The Ethics of Critical Care

[vegternarian]

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So I'm writing a paper right now, and doing the usual procrastination. It's for my critical reasoning class, we have to take a scholarly paper from our field (vet medicine for me, obviously) and then identify major and minor arguments. I spent a good hour and a half finding the article in a research database, scanning technical jargon and trying to find something that was readable at my level of veterinary experience and that also sparked interest. I stumbled across a great one from the Journal of Veterinary Emergency and Critical care entitled Ethics of Critical Care, written by a PhD studying philosophy at Colorado State. Very interesting!

So, I'd like to start a discussion. As a future practitioner of veterinary medicine (hopefully!!!), is your moral obligation ultimately to the patient or to the client? Do you consider the preferences of the client over the welfare of the patient? Why?

🙂

 

[AuburnPreVet]

can you be a bit more specific as to what the article was getting at? the obligation is to the patient, client, and your own morals... as all 3 are involved in the "veterinary client patient" relationship. With that said, the client makes the decisions regarding what treatment will be done, but if you find yourself uncomfortable you can (obviously) terminate the relationship -- tricky in emergency care, I assume.

 

[rexosaurus]

i think the answer to this is somewhat obvious: your obligation is to patient health. sometimes it is difficult to achieve this goal due to cantancerous clients, but your job is to ease the pain and suffering of animals, although pleasing their owners should come secondary. i understand the need for a positive relationship with a client, but patient health is of utmost importance. i have worked in critical care medicine, and it does get ugly at times because peope are sometimes not the most compliant. at this point, and rarely, animals can be taken from their owners in the most extreme cases. this is an example of moral and ethical obligation to the animal, because, after all, this is why we are becoming vets right?

 

[vegternarian]

can you be a bit more specific as to what the article was getting at? the obligation is to the patient, client, and your own morals... as all 3 are involved in the "veterinary client patient" relationship. With that said, the client makes the decisions regarding what treatment will be done, but if you find yourself uncomfortable you can (obviously) terminate the relationship -- tricky in emergency care, I assume.

The article concludes that you should use three ethical "types"- personal, professional, and societal when determining the ethics of veterinary care. Personal, meaning your own ethical fabric; professional, which would be the consensus of the veterinary community; and societal, meaning the ethics pertaining to animals of the society you practice in. The author recommended considering societal and professional ethics within the context of a "pediatric" model of patient/client/vet relationship (constituting your personal ethics) in which you, the vet, choose the patient as your ultimate ethical responsibility rather than the client. Of course he acknowledges that it's ultimately the clients decision to make regarding the course of the treatment, but that veterinarians do have the aesculapian authority to persuade clients in a different direction. Is that more clear? It's a ten page article, it's hard to boil it down to a paragraph.

 

[Rebeki]

I also work in an emergency hospital and I have seen that while ultimately we have the best interests of the animals at heart, finances often complicate the situation. For some people, it is just not possible to spend several thousand dollars to hospitalize their critically ill pet. It is really sad, but animals hospitals for the most part are not charities and do not work for free.

 

[Bill59]

i think the answer to this is somewhat obvious: your obligation is to patient health.

But not exclusively.

"Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health, the relief of animal suffering, the conservation of livestock resources, the promotion of public health and the advancement of medical knowledge."

Fortunately, in many cases these responsibilities don't conflict. The tough cases are when they do.

 

[rexosaurus]

But not exclusively.

"Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health, the relief of animal suffering, the conservation of livestock resources, the promotion of public health and the advancement of medical knowledge."

Fortunately, in many cases these responsibilities don't conflict. The tough cases are when they do.

ah yes, this is true 🙂

 

[Cheska]

One great source to look up for ethics is Dr. Bernard Rollin- this guy is awesome! He is a prof at CSU-- he has a ton of books published on ethics, but he also has many journal publications too about vet med, lab animal ethics, etc. I took his class last semester, I don't think I have ever done so much thinking in my life. And of course if you ever get a chance to hear him lecture- go!!! All third year CSU vet students have an ethics class with him.

One more thought: I worked at a low cost vet clinic in Denver- really bad neighborhood! One thing that always got in the way of the ideal ethical situation was of course money. A kitten would come in with a bad upper respiratory infection, and the kids who brought it couldn't afford the exam, any antibiotics, let alone a euthanasia fee. It is a tough situation when you know the ethical thing to do, but money gets in the way-- especially in an emergency/ critical care situation.

 

[vegternarian]

One great source to look up for ethics is Dr. Bernard Rollin- this guy is awesome! He is a prof at CSU-- he has a ton of books published on ethics, but he also has many journal publications too about vet med, lab animal ethics, etc. I took his class last semester, I don't think I have ever done so much thinking in my life. And of course if you ever get a chance to hear him lecture- go!!! All third year CSU vet students have an ethics class with him.

What a coincidence, that's who wrote the article. 🙂

 

[Cheska]

What a coincidence, that's who wrote the article. 🙂

Small world... at first glance, he is this tough, bearded New Yorker motorcycle guy... but then you talk to him and he has the softest heart when it comes to animals, even lab mice!

 

[alliecat44]

I think it's important to recognize that not all ethical dilemmas (i.e., places where the patient's interests conflict with those of the client) have to do with limited finances. As a technician at a large specialty hospital, I've seen the opposite occur many times. Probably the most accessible examples come from surgical cases. Our surgeons--who happened to be two of about thirty surgical oncologists in the world--were sometimes asked to perform procedures that they were technically capable of, and that few surgeons in the world had ever done--or done regularly, at least. However, there were times when such procedures were contraindicated for the patient for a variety of reasons--and yet the clients insisted that, since "money is no object," everything possible should be done for their pet. If performing a procedure can extend the longevity of a patient's life but at a reduced quality (increased level of pain, etc), should it be done? Just because we CAN, does it mean we SHOULD? What if it means that Mrs. Smith will take her cat down the street and "make" someone less skilled/knowledgeable do the procedure? The outcome would likely be even worse. If you know that Mrs. Smith will have the procedure done regardless of surgical experience, do you change your mind and give Fluffy what you think will be Fluffy's best shot with the surgery itself?

Interestng questions. I was very proud to work with clinicians who occasionally did refuse to provide certain types of care to certain patients. These cases were few and far between, but they do happen.