to euthanasia versus less than half for emergency euthanasia (n = 286, 46.4%). Practices and views about euthanasia varied. Female veterinarians and veterinarians located in metropolitan regions were more likely to administer a premedication or sedation prior to non-emergency euthanasia (p < 0.05). Veterinarians in private mixed animal practices were less likely to administer a premedication or sedation prior to a non-emergency euthanasia (p < 0.05). For non-emergency and emergency euthanasia, veterinarians who worked in "other" practice types were more likely to administer a premedication or sedation than private companion animal practices (p < 0.05). The possible reasons for differences in euthanasia practices are explored, and scope for refinement is identified.

Euthanasia and Pain in Canine Patients with Terminal and Chronic-Degenerative Diseases: Ethical and Legal Aspects

Euthanasia is commonly performed in veterinary medicine to humanely induce the death of an animal when its quality of life is affected by pain or chronic degenerative diseases. The choice of euthanasia is a bilateral decision that represents a challenge for both the veterinarian and the owner of the animal due to the close emotional human-animal bond. Currently, there is legislation that can orient veterinarians concerning euthanasia and the causes that would justify this resolution. However, it is still controversial, and deciding it as the last available resort requires considering it from a medical, legal, and moral perspective. Therefore, this review aims to explore the ethical and legal implications of euthanasia in canine patients. It will analyze the reason that can justify euthanasia in animals with pain or terminal and chronic degenerative diseases, highlighting the importance of effective communication, ethical knowledge, and consideration of euthanasia as a multimodal resolution.

Validation of the HHHHHMM Scale in the Italian Context: Assessing Pets’ Quality of Life and Qualitatively Exploring Owners’ Grief

Witnessing a companion animal’s death can be a stressful psychological experience for human guardians, affecting their ability to grieve. The veterinary and psychological sciences offer useful tools for supporting human guardians during their companion animal’s terminal illness. Accordingly, the present study aimed to validate the HHHHMM Quality of Life Scale in the Italian context. The study followed a mixed-methods design and involved 314 participants. The Mourning Dog Questionnaire (MDQ), Lexington Attachment to Pets Scale (LAPS), Pet Bereavement Questionnaire (PBQ), and open-ended questions were adopted to test the research hypotheses and qualitatively explore the grieving experience. The results showed that the model’s fit was partially adequate, with all parameters being significant and over 0.40. Moreover, human guardians’ anger levels were high when their companion animal’s quality of life was poor, and greater levels of grief were associated with higher levels of attachment. Gender differences were observed only with the LAPS, and a negative correlation with age was found with the LAPS and PBQ. A thematic qualitative analysis revealed four themes: continuing bonds, coping strategies, shared moral values, and perceived support. Thus, the research reaffirmed the importance of adequate veterinary and psychological support for human guardians experiencing the loss of companion animals.

Two Worlds in One: What 'Counts' as Animal Advocacy for Veterinarians Working in UK Animal Research?

The concept of advocacy is of increasing importance to the veterinary profession internationally. However, there are concerns around the ambiguity and complexity of acting as an advocate in practice. This paper explores what 'animal advocacy' involves for veterinarians working in the domain of animal research, where they are responsible for advising on health and welfare. In focusing on the identity of veterinarians working in an arena of particular contestation, this paper provides empirical insights into how veterinarians themselves perform their role as an 'animal advocate'. Analysing interview data with 33 UK 'Named Veterinary Surgeons', this paper therefore examines what 'counts' as animal advocacy for veterinarians, considering the way their role as animal advocate is performed. Focusing on the themes of 'mitigating suffering', 'speaking for', and 'driving change' as three central ways in which veterinarians working in animal research facilities act as animal advocates, we draw out some of the complexities for veterinarians working in areas where animal care and harm coexist. Finally, we conclude by calling for further empirical exploration of animal advocacy in other veterinary domains and for more critical attention to the wider social systems which produce the need for such advocacy.

Broadening the Veterinary Consultation: Dog Owners Want to Talk about More than Physical Health

Few veterinary professionals use formal quality of life (QOL) assessment tools despite their recommendation from veterinary governing bodies to enable holistic welfare assessments and target welfare improvement strategies. Perceived barriers include resistance from owners, and this study aimed to elucidate understanding of dog owner engagement with conversations and tools relating to QOL. An online survey that investigated owner experience, comfort, and opinions about vet-client discussions on topics connected to canine health and well-being, including QOL, was completed by 410 owners. Almost all owners (95.8%) were reportedly comfortable discussing QOL, yet only 32% reported their vets had addressed it. A high proportion of owners (70.8%) expressed interest in assessment tools, but only 4.4% had experienced one, none of which were QOL tools per se. Semi-structured interviews of a sub-set of four owners provided a more in-depth examination of their experience of a health and well-being assessment tool. Thematic analysis generated three themes: 'Use of assessment tools supports client-vet relationship and empowers owners', 'Owners want to talk about holistic dog care', and 'Owner feelings on the wider application of assessment tools'. Overall, our findings suggest that owners want to broaden the veterinary consultation conversation to discuss QOL and are interested in using tools, and therefore veterinary perceptions of owner-related barriers to tool application appear unfounded. Indeed, tool uptake appears to improve the vet-client relationship and boost owner confidence.

Life, Death, and Humanity in Veterinary Medicine: Is it Time to Embrace the Humanities in Veterinary Education?

Medical humanities is a multidisciplinary, interdisciplinary field of study that has experienced explosive growth in the United States since the 1960s. Two key components of medical humanities include first, the use of literature, poetry, and visual arts in the education of medical students, and second, the representation or examination of medical culture by scholars in the humanities, arts, and social sciences such as literary and film creators, sociologists, and anthropologists. The American Association of Medical Colleges recently reported that as of 2018, approximately 94% of medical schools had core or elective humanities offerings in their curricula. The examination of the medical milieu by scholars across the humanities has resulted in the emergence of important specialty fields such as end-of-life care, disability studies, and health disparities research. Veterinary medicine has been slow to embrace the humanities as relevant to our profession and to the education of our students. Only sporadic, isolated attempts to document the value of the arts and humanities can be found in the veterinary literature, and valuable observations on our profession made by scholars in diverse disciplines of the humanities are largely buried in publications not often accessed by veterinarians. Here a case is made that the time is right for the emergence of a more cohesive field of veterinary humanities. Embracing the observations of humanities scholars who engage with our profession, and appreciating the ways in which the humanities themselves are effective tools in the education of veterinary professionals, will bring many benefits to our evolving profession.

Scoping review of end-of-life decision-making models used in dogs, cats and equids

BACKGROUND

End-of-life decisions for companion animals can be stressful for veterinarians and owners, and when delayed result in poor animal welfare. Delayed euthanasia has been identified as a particularly prominent issue for horses. This scoping review aimed to identify the available literature on veterinary decision-making models, which can support end-of-life planning.

METHODS

A protocol was preregistered, and a structured literature search was performed on six electronic databases. Publications were reviewed against specifically developed eligibility criteria. Data from original studies and narrative-type reviews were extracted separately, and the components of each model were charted.

RESULTS

A total of 2211 publications were identified, 23 met the inclusion criteria and were included in the final review. Eight were original research studies and 15 were narrative reviews or similar. Publications were not indexed uniformly, increasing the difficulty of discovering relevant sources. The end-of-life decision-making process comprised three stages: (1) making the decision, (2) enacting the decision and (3) aftercare. Twenty key components of decision-making models were identified, although no publication reflected all of these.

CONCLUSIONS

A lack of original research studies and equine-specific publications was identified. Shared decision-making models for euthanasia in veterinary practice should include all three stages and consider species-specific issues.

Using electronic health records to explore negotiations around euthanasia decision making for dogs and cats in the UK

BACKGROUND

End-of-life decision making for animals happens daily in veterinary practice. However, access to such discussions as they happen is difficult, in view of the highly emotional circumstances of end-of-life consultations. Despite the expanding literature on euthanasia, few studies have explored the circumstances of euthanasia disagreement or delay.

METHODS

To explore euthanasia discussions in veterinary practice, consultations recorded in electronic health records in a UK veterinary surveillance database (SAVSNET) were examined. From a sample of 2000 identified consultations, 69 canine and 76 feline consultations were purposively sampled for detailed thematic analysis. Specifically, consultations were selected if they involved a decision to delay euthanasia, including disagreement about the timing of euthanasia.

RESULTS

Reasons identified for euthanasia refusal or delay included client-related factors (e.g., allowing other family members to say goodbye, differing opinions on the quality of life) and veterinary surgeon-related factors (eg, the wish to carry out further investigations or to try a new treatment). In the instance of refusal or delay, palliative treatment was commonly provided to preserve animal welfare.

CONCLUSION

This study illustrates some of the processes used to negotiate end-of-life decision making in dogs and cats. Its findings shed light on the importance of palliative care in providing owners with time to decide.

Barriers to Utilizing Non-replacement Male Calves in the Australian Dairy Industry: A Qualitative Study

Male non-replacement calves in dairy systems represent an underutilized economic resource for dairy producers worldwide. Despite this, increasing the practice of rearing non-replacement male calves has significant barriers both in on-farm adoption and practice. Poor neonatal rearing practices, higher levels of morbidity and mortality, and disaggregated production pathways with multiple points of handling, have all been described as barriers to adoption of surplus calf production. To identify the critical decision-determining challenges associated with broader adoption of raising non-replacement stock, and to investigate the whole-of-value chain issues faced by dairy producers to rear non-replacement male calves, we undertook a series of semi-structured interviews with Australian dairy producers to interrogate their key challenges. To achieve this, a constructivist grounded theory approach was used to inform the process of analysis of in-depth interviews with Australian dairy producers regarding their current practices and perceptions. Five major themes emerged from these conversations that were key barriers to on-farm non-replacement calf rearing in the producer group participants. These were: impacts of drought on cost and availability of feed for these calves and the whole herd; the management requirements of non-replacement male calves as an additional workload to that of their current operation; their attitudes and current practices to and surrounding euthanasia; perceived ease of supply-chain access for these calves, and their perceptions of the economic value of dairy-beef product as a return on investment. Understanding the barriers to adoption of non-replacement calf rearing, and addressing the value proposition for dairy beef, can assist increased uptake of non-replacement calf rearing. These findings will allow development of strategies to address these barriers, and extension of viable management strategies to increase adoption of profitable business practices surrounding non-replacement male calf production.

Managing conflicting ethical concerns in modern small animal practice-A comparative study of veterinarian's decision ethics in Austria, Denmark and the UK

Small animal veterinarians frequently have to manage conflicting interests. Beside the key consideration of the patient’s interests, small animal veterinarians are often challenged to consider not only client’s emotional needs, but also their own personal aspirations to provide quality patient care and to make a good living as a professional. Further, veterinarians have an interest in continuous professional development and the use of the newest treatments, which may influence their decision-making process. Based on published work, we hypothesize the existence of four decision ethics orientations that veterinarians can use to manage potentially conflicting concerns. These are: the patient-focused, the client-empathetic, the client-devolved and the development-oriented decision ethics orientations. We surveyed small animal veterinarians in Austria, Denmark, and the UK using a questionnaire (N = 648), and successfully identified the four decision ethics orientations in all three countries. The patient-focused and client-empathetic decision ethics orientations are salient in all countries, whereas Danish and UK veterinarians are slightly more client-empathetic and client-devolved compared to their Austrian colleagues. Across countries our findings show that experienced and older veterinarians tend to be more client-empathetic. Younger and less experienced professionals are more development-oriented compared to their older and more experienced colleagues. In contrast to other studies investigating ethical issues in small animal practice, we found no evidence that gender plays a decisive role in the tendency towards any decision ethics orientation. We also show that veterinarians with a higher client-empathetic orientation and development-orientation more often discuss the possibility of health insurance with clients who do not have it. The present study provides a first empirical insight into how veterinarians manage challenging expectations and ethical concerns as part of decision making in modern small animal practice.

How decision-making about euthanasia for animals is taught to Australasian veterinary students

This study set out to explore how euthanasia decision-making for animals was taught to students in eight Australasian veterinary schools. A questionnaire-style interview guide was used by a representative at each university to interview educators. Educators were interviewed about their teaching of euthanasia decision-making for four categories of animals: livestock, equine, companion and avian/wildlife. Using thematic analysis, the terms provided by participants to describe how (mode of teaching) and what (specific content) they taught to students were categorised. Information about content was categorised into human-centred factors that influence decision-making, and animal-based indicators used to directly inform decision-making. All eight representatives reported some teaching relevant to euthanasia decision-making at their university for livestock, companion animal and avian/wildlife. One representative reported no such teaching for equid animals at their university. Observation of a euthanasia case was rarely reported as a teaching method. Five universities reported multiple modes of teaching relevant information, while two universities made use of modalities that could be described as opportunistic teaching (e.g., 'Discussion of clinical cases'). Factors taught at most universities included financial considerations, and that it is the owner's decision to make, while animal-based indicators taught included QoL/animal welfare, prognosis and behaviour change. Overall, most universities used a variety of methods to cover relevant material, usually including lectures and several other approaches for all animal types. However, because two universities relied on presentation of clinical cases, not all students at these veterinary schools will be exposed to make, or assist in making, euthanasia decisions.

How management of grief associated with ending the life of an animal is taught to Australasian veterinary students

OBJECTIVE

Veterinarians have an important role in supporting and understanding their clients' grief. Veterinary schools have a duty to teach students how best to manage grief - both that of the students/future veterinarians and the clients. This study explores how grief management, associated with ending the life of an animal, was taught to students in eight Australasian veterinary schools.

METHODS

A questionnaire-style interview guide was used by a representative at each university to conduct structured interviews with educators in a snowball sampling approach. Educators were interviewed about the teaching of grief management for four categories of animals: livestock, equine, companion and avian/wildlife. The terms used by participants to describe what they taught were grouped into common themes. Teaching was defined by individual participants and included structured and unstructured approaches. The stage in the degree (preclinical or clinical years) that grief management was taught in the veterinary curriculum and by whom (e.g. clinicians or psychologists) is also described.

RESULTS

Grief management was taught more in preclinical than clinical years. However, due to how grief was characterised, much of this teaching was general 'nonspecific' teaching that included all categories of animals. Client grief was taught more generically, whereas, grief of veterinarians was taught using specific examples given by clinicians.

CONCLUSION

A more robust end-of-life (EoL) management curriculum that includes all aspects of grief management is likely to increase job satisfaction, client happiness and professional satisfaction.

Factors Contributing to the Decision to Euthanize: Diagnosis, Clinical Signs, and Triggers

This article reviews factors contributing to the decision to euthanize a patient by exploring the diagnosis, clinical signs, and triggers behind the choice. By investigating these triggers, the article helps guide practitioners to proactively manage areas of concern that lead to the decision of euthanasia. Included in this article is a benchmark comprehensive survey for pet families that standardizes documentation of family decision making surrounding end of life and euthanasia. Increased knowledge about diagnosis, clinical signs, and triggers may improve the technical and communication skills of professionals about specific conditions that are encountered at the end of life.

Euthanasia from the Veterinary Client's Perspective: Psychosocial Contributors to Euthanasia Decision Making

End-of-life decision making for a companion animal relies on the veterinarian acting as educator and counselor. However, little research has been conducted to understand client variables in this context. The current study examined potential client-related contributors to steps taken toward a euthanasia decision. Caregiver burden, anticipatory grief, depression, stress, and income all correlated positively with this outcome. However, when client factors were examined in a regression model controlling for animal quality of life, only caregiver burden and income emerged as significant predictors. All 3 caregiver burden factors: general strain, affective/relational discomfort, and guilt/uncertainty were significantly related to consideration of euthanasia.

Owner and Veterinarian Perceptions About Use of a Canine Quality of Life Survey in Primary Care Settings

This paper describes dog owner and veterinarian perceptions around the use of a validated canine quality of life (QOL) survey to facilitate wellness conversations in two clinical settings: a veterinary teaching hospital (pilot, Phase 1) and five corporate general practice hospitals (Phase 2). Phase 1 results showed that dog owners felt the survey was valuable for understanding their dog's QOL, with 81% of owners expressing interest in learning more about canine QOL. Phase 2 reinforced owner perceptions about the survey conveyed during the pilot phase, and veterinarians reported that the survey facilitated client communication related to preventive care without increasing consultation time. These results demonstrate that beyond using QOL assessments to track patient health, the use of a QOL survey during veterinary visits could improve owner-veterinarian discussions around QOL, wellness, services and preventive care. To fully realize these benefits in clinical settings, veterinary staff preparation may be needed to communicate the purpose of QOL assessments to clients and thus facilitate deeper conversations about client needs and concerns. Key tools for achieving these could therefore include (1) sufficient veterinary team training to understand the QOL assessment and its purpose (2) training in how to communicate QOL to clients, and (3) reflexive use of QOL assessment results to engage clients in preventive care discussions. The veterinarian and client can then discuss the pros and cons of the various aspects of QOL and preventive care to arrive at a cooperative decision.

Philosophy of a "Good Death" in Small Animals and Consequences for Euthanasia in Animal Law and Veterinary Practice

Simple Summary

Euthanasia in veterinary practice is often discussed as one of the profession’s major burdens. At the same time, it is meant to bring relief to terminally ill and/or severely suffering animal patients. This article examines “euthanasia” from a philosophical perspective regarding different definitions and underlying basic assumptions concerning the meaning of death and welfare for nonhuman animals. These theoretical issues will then be discussed in relation to laws and guidelines on euthanasia and practical challenges with end-of-life decisions in small animal practice. Factors which are identified as potential causes of the complex problems regarding euthanasia are as follows: the confusing framework for euthanasia in law and soft regulations; the inclusion of many stakeholders’ perspectives in end-of-life decision-making; potential conflicts between the veterinarians’ personal morality and legal requirements and professional expectations; and, most of all, the veterinarians’ lack of awareness for underlying philosophical assumptions regarding possible understandings of euthanasia. Different practical suggestions are made to clarify and facilitate euthanasia in small animal practice.

Abstract

Moral stress is a major concern in veterinary practice. Often, it is associated with the challenges in end-of-life situations. Euthanasia, however, is also meant to bring relief to animal patients and their owners. The reasons for the moral strain euthanizing animals causes to professional veterinarians need to be further clarified. This article investigates “euthanasia” from a philosophical, legal, and practical perspective. After introducing relevant aspects of euthanasia in small animal practice, the term is analyzed from an ethical point of view. That includes both a broad and a narrow definition of “euthanasia” and underlying assumptions regarding different accounts of animal death and well-being. Then, legal and soft regulations are discussed with regard to the theoretical aspects and practical challenges, also including questions of personal morality. It is argued that the importance of ethical definitions and assumptions concerning euthanasia and their intertwinement with both law and practical challenges should not be neglected. The conclusion is that veterinarians should clarify the reasons for their potential discomfort and that they should be supported by improved decision-making tools, by implementation of theoretical and practical ethics in veterinary education, and by updated animal welfare legislation.

Timely Euthanasia in the United States Dairy Industry-Challenges and a Path Forward

Euthanasia is a valuable management tool utilized on dairies to end the suffering of sick or debilitated cows. Euthanasia should be implemented if an animal's pain cannot be adequately alleviated and if there is a limited chance of recovery. To be humane, euthanasia should be quick, painless, and administered by a trained individual. Despite its importance in ensuring cow well-being, the timeliness with which euthanasia decisions are made for dairy cattle is often overlooked or neglected. The timeliness of euthanasia is as important as the efficient, rapid administration of euthanasia itself. Timely euthanasia is a critical component of many on-farm animal care and verification programs yet opportunities exist within the industry to improve how effectively the industry is executing this critical component of cow management. There are challenges associated with performing euthanasia in a timely manner, such as inconsistencies in treatment protocols, inadequate employee training, difficulties assessing a cow's quality of life, and impacts of the human-animal bond on decision-making. The objective of this paper is to explain the importance of timely euthanasia to dairy cattle welfare, identify the challenges that can prevent the timeliness of euthanasia, and provide solutions and practical suggestions for improving the management of timely euthanasia on dairies.

The Welfare of Pig-Hunting Dogs in Australia

Hunting feral pigs using dogs is a popular recreational activity in Australia. Dogs are used to flush, chase, bail, and hold feral pigs, and their use for these activities is legal in some states and territories and illegal in others. However, there is little knowledge about the health and welfare of dogs owned specifically for the purpose of pig hunting. We conducted a review of the literature on working dogs in Australia and overseas to determine the likely welfare impacts confronting pig-hunting dogs. We identified numerous challenges facing pig-hunting dogs throughout their lives. Risks to welfare include overbreeding, wastage due to behavioural incompatibilities, the use of aversive training techniques including electronic shock collars, solitary kenneling and tethering, high exposure to infectious diseases including zoonotic diseases, inadequate vaccination and anthelmintic prophlyaxis, high incidence of traumatic and other injuries during hunts, climatic exposure during transportation, mortality during hunts, and a suboptimal quality of life after retirement. There are also significant welfare concerns for the wild pigs hunted in this manner. We conclude that research needs to be conducted in order to determine the current health and welfare of pig-hunting dogs, specifically in Australia. The humaneness of this method of pest control urgently requires further assessment.

The Use of Chemotherapy to Prolong the Life of Dogs Suffering from Cancer: The Ethical Dilemma

Despite the emergence some years ago of oncology as a veterinary specialty, there has been very little in the way of ethical debate on the use of chemotherapy in dogs. The purpose of this article is to undertake an ethical analysis to critically examine the use of chemotherapy to prolong the life of dogs suffering from cancer. If dogs have no concept of the future and are likely to suffer at least some adverse effects with such treatments, consideration should be given as to whether it is ethical and in the animal's best interests to use chemotherapy. Chemotherapeutic drugs are mutagenic, carcinogenic, teratogenic and may be irritant. Furthermore, chemotherapy may involve multiple trips to the veterinarian, multiple procedures and periods in isolation. Cancer-associated pain has been shown to be under-diagnosed and pet owners overestimate the effects of chemotherapy on treatment survival time. Of additional concern is the public health risks associated with chemotherapeutic drugs. As chemotherapy is not generally considered curative, it is in effect palliative care. However, palliative care may not be in the best interests of a terminally ill animal. As the specialty of veterinary oncology continues to grow and as the use of chemotherapy becomes more commonplace in the treatment of animals with cancer, it is imperative that there is an ongoing ethical debate on the use of chemotherapy in animals.

"Patients' interests first, but … "⁻Austrian Veterinarians' Attitudes to Moral Challenges in Modern Small Animal Practice

Simple Summary

Hip arthroplasty, heart valve replacement, dialysis, and specialties such as oncology, cardiology and neurology are becoming standard in modern small animal practice, which, in some respects, is not far behind the field of human medicine. This focus group study of veterinarians (n = 32) examined the effect of these advances and the challenges they introduce. The study shows that while modern diagnostics and therapies deliver benefits in patient care, they also add complexities to decision-making. Although the veterinarians participating in the study were aware of their duty to act in the best interests of the animal, their decisions were highly dependent on factors such as the client’s financial background and the emotional bond between client and animal, as well as the veterinarian’s place of work, and level and field of specialization, and certain economic aspects of the practice. The overall conclusion is that veterinarians are increasingly torn between patients’ interests, medical feasibility and factors related to the client, the veterinarian, and professional colleagues. The findings also suggest that services are not only oriented towards the provision of medical care in a strict medical sense. On top of this, veterinarians need to deal with various expectations and wishes of clients which influence their decision-making. As it will be shown, factors like the possibility of referring patients to specialist veterinarians or prompt diagnostic results influence their decision-making.

Abstract

Small veterinary practice is experiencing steady improvement in diagnostics and therapies which enable veterinarians to offer evermore advanced medical care for their patients. This focus group study of veterinarians (n = 32) examined the impact of these improvements and the potential challenges they introduce in small animal practice. It shows that while advanced diagnostics and therapies deliver benefits in patient care, they also add complexities to decision-making. Although the veterinarians participating in the study were aware of their duty to act in the best interests of the animal, their decisions were highly dependent on factors such as the client’s financial background and the emotional bond between client and animal, as well as the veterinarian’s place of work, and level and field of specialization, and certain economic aspects of the practice. The overall conclusion is that small animal veterinarians are increasingly torn between serving the best interests of the animal, medical feasibility and contextual factors related to the client, the veterinarian, and professional colleagues. Further, the findings suggest that services are not only oriented towards the provision of medical care in a strict medical sense. On top of this, veterinarians need to deal with various expectations and wishes of clients which influence their decision-making. As it will be shown, factors like the possibility of referring patients to specialist veterinarians or prompt diagnostic results influence their decision-making.

Compassion Fatigue, Euthanasia Stress, and Their Management in Laboratory Animal Research

This review is designed to assist both individuals and organizations involved in animal-based research to understand and appreciate the importance and potential risks of compassion fatigue and euthanasia stress. We reviewed current literature regarding compassion fatigue and euthanasia stress as they relate to the laboratory animal science community. Definitions, recognition, and mitigation steps are clarified. We offer educational and mitigation advice and present needs for future research on these topics that is related directly to the laboratory animal science community.

Austrian Veterinarians' Attitudes to Euthanasia in Equine Practice

Euthanasia of companion animals is a challenging responsibility in the veterinary profession since veterinarians have to consider not only medical, but also legal, economic, emotional, social, and ethical factors in decision-making. To this end; an anonymous questionnaire-based survey of Austrian equine veterinarians examines the attitudes to the euthanasia of equine patients in a range of scenarios; to identify factors which may influence decisions on the ending of a horse's life. This paper describes the distributions of demographic and attitude variables. Mann-Whitney U tests were used to test the associations of gender, work experience, and equine workload with attitudes in relation to euthanasia statements and case scenarios. In total, 64 respondents (response rate = 23.4%) completed the questionnaire. The study showed that veterinarians consider contextual and relational factors in their decision-making. They are aware of owners' emotional bonds with their horses and financial background, however, requests for convenience euthanasia are typically rejected. Although some significant differences between the tested variables emerged, the attitudes of the veterinarians were shown to be largely shared. In conclusion, veterinarians are aware of the multiple factors that influence their decision-making and gave indications as to the weight of animal- and owner-related factors in the handling of euthanasia.

The role of focal adhesion kinase in transforming growth factor-β2 induced migration of human lens epithelial cells

The migration of lens epithelial cells towards the posterior capsule is a key event in the development of posterior capsule opacification (PCO). Accumulating evidence has described crosstalk between growth factors and adhesive signaling pathways in wound healing and cell migration. The aim of the present study was to elucidate an aberrant transforming growth factor (TGF)‑β2 signaling pathway that regulated the migration of lens epithelial cells in the pathological context of PCO. The expression of fibronectin, focal adhesion kinase (FAK) and phosphorylated (p)‑FAK in HLE‑B3 cells following TGF‑β2 treatment was determined by western blot analysis and the expression of integrin α5β1 was detected by flow cytometry. Cell migration capacity was measured by wound healing and Transwell assays in the presence of 1,2,4,5‑tetraaminobenzene tetrahydrochloride, a selective FAK inhibitor, fibronectin small interfering RNA interference, arginylglycylaspartic acid peptides or α5β1‑integrin neutralizing antibodies. The 1,2,4,5‑tetraaminobenzene tetrahydrochloride was administered daily to 16 rabbits following cataract surgery. Fibronectin and TGF‑β expression were increased in the PCO group, demonstrated by immunofluorescence assays. PCO grading was conducted by slit‑lamp biomicroscopy and evaluation of posterior capsule opacification software. It was observed that TGF‑β2 promoted HLE‑B3 cell migration and upregulated fibronectin expression, which was followed by an increased phosphorylation of FAK. In addition, TGF‑β2 treatment and fibronectin surface coating significantly increased cell migration and FAK activation, which was inhibited by disrupting fibronectin‑integrin α5β1 interaction with the arginylglycylaspartic acid peptide, α5β1‑integrin neutralizing antibody or fibronectin depletion. Finally, suppression of FAK signaling by its inhibitor significantly decreased cell migration in vitro and attenuated PCO development in vivo. In summary, TGF‑β2 was indicated to promote the migration of lens epithelial cells through the TGF‑β2/fibronectin/integrin/FAK axis. Inhibition of FAK activity decreased TGF‑β2‑mediated cell migration in vitro and improved the symptoms of PCO in a rabbit model.

Drawing the line in clinical treatment of companion animals: recommendations from an ethics working party

Modern veterinary medicine offers numerous options for treatment and clinicians must decide on the best one to use. Interventions causing short-term harm but ultimately benefitting the animal are often justified as being in the animal's best interest. Highly invasive clinical veterinary procedures with high morbidity and low success rates may not be in the animal's best interest. A working party was set up by the European College of Veterinary Anaesthesia and Analgesia to discuss the ethics of clinical veterinary practice and improve the approach to ethically challenging clinical cases. Relevant literature was reviewed. The 'best interest principle' was translated into norms immanent to the clinic by means of the 'open question argument'. Clinical interventions with potential to cause harm need ethical justification, and suggest a comparable structure of ethical reflection to that used in the context of in vivo research should be applied to the clinical setting. To structure the ethical debate, pertinent questions for ethical decision-making were identified. These were incorporated into a prototype ethical tool developed to facilitate clinical ethical decision-making. The ethical question 'Where should the line on treatment be drawn' should be replaced by 'How should the line be drawn?'