Business Briefs: Handling Ethical Dilemmas

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Ethical practice is important to many veterinarians. There are common ethical dilemmas that seem to arise with frequency, especially in equine practice. Fortunately, the AAEP has recognized this pain point. That group provides a session at each annual convention dedicated to ethics, as well as six annual articles on ethics in the Equine Veterinary Journal. Additional materials are currently being prepared by the AAEP Ethics Committee for the ethics surrounding each of the new AAEP Commission on Sustainability’s subcommittees—compensation, internships, students, practice culture and emergency duty. 

Common Ethical Dilemmas in Equine Practice

Issues with ethical ramifications in equine practice include deciding whether to offer a full range of treatment options. This would be despite some of the most advanced treatments available not having strong published evidence yet. Another might be making decisions related to animal welfare such as whether it is more humane to euthanize a horse or continue with treatment. You might face navigating possible competing interests between a horse’s owner, trainer and rider. Or you might be deciding when to use compounded medications or medical devices and under what circumstances. 

In veterinary medicine, there is a lack of universally accepted moral standards assigned to animals. Unlike humans, who are generally treated with a base level of dignity, views on how animals should be treated vary wildly among different countries as well as within the population in the United States. This can sometimes lead to tension between owners and veterinarians.  

According to the AVMA, fewer than 15% of horse owners consider their horses to be livestock, but that percentage is still sizeable. Conflicts might manifest during cost discussions because owners might not see the value in the diagnostic or treatment approaches that are being recommended. This supports the importance of presenting a range of options at different price points. 

Ethical Framework for Veterinarians

According to Brown University, an ethical framework provides a set of standards for behavior that helps us decide how we ought to act in a range of situations. In 2001, Siobhan Mullen and David Main published a framework for a process that veterinarians can use when faced with ethical dilemmas. It can be divided into four steps: 

  1. Identification of possible outcomes 
  1. Establishment of stakeholder interests 
  1. Formulation of an ethical decision 
  1. Minimization of the decision’s impact 

In your identification of possible outcomes, consider all of the realities surrounding the client, patient and caregiving situation. Formulate a list of all possibilities for resolving the patient’s health needs. Next, establish the stakeholders’ interests or motivations for their positions. The client’s interests might be different from those of the trainer, agent or rider. While it is likely that none of them want to harm the horse, perhaps they have limited time and/or money. These limited resources might not be adequate to solve the patient’s issue. The owner might want to pass over the responsibility for decision-making to the trainer, agent or rider. Or they might wish to decrease the burden on personal resources through decisions that trample on the veterinarian’s values. 

As well as considering the legal or ethical guidelines surrounding animal welfare or professional conduct, you should attend to factors related to legal ownership and liability. Remember that it is likely in no one’s self-interest that the animal continues to suffer. So, avoiding this scenario would be the minimum acceptable ethical outcome.  

When making ethical decisions, the competing factors are often shades of gray with no right or wrong answers. Because the priority is the patient’s well-being and lack of suffering, you must make clients aware that they have choices and a responsibility to act. After offering all the possible options while being compassionate and open-minded in considering all perspectives, try to arrive at a decision together. Some options suggested by the horse’s stakeholders might clearly not be in the patient’s best interest, and it is important to state that fact and seek to understand while being the horse’s strongest advocate. 

Maintaining Objectivity in Ethical Dilemmas

Minimizing the decision’s impact requires trying to remain objective and offering a curious, compassionate dialog. This can help the decision-makers feel that you understand their concerns. If they feel that you are not open to their perspectives, they are more likely to shut down, ignore your advice or feel badly treated.  

Although the final decision might not be the one you would decide if you were the horse’s owner, if the standard of minimizing suffering and advocating for the horse is met, you can be confident that you have been ethical.

Disclaimer from sponsor: This content is subject to change without notice and offered for informational use only. You are urged to consult with your individual business, financial, legal, tax and/or other medical providers with respect to any information presented. Synchrony and any of its affiliates, including CareCredit, (collectively, “Synchrony”) makes no representations or warranties regarding this content and accept no liability for any loss or harm arising from the use of the information provided. All statements and opinions in the article are the sole opinions of the author. Your receipt of this material constitutes your acceptance of these terms and conditions.

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