ethics portfolio

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Journal of Agricultural and Environmental Ethics (2018) 31:739–749 https://doi.org/10.1007/s10806-018-9752-5

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REVIEW PAPER

An Overview on Ethics and Ethical Decision‑Making Process in Veterinary Practice

Binoy S. Vettical1

Accepted: 13 November 2018 / Published online: 22 February 2019 © Springer Nature B.V. 2019

Abstract Veterinary ethics is a coordination of ethical principles that apply morals, values and judgements to the practice of veterinary profession. Veterinary ethics cover its prac- tical application in veterinary practices as well as on its history, philosophy, theol- ogy, and sociology. Veterinary ethics combine veterinary professional ethics and the focus of animal ethics. It can be inferred as a critical manifestation on the provision of veterinary services in hold of the profession’s responsibilities to animal kind and mankind. Many ethical issues arise in a business unit in veterinary practice. When- ever such issues arise, it may lead to dilemmas, then proper and well-thought out ethical decision is to be made. Ethical decision making process in a business unit in veterinary practice is the use of ethical theories, principles, and rules by veteri- nary professionals and paraprofessionals in resolving ethical dilemmas in the vet- erinary practice. In order to resolve ethical dilemmas, being aware of and revela- tion to ethical theories is essential. Thoughtfulness of animal welfare and ethical issues is an essential component of a good ethical veterinary practice. This article reviews and discusses the ethics and major steps engaged in the ethical decision- making process in a business unit in veterinary practice. Strong commitment to the role, organization’s commitment to ethics and staff support could lower the levels of moral stress while facing ethical dilemma in a veterinary practice. Though using the ethical frameworks portrayed may not change the actual decisions finally reached by veterinary professionals, a good knowledge of ethical issues is imperative for client communication, better job satisfaction and preserving a positive public outline for both the individual and the veterinary practice.

Keywords Ethics · Ethical decision making · Veterinary practice

* Binoy S. Vettical edserv@pennfoster.edu; binvsren@yahoo.com; binoy.vs@reprobiotech.ae

1 Penn Foster College, 14300 N. Northsight Blvd., Suite 125, Scott Dale, AZ 85260, USA

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Introduction

The term ethics is derived from the Greek word ethos, meaning custom or char- acter. It is defined as the discipline dealing with what is good and bad and with moral duty and obligation. Veterinary profession has been founded in Lyon, France in 1761 (Jones 2011). While the eighteenth century veterinarian was pri- marily concerned with the maintenance of agricultural economy, the present day veterinarian has much wider range of roles and responsibilities. Rise of inten- sive livestock production, technological progression, innovation in genetic engi- neering, raise in laboratory animal research, a growth in the status and economic value of companion animals, and a growing appreciation of human and animal bond enhances the veterinarian’s role in the society(Rollin 2006). The connection between human beings and members of the animal kingdom is usually a good one, with the increasing presence of companion animals in our homes bringing people a feeling of closeness with the natural world and many positive, healthful benefits (Leininger 1998). Veterinarians are often called upon to make ethical- decision making in many areas and ways they have not done so previously. Veter- inary ethics is a field of ethics concerned with the practical application of ethical theories, principles, and moral standards to the conduct of individuals involved in veterinary service delivery systems that are meant to benefit animals, owners, and the public (Kimera and Mlangwa 2015). There are various studies and pub- lications about veterinary ethics and animal welfare (Singer 1978, 1993a; Rollin 1978, 2002, 2006, 2009, 2011; Tannenbaum 1989, 1995; Bowden 2012; Woods 2013; Yeates 2013), but there are only limited studies on the process of ethical decision making in veterinary practices (Tannenbaum 1989; Bowen 2005). This article review and discusses the ethics and most important steps engaged in the ethical decision-making process in a business unit in veterinary practice.

Veterinary Ethics

It was only in the late 1970s and 1980s that veterinarians responded to budding ethical issues in the perspective of animal use and their welfare, which is called animal ethics (Rollin 2006). The veterinarian’s role has become more complex with new ethical challenges being posed by issues such as growing public aware- ness regarding animal welfare, increasing economic value of companion animals, growth of veterinary specialization, experimentation with alternative and com- plementary medicine, and concern for pain management and mental well-being of animals (Rollin 2006). In the development of veterinary ethics, the field has drained greatly from medical ethics (Sugarman and Sulmasy 2010), research ethics, animal ethics, and animal welfare (Yeates and Main 2008; Kimera and Mlangwa 2015; Henk ten Have 2016).

Stephens (2012) considers veterinary ethics to be composed of veterinary pro- fessional ethics and animal ethics. Tannenbaum (1995) defines animal ethics as

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the moral obligations that people have for animals and restricts veterinary eth- ics to the provision of veterinary care. Veterinary ethics is a subfield of bioeth- ics. Bioethics is the study of ethics and philosophical implications of certain biomedical technologies (Beauchamp and Childress 2001). Animal ethics is cen- tered on uses of animals by veterinarians and others. Another perspective of eth- ics is inherent in the concept of animal wellbeing functionalized as animal wel- fare. Yeates (2009) describes the role of veterinary oversight of animal welfare as a key veterinary privilege. It is widely recognized that assessments of animal welfare involve a number of assumptions that are ethical in nature (Tannenbaum 1995; Sandoe and Christiansen 2008). While animal ethics refer to the moral issues surrounding the use of animals, veterinary ethics are concerned with how veterinarians make decisions and act as professionals for the provision of vet- erinary care. In this process of professional decision making veterinarians will need to consider issues of animal ethics but their professional ethics necessarily include and go beyond these concerns (Tannenbaum 1989).

For practical purposes veterinary ethics have been divided into four branches (Tannenbaum 1995). The four branches are descriptive, official, administrative, and normative. Descriptive ethics deal with factual descriptions of moral behavior and belief. It includes describing ethical reasoning and perspectives of stakeholders on ethical issues. In veterinary profession, descriptive ethics refer to the study of ethi- cal views of veterinarians and veterinary professionals regarding their behavior and attitudes. This relates to what members of the profession think is right and wrong and does not involve making value judgments about what is moral or immoral in a professional’s behavior. Official veterinary ethics involve the creation of the official ethical standards adopted by organizations of professionals and imposed on their members. Administrative veterinary ethics involve actions by administrative govern- ment bodies that regulate veterinary practice and activities in which veterinarians engage. Normative ethics refers to the search for correct principles of good and bad, right and wrong, and justice or injustice. In short, descriptive ethics, also known as comparative ethics, is the study of people’s beliefs about morality and it contrasts with prescriptive or normative ethics, which is the study of ethical theories that pre- scribe how people ought to act (Gavriel 2015). So also the difference between ethics and law lies in enforcement; the government enforces laws, whereas the professional associations that developed the ethics enforce ethics (Prendergast 2015).

Veterinary ethics is a coordination of ethical principles that apply morals, values and judgments to the practice of veterinary profession. Prendergast (2015) described that, there are three areas of ethics which exist and affect each team member on every level in a business unit in veterinary practice; social, personal, and profes- sional ethics which are interrelated, yet they affect each person differently. Social ethics are the consensus principles adopted or accepted by society at large and codi- fied into laws and regulations. Personal ethics define what is right or wrong on an individual basis. Professional ethics, as stated, are developed by the professionals of a particular discipline, developing rules, codes, and conduct for the profession to fol- low. Research indicates that there is a strong connection between the perception of organizational justice and ethical attitudes and behavior (Regan 2013). Veterinarians practice veterinary medicine in a variety of situations and circumstances. Exemplary

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professional conduct upholds the dignity of the veterinary profession. Veterinarians are expected to adhere to a progressive code of ethical conduct. Veterinary ethics are developed by the veterinary profession, which each team member must adhere to. For example, in USA, American Veterinary Medical Association (AVMA), Veteri- nary Hospital Managers Association (VHMA), National Association of Veterinary Technicians in America (NAVTA) and in UK and Ireland Royal College of Vet- erinary Surgeons (RCVS) and the Veterinary Council of Ireland, respectively have developed a Code of Ethics for each member to follow.

Veterinary practitioners often face dilemma or conflicts in many situations. When a pet that has been hit by a car, is brought in an emergency situation (Christiansen et  al. 2016), animals are left at practice unclaimed (Ahern 2018), a decision is to be taken for animal euthanasia (Rollin 1978, 2009, 2011; Bernard 1987), attend- ing, consulting and referring a case (Vlissingen 2001; Main 2006; Hernandez et al. 2018), conducting research (Yeates and Main 2009), publishing research articles, as an academic advisor (Buck et al. 2001; Vlissingen 2001; Baumans 2004; Metzger 2015; Joordens 2018), treating co-workers fairly with mutual respect, neglecting ani- mals (Hernandez et al. 2018), handling the outbreak of contagious and zoonotic dis- eases (Lindahl and Grace 2015; McIvor 2016), noticing animal cruelty (Fleck 2012; Ben 2016) are some of the situations among many others, where veterinary profes- sionals face dilemma or conflicts in a business unit in veterinary practice, and are committed to ethical decision-making. As an example, considering animal cruelty, it has several types which may be one of simple neglect, gross neglect, intentional abuse, animal hoarding, organized abuse, ritualistic abuse or animal sexual assault (Mogbo et al. 2013). The definition of animal cruelty may also vary from that of an animal activist to a hunter or a farmer. There is a legal definition of animal cruelty (Duel 2000) and these varied definitions of animal cruelty may create a dilemma in a veterinary practice. There are a number of conceptual approaches to the issue of cruelty to animals. Utilitarianism supports the view that animal welfare matters just as much as human welfare (Bentham and Mill 1961; Mill 2003). Utilitarianism is an ethical theory that says an action is morally right if it benefits the greatest num- ber of beings with the greatest good. Jeremy Bentham is considered the father of modern utilitarianism (Singer 1985). Under utilitarian ethics, the ends always justify the means. Bentham’s utility is opposed to Singer’s equal consideration of interests (Bentham 1780; Singer 1975, 1993b). Singer (1975) argues that the basic principle of equality should be extended to nonhuman animals. The concept of “death is not a welfare issue” creates a conflict for many who consider animal welfare to be an appropriate basis for decision-making in animal ethics but also consider that an ani- mal’s death is ethically significant (Yeates 2010a). He has argued that an animals’ choices be respected when the relevant human decision maker’s capacities to decide are potentially challenged or compromised (Yeates 2018). Immanuel Kant was an opponent of utilitarianism. In Kantian philosophy, it is believed that certain types of actions including murder, theft, and lying were absolutely prohibited (Alexan- der and Elizabeth 1975) and a decision can be truly moral only if it is made by an autonomous, rational decision maker. According to this philosophy, animals are not autonomous and therefore, the categorical imperative does not apply to them (Paton 1948). One of the central propositions in Kant’s ethical system is that persons, and

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persons alone, are the proper object of respect (Alexander and Elizabeth 1974). Bentham (1780) explains that animals may be killed to be eaten, as long as we do not hurt them. The sentience lies at the heart of utilitarianism. Given that animals are sentient, we must not hurt them, though it may be admissible to kill them; which is not the same in moral terms (Bentham 1780). This view justifies certain human practices that cause pain, discomfort, suffering and death towards non-humans.

In most cases, failure to recognize that there is an ethical component to some decisions lead to improper decision making and unethical outcome. In short, in the process of decisions making there are always different interests at stake, all of which must be well thought-out; there are those of the animal, the owner, a third party, society as a whole and of the veterinarian (Vlissingen 2001). The process of ethical decision-making and various steps involved in this process are detailed in this paper.

Ethical Decision‑Making Process and Stress Factors

Ethical and moral issues arise commonly in veterinary practice. Decision-making in a business unit in veterinary practice will always be complex as often one or more courses of action may be reasonable for a given situation. The value of emphasiz- ing ethics in everyday clinical practice is that it helps the clinician to reflect on their course of action, it empowers clinicians to advocate for their patients and it is criti- cal for informing policies for the profession and for animal welfare (Kong 2015). Veterinarians have an ethical obligation to provide good care for their patients and for that they need a good knowledge in ethical decision-making, otherwise there is a gap between the theory of ethical veterinary practice and its actual application, which can lead to significant moral conflict and burn-out as well as significant ani- mal welfare issues. Exposing veterinary students to a wide range of ethical frame- works (Bowden and Smythe 2008; Mullan and Fawcett 2017), including utilitarian- ism, deontology, rights-based theories, virtue ethics (Gardiner 2003; Arries 2005), principle-based ethics and social justice, as well as examination of value systems, alternative views, conflict resolution and decision-making processes will help to improve the knowledge in ethical decision making (Main et al. 2005). A joint report of the Federation of Veterinarians of Europe (FVE) and the European Association of Establishments for Veterinary Education (EAEVE) called for more uniform, com- prehensive teaching of animal welfare, ethics and law across veterinary schools, stating “one cannot be a good clinician without being aware of the ethical issues in decision-making in practice” (Morton et al. 2013). Kong (2015) describes the crea- tion of an ethics community in human medicine to nurture ethical reasoning and moral imagination. In veterinary medicine, this could include nonjudgmental and peer-to-peer discussions with like-minded colleagues, as well as veterinary ethicists and academic researchers. Moore (2010) describes a “common-morality theory” in bioethics characterized by pre-theoretical common-sense ethical judgment that acts as starting point of view for most ethical frameworks.

The foundation of ethical decision-making involves choice and balance and hence it is a guide to discard bad choices in favor of good ones (Chmielewski 2004). For tougher decisions, three rules of management may be helpful, which are; the rule of

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private gain, if everyone does it, and benefits versus burden (Hojnacki 2004). Eth- ical decision-making process requires a persuasive and rational justification for a decision. Rational justifications are developed through a logical process of decision making that gives proper attention to such things as facts, alternative perspectives, and consequences to all stakeholders, and ethical principles (Laura et al. 2017).

One of the key areas of conflict in a business unit in veterinary practice is conflict between the interests of the animal or patient and the interests of the client, who typ- ically is paying for treatment (Hernandez et al. 2018). Rollin (2006) discussed about the fundamental question of veterinary ethics: “to whom does the veterinarian owe primary obligation: owner or animal?” Ethical dilemma arises when veterinarians have competing responsibilities with no apparent way to prioritize one over the other (Morgan and McDonald 2007). Besides, a more contentious definition of an ethical dilemma is when there is a clear ethical alternative but it is exigent to accomplish due to contextual factors like client interests (Morgan and McDonald 2007). As a matter of fact, many ethical dilemmas are resolved by prioritizing the interests of the client over the interests of the animal. While the ultimate decision for care rests with the client, they may expect veterinarians to exert their Aesculapian authority in many situations (Rollin 2002; Yeates and Main 2010). Ethical decisions can also be determined by personal moral perspectives which may differ based on the type of patient-client-veterinarian relationship. This can be influenced by the degree of association from the client and in addition the increased consciousness and hope from knowledgeable customers (Coe et al. 2007; Shaw et al. 2010).

Ethical issues that arise in veterinary practice can lead to moral stress (Rollin 2011). For example, most common ethical dilemmas veterinarians face in veteri- nary practice are limited treatment options due to financial constraints, euthaniz- ing of healthy animals (Yeates 2010b), and owners wishing to continue treatment of terminally ill animals. Veterinarians face ethical dilemmas in this context regu- larly and consider them stressful (Main 2007; Batchelor and McKeegan 2012). Per- forming euthanasia has been described as an occupational stressor and related to even suicidal behavior in veterinarians (Stark and Dougall 2012).The reason most often given by veterinarians in the context of wanting to refuse euthanasia, but not doing so was “Fear of what owners would otherwise do to the dog”(Yeates and Main 2011). Moreover, having responsibilities towards animal patients and owners at the same time, raises further fundamental questions in veterinary medical eth- ics (Tannenbaum 1993) lead to moral stress (Rollin 2009, 2011). An approach such as the Principles of Biomedical Ethics (Beauchamp and Childress 2013) in human medicine, which integrates important ethical viewpoints, is not applied in veterinary medicine. The definition of Reynolds et al. (2012) hypothesize that moral stress is a psychological state born of an individual’s uncertainty about his or her ability to fulfill relevant moral obligations. According to these authors their model draws from a theory of the self (identity theory) and a theory of others (stakeholder theory) to suggest that this uncertainty arises as a manager faces competing claims for limited resources from multiple stakeholders and/or across multiple role identities.  Moral stress is defined and discussed as the influence of stressful situations in decision making by veterinary professionals in many other studies as well (Batchelor and McKeegan 2012; Crane et  al. 2013, 2015; Hartnack et  al. 2016). Studies showed

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that those who have strong commitment to their role and who perceive their organi- zations as committed to ethics and staff support experienced lower levels of moral stress (Fisher et  al. 2013). Accordingly, strong commitment to the role, organiza- tion’s commitment to ethics and staff support could lower the levels of moral stress while facing ethical dilemma in a veterinary practice.

Ethical Decision‑Making: A Systematic Approach

A systematic approach is very important in ethical decision-making. There are vari- ous steps involved in a systematic approach. The first step in taking ethically respon- sible decisions is to determine the facts of the situation. Identify and recognize a decision or issue as an ethical decision or ethical issue is the second step in respon- sible ethical decision making. It is easy to be led off track by a failure to recognize that there is an ethical component to some decisions. The tendency to ignore or the lack of the ability to recognize, ethical issues in decision making is known as nor- mative myopia. Normative myopia, a comparatively new concept introduced in the corporate social performance literature by Swanson (1999), refers to the propensity of executives to ignore, suppress, or deny the role of ethical values in their deci- sions. In a preliminary study, Orlitzky et  al. (2006) extend Swanson’s concept of normative myopia by using it as a point of reference for studying executives’ prefer- ence for high pay dispersion. Chugh and Bazerman (2007) argued that people often fail to perceive and process stimuli easily available to them. The authors called this phenomenon “bounded awareness” and the authors explained that in-attentional blindness and change blindness are examples of this phenomenon.

The third step in taking an ethical decision making is to identify and to consider all of the people affected by a decision, the stakeholders. The important fact that there are many perspectives and interests at stake means that ethical decisions often involve dilemmas. Each alternative will entail costs on some stakeholders and offer settlement to others. Once we have examined the facts, recognized and identified the ethical issues involved, and identified the stakeholders, we need to consider the avail- able alternatives. In this context moral imagination - creativity in identifying ethical options-is one component that tells apart good people who make ethically responsi- ble decisions from good people who do not. Patricia and Brian (2009) defined moral imagination as the ability to discover and evaluate possibilities within a particular set of circumstances by questioning and expanding one’s operative mental frame- work. The authors explained that the moral imagination must go hand-in-hand with practical moral reasoning, which enables a manager to contextualize potential sce- narios and decisions in terms of values, principles, and moral norms. Laura et  al. (2017) detailed that, when one is facing an ethical decision, moral imagination is the ability to envision various alternative choices, consequences, resolutions, benefits, and harms. The next step in the decision-making process is to compare and weigh the alternatives based on consequences for all stakeholders, duties, rights and princi- ples, and implications for personal integrity and character. After exploring all these alternatives, the next step is to make a decision. In business, in most cases, making a decision means formulating a plan and carrying it out. To complete the process,

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proceed to the final step: evaluate the implications of decisions, to monitor and learn from the outcomes, and to modify actions accordingly when faced with similar chal- lenges in the future.

Conclusion

Ethical and moral issues occur normally in all areas of veterinary practice. Gain- ing knowledge in ethics education during studies and veterinary training may help to improve ethical compassion and endow veterinary professionals with frame and vision that support ethical decision-making. Good communication should be estab- lished in the veterinary-client relationship when serious welfare matters are just around the corner. Ethical decision-making process requires an influential and bal- anced rationalization for a decision. Coherent justifications are formulated through a logical process of decision making that gives proper attention to such things as facts, alternative perspectives, and consequences to all stakeholders, and ethical princi- ples. Strong commitment to the role, organization’s commitment to ethics and staff support could lower the levels of moral stress while facing ethical dilemma in a vet- erinary practice. Further investigation and dissertation on veterinary practice related ethical issues may perk up veterinary instruction and paraphrase of ethics assump- tion and way of thinking into functional practice.

Acknowledgements Binoy, S. Vettical would like to thank the supervisors, instructors and other staff of Penn Foster College, Arizona, U.S.A. for their support during his CVPM program.

Compliance with Ethical Standards

Conflicts of interest The authors declare no conflict of interest.

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