Resolving Ethical Dilemmas in a Tertiary Care Veterinary Specialty Hospital: Adaptation of the Human Clinical Consultation Committee Model

Rosoff, Philip M.; Moga, Jeannine; Keene, Bruce W.; Adin, Christopher A.; Fogle, Callie; Ruderman, Rachel; Hopkinso, Heather; Weyhrauch, Charity

doi:10.1080/15265161.2017.1409824

Cited by 31 publications

(18 citation statements)

References 45 publications

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“…Veterinary teams can establish structures to provide advice about alternative courses of action, help in mediating conflicting perspectives and (where appropriate) professional assurance that the best, least worst or right course of action was taken. Discussion of active ECS with an ethics committee may address these needs, though there are practical and resource constraints to consider (66,67). However, it may be possible to meet at least the first need in ethics rounds, or indeed in morbidity and mortality (M&M) rounds (68,69).…”

Section: What Can Veterinary Teams Do To Prepare For Ethical Challenges?mentioning

confidence: 99%

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

et al. 2021

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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.

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Section: What Can Veterinary Teams Do To Prepare For Ethical Challenges?mentioning

confidence: 99%

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

et al. 2021

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“…In addition to advanced imaging, in recent discussions of veterinary ethics, AVC has been associated with cancer chemotherapy, radiotherapy, immunotherapy, stem-cell treatment, personalised medicine, hip arthroplasty, heart-valve replacement, dialysis, 3-D printing of prostheses, interventional radiology, stereotactic radiosurgery, interventional cardiology and surgical innovation [ 23 , 24 , 25 , 26 , 27 , 28 ]. However, what is considered to be AVC may vary between practitioners: a procedure that is considered routine by a veterinary surgical oncologist may be considered advanced by a general practitioner.…”

Section: What Constitutes Advanced Veterinary Care?mentioning

confidence: 99%

“…Around 35% performed invasive procedures, against their professional judgement, to avoid a client complaint, where the owner demanded this treatment [ 31 ]. According to Rosoff and colleagues, “the skills to carry out technologically sophisticated diagnostic and therapeutic actions—in many ways mirroring those routinely employed in human medicine—have developed within a culture and professional standard of yielding to what clients (i.e., owners) want to have done to and for their animals” [ 28 ].…”

Section: What Constitutes Advanced Veterinary Care?mentioning

confidence: 99%

Ethical Challenges Posed by Advanced Veterinary Care in Companion Animal Veterinary Practice

Quain

Ward

Mullan

2021

Animals

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Advanced veterinary care (AVC) of companion animals may yield improved clinical outcomes, improved animal welfare, improved satisfaction of veterinary clients, improved satisfaction of veterinary team members, and increased practice profitability. However, it also raises ethical challenges. Yet, what counts as AVC is difficult to pinpoint due to continuing advancements. We discuss some of the challenges in defining advanced veterinary care (AVC), particularly in relation to a standard of care (SOC). We then review key ethical challenges associated with AVC that have been identified in the veterinary ethics literature, including poor quality of life, dysthanasia and caregiver burden, financial cost and accessibility of veterinary care, conflicts of interest, and the absence of ethical review for some patients undergoing AVC. We suggest some strategies to address these concerns, including prospective ethical review utilising ethical frameworks and decision-making tools, the setting of humane end points, the role of regulatory bodies in limiting acceptable procedures, and the normalisation of quality-of-life scoring. We also suggest a role for retrospective ethical review in the form of ethics rounds and clinical auditing. Our discussion reenforces the need for a spectrum of veterinary care for companion animals.

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“…Establishing CESS in veterinary medical institutions appears like a logical next step. However, so far only few implementations of CESS in veterinary medicine have been published (Adin et al, 2019;Moses, 2018;Rosoff et al, 2018;Springer et al, 2018).…”

Section: Introduction: Forms Of Clinical Ethics Support Servicesmentioning

confidence: 99%

1. Food justice, food security, and climate engineering

Kortetmäki

2021

Justice and Food Security in a Changing Climate

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Both the planning of EurSafe2021 and the origin of this book were profoundly influenced by the Covid-19 pandemic, and we are extremely pleased to see that so many contributions still arrived. We would like to thank all authors for sharing their work and insights and all reviewers for their muchappreciated expertise on the vast range of topics. We are grateful for the support and encouragement received from the EurSafe board and Svenja Springer, in preparing this conference despite the challenging circumstances. Our special thanks go to

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Resolving Ethical Dilemmas in a Tertiary Care Veterinary Specialty Hospital: Adaptation of the Human Clinical Consultation Committee Model

Cited by 31 publications

References 45 publications

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

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

Ethical Challenges Posed by Advanced Veterinary Care in Companion Animal Veterinary Practice

1. Food justice, food security, and climate engineering

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