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

Abstract

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.

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

“…Aside from the companion animal bond, companion animals may have featured more prominently in vignettes due to a broader spectrum of treatment options (introducing more variables to consider in decisions around euthanasia) [62], and ethical challenges associated with advanced veterinary care [63]. This focus of the veterinary profession on companion animals has been criticised as socially irrelevant in the face of the growing human population, stress on global resources, and increasing threats to biosecurity [64].…”

End-of-life decisions: A focus group study with German health professionals from human and veterinary medicine

“…This perspective is a valuable addition to the dominant image of a “good death” under palliative care. After all, the treatment of dying patients in companion animal clinics might share limitations and constraints with procedures in human ICUs, as suggested by recent research on dysthanasia in veterinary practice ( 37 ). Those very specific questions were, however, not dealt with in our study.…”

Killing Kira, Letting Tom Go?—An Empirical Study on Intuitions Regarding End-of-Life Decisions in Companion Animals and Humans

“…At second glance, the collective support of that option challenges the basic rule in veterinary practice, not to let an animal severely suffer for a moderate time to prolong their life (with a good quality) afterwards. Research on veterinarians’ perspectives and arguments or, in a second step, a public dialogue regarding chances and limitations of the increasing treatment options in veterinary medicine are necessary to additionally shed some light on follow-up questions regarding overtreatment and caregiver burden [ 10 ].…”