Moral and ethical conflict: Veterinary profession’s dark side revealed

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A majority of respondents to the survey reported feeling conflict over what care is appropriate to provide, with 79% being asked to provide care that they consider futile.
A majority of respondents to the survey reported feeling conflict over what care is appropriate to provide, with 79% being asked to provide care that they consider futile. [file image]
Moral distress and mental health issues among veterinarians have been highlighted following a survey of more than 800 vets in North America.

Concerns about ethical conflicts, moral distress, and burnout in veterinary practice are steadily increasing, according to the authors of an article published online before inclusion in the Journal of Veterinary Internal Medicine, based on the survey.

“After a number of well‐publicized suicides, the veterinary profession has acknowledged the importance of good mental health and wellness as a foundation of practice,” they wrote.

A Centers for Disease Control and Prevention survey of more than 10,000 US veterinarians in 2014 determined that more than 1 in 6 veterinarians might have experienced suicidal ideation and nearly 1 in 10 may have serious psychological distress.

A majority of respondents to the survey reported feeling conflict over what care is appropriate to provide, with 79% being asked to provide care that they consider futile. About half refused such requests.

These feelings may stem from the complex ethical structure in veterinary medicine, with professional obligations to the animal patient, the animal owner, other veterinary professionals and society at large.

The study of 889 vets was designed to document the existence of unlabeled ethical conflict in North American veterinary clinical medicine and assess whether it is a frequent and relevant problem for veterinarians. “We sought to determine how much formal training veterinarians received at any point in their training about how to navigate these situations. Moreover, the frequency with which veterinarians disagree with requests by animal owners for certain kinds of treatment such as futile or non‐beneficial treatments was investigated. Finally, we inquired about the nature and extent of the distress that veterinarians feel in these situations and what coping methods they have used.”

With respect to euthanasia, 29.3% stated that they sometimes or often receive what they consider to be inappropriate requests for the procedure, and about 19% of respondents said they sometimes or often acceded to these requests. Almost 45% said it caused them or their staff a moderate amount of distress and 18.7% reported it caused them or their staff severe distress.

Overall, 73% of respondents stated that not being able to do the right thing for a patient caused their staff moderate to severe stress and 78% replied that it caused them moderate to severe distress.

Twenty‐six percent of respondents said their empathy for their patients had waned over time and 31% said that their empathy for pet owners had waned over time, and 60% of respondents said they feel like they have prioritized the needs of animal owners over their patients.

In acknowledging the limitations of the study, the authors said that even if the findings are not broadly representative, they still are highly concerning. “They show that many veterinarians are not happy in aspects of their work, feel discomfort and distress about various elements of their work, and do not have many outlets for their distress.

“The results validate current concerns for the mental health and well‐being of veterinarians given that they suffer in the face of multiple conflicts at work and utilize very few outlets for support and help,” they said.

“Veterinarians would benefit from training and support in managing the distress they inevitably will feel in their everyday work. Our findings indicate that, to date, such training and support have not yet happened. We hope our findings as well as future research will lead to supportive, positive changes that will make the practice of veterinary medicine sustainable, less damaging and, in the end, better for veterinarians, their patients, and staff.”

Moses L, Malowney MJ, Wesley Boyd J. Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians. J Vet Intern Med. 2018;18. https://doi.org/10.1111/jvim.15315

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