Professional ethics
Being a professional entails making decisions of consequence and to
help ensure these are morally acceptable, the necessary principles and
tools are provided by professional ethics.
Veterinarians are professionals who must make
ad hoc decisions that influence the fate of animals and affect the lives
of the people who own or look after them. They also have to address issues of
public interest, such as public health. The central role they play in
decision-making implies considerable collective and individual responsibility.
However, not every decision requires an unique ethical or moral consideration
or judgement, although, no matter in what field a veterinarian works,
be it clinical practice, research, education, or public health, he or
she will always be faced with dilemmas that have no obvious solution. In these situations
they have to make a decision, but in the knowledge that afterwards it may
be questioned or have an outcome that was never intended. In the process of making decisions there are invariably different interests at stake, all of which must be considered;
there are those of the animal, the owner, a third party (which may be
society as a whole) and of the veterinarian.
The animals' interests
The immediate interest of an animal is to live in an environment that
it can adapt to in the absence of lasting pain or impairment of health.
Man bestows values on animals, including those of economic, recreational,
intrinsic and naturalistic origin [1],
although they are clearly not aware of this fact. The context and population
within which an animal belongs are determining factors for the way in
which the veterinary profession relates to it, and are beyond the influence
that respect for an individual animal might have.
For very obvious reasons veterinary ethics are more complicated than medical ethics:
The informed opinion of the animal in question is never available
To sustain the life of an individual animal is not a central issue because most domestic animals do not complete their natural life span
At best, the reasons for keeping animals are not contradictory to their interests
The role of the veterinary profession
The veterinary profession is essential for the proper care of animals
kept in captivity and, to a lesser extent, for the health and welfare
of wild fauna. If there were no veterinary medicine, it would surely
be invented for the benefit of animals and mankind. This does not mean,
however, that veterinarians always do 'the right thing'. Only an acute
awareness of ethical dilemmas, and an ability to critically reflect,
can assist in the making of appropriate decisions and the finding of
acceptable compromises.
Policy and legislation on animals
Fortunately, it is now generally accepted that the well being of animals
in captivity must be given reasonable consideration; this is certainly the case
in most industrialised countries. The last two decades have
seen the implementation of a substantial body of new, or renewed, legislation
to address issues such as the welfare and use of farm and laboratory
animals, the methods used for slaughtering animals and the performance
of routine surgical interventions. Zoos, and similar institutions, have
also made a concerted effort to improve their husbandry practices and
to broaden their aims. They now run breeding programmes to help conserve
endangered species as well as programmes to educate the public on the
habits and natural environment of animals.
Many more difficulties are faced when genuine attempts are made to regulate
the practice of selective animal breeding, which has affected the well
being of some domestic species and breeds because of physiological or
behavioural abnormalities. It is also much harder to address welfare
issues when animals are kept as pets, perhaps because it leads to direct
confrontation with the pet owning public, many of whom are neither open
to criticism nor willing to change their behaviour. Collectively, the
pet owning public is large and therefore represents a significant number
of people with substantial political influence. Animal welfare organisations
also play a major role in policy-making processes but they, too, meet
barriers when the interests of their members are affected. Thus, they
concentrate their attention on commercial businesses that keep and use
animals primarily for profit [2].
The veterinarian as the animals' advocate
The veterinary profession is a follower rather than an initiator in
the development of policies that aim to safeguard and improve the welfare
and moral status of animals. Codes of ethics for veterinarians focus
mainly on professional conduct in relation to colleagues and clients,
such as advertising and the adoption of one another's clients. Meanwhile,
the interests of animals are considered implicit rather than being discussed
explicitly.
Time and again, veterinarians are confronted with situations that result
from other people's actions and therefore are beyond their control.
They must apply their professional judgement to situations where there
are no strict rules or regulations. Inevitably, this gives rise to
moral dilemmas, the most common of which are mentioned below. Also mentioned are decision-making frameworks, based on thinking through the consequences of all available options.
Curative veterinary medicine
This first example of a typical dilemma faced by a veterinarian in practice
is relevant to small animal practice, but could be equally well applied
to other situations.
A puppy is presented with front limb lameness. The condition results
from a disproportionate growth of the radius and ulna causing the
radius to curve, which subsequently puts excessive stress on the distal joints of
the leg. Certain short-legged breeds are predisposed to this abnormality,
but it is possible to treat the condition surgically. In the very worst
cases repeated surgical intervention may be required.
The only alternative is to euthanise the animal. Although the
condition is severe enough to necessitate veterinary intervention, it
does not present an emergency situation and therefore there is time
to think before a decision has to be made.
There are numerous interests involved in this scenario. First,
those of the puppy. Its life is dependent not only on the prognosis made by the
consulting veterinarian, but also on the amount and duration of pain
and post-operative immobility it is likely to experience. Although the prognosis
of treatment is generally good, it is anticipated that the amount and duration of post-operative
discomfort will be long lasting and severe. Consequently,
the normal psychological and physical development of the animal will
be impaired, or at best delayed. The only way to prevent this discomfort,
and any other problems, is to choose euthanasia.
The interests of the owner are more diverse. The reasons for acquiring
a puppy of this particular breed are undoubtedly personal. However,
if the owners are breeders there are several reasoins why they may choose to euthanise the puppy. The alternative treatment is costly, the puppy cannot
be sold before it is completely cured which makes it too old to sell because most clients want to buy a
young puppy and, finally, a conscientious breeder would not breed from an animal
with a condition that has a genetic predisposition. In contrast, if
the owner is a family with young children and the puppy is to serve
as the family pet, the situation is very different. Money may not be
a problem, but there are still moral and emotional issues to consider.
It can be assumed that the family is emotionally attached to the puppy,
perhaps more so because of its difficult start in life. The children's
development of a sense of 'animal awareness' may have been an important
reason why the parents acquired a pet in the first place and thus the puppy
became a family member the moment it arrived. To decide a member of
the family should be euthanised is no small matter and to replace the
puppy with another may be unacceptable to the family when it is confronted
with the situation. In summary, the family is willing to do whatever
it takes to provide a good life for their puppy.
At this point in the decision-making process, the veterinarian's prognosis
and advice become crucial. He can advise on the severity of the condition,
on its likely causes and on the required treatment and post-operative
care and expected quality of life for the puppy. We can assume he is
a highly skilled and optimistic individual; he wants to do all he can
to help because he likes the family. Furthermore, orthopaedic surgery
is something that his clinic is very capable of performing and it will
provide a substantial income. If he recommends euthanasia there is a
chance that this client will seek a second opinion and if the therapy
is then performed successfully elsewhere the client is unlikely to return.
Thus, there are matters of business to consider in the decision-making
process.
Finally, there are the interests of third parties to consider. A breed's
predisposition to abnormal growth in a front limb may easily become
exaggerated when there is a practical solution to the problem, such
as surgery. However, this is not something the individual practitioner
can influence. Once a form of therapy has been developed, it is only
a matter of time before it is made available to the public. The practitioner
must decide whether to provide the therapy, to refer the customer to
another clinic, or to refrain from recommending the treatment altogether.
In these situations, the veterinary profession can only hope that the
breed society tries to prevent the problem from arising by the implementation
of selective breeding. Nevertheless, there remain some professional
responsibilities to consider. Could or should the breeder of this puppy
be informed of the defect? Are the present owners the best people to
do this, given their lack of professional knowledge and the inevitable
disappointment felt after purchasing the puppy? Should the veterinarian
contact the puppy's breeder? Whichever, the practitioner should certainly
recommend that the new owners of the puppy never use it for breeding
and he might even propose that immediate castration/vasectomy or ovaryhysterectomy
be performed.
Analysis of this case, with a view to developing a model for decision-making
and identifying the relevant professional responsibilities, might lead
to the following scheme, which summarises the interests of all parties
concerned:
Animals' interests: the availability of therapy, the chance of therapy being successful, the quality of life after recovery from therapy and the amount and duration of pain and distress during the period of treatment and healing.
Owners' interests: consideration for the health and well being of the animal, the emotional bond with the animal, the costs of treatment - monetary and labour, the chances of successful treatment and the suitability of the animal for its intended use after healing.
Veterinarians' interests: consideration for the health and well being of the animal, his relationship with the client and the professional challenge and commercial interest the case offers.
Interest of the population to which the animal belongs: the absence of inheritable problems that cause serious defects.
This scheme may be applied to conditions observed and treated routinely
in veterinary practice, such as entropion in dogs and cryptorchidism
in horses. It is rewarding to find that many interventions become quite
acceptable from a veterinary point of view. The scheme reveals how important
the intended use of an animal is when choosing a form of therapy and
also how the specific interests of the animal can be included. It is
useful to the veterinarian for the analysis of situations that are ethically
complicated and helps him to include all the relevant issues needed
for making decisions. By using such a scheme, veterinarians improve
their communication with clients and colleagues.
Veterinary research
When clinical cases, such as the puppy with a deformed front limb, are
extrapolated to the clinical research environment it is clear that the
development of diagnostic and therapeutic tools leads automatically to
their application, unless the cost of their application is truly excessive.
For this reason, the possible implications of research projects should be
analysed and discussed at regular intervals, particularly during the initial
stages of planning. During discussions, however, care should be taken to
avoid extrapolating information pertinant to man to animals and vice versa.
A few examples in which this danger is relevant are given below.
1. Infectious diseases
Major efforts have been, and continue to be, made in order to develop
vaccines against infectious diseases that affect man. When patients do become infected they usually receive good medical care and, if necessary,
are treated in isolated units. However, for animals the situation
is quite different; there is a much wider range of treatment strategies to consider.
The most drastic course of action is the destruction of all diseased animals as well
as those that are clinically healthy but have had contact with possible sources
of the disease. To select the optimum strategy for animals affected by disease,
man must consider the differential moral status he assigns to domestic animal
species; for instance, diseases
affecting production animals may be eliminated by the large scale destruction of
animals. Complex legislation and international treaties have been designed for
the organised control of animal diseases by such means. In contrast, equally serious
diseases in companion animals are more likely to lead to the development of vaccines.
2. Cloning and stem cell technology
The recent development of nuclear transfer technology has enabled the
production of many genetically identical offspring from a single adult
animal [3]. Briefly, the technique
involves the transfer of nuclei from donor cells into enucleated fertilised
ova, which are deposited into the uterus of unrelated recipient females;
novel but genetically identical individuals are born. The scientific
potential of this technique is immense. It enables the development not
only of fundamental research into the function of genes, but also of
basic research into phenomena such as ageing. Not too surprisingly,
it has raised many moral objections, the most prominent being its potential
application for the production of human clones. Pressure groups that
oppose the use of the technique in animals foresee major trouble if
the technology were ever to be applied to man. Some people predict that
powerful individuals might attempt to produce the equivalent of the
"Boys from Brazil" (clones derived from Adolf Hitler), or that extremely
wealthy people may wish to clone themselves in order to guarantee a
supply of fully compatible tissues and organs for transplantation, in
case they should need them later in life. The only way to make such
scenario's unlikely is the enforcement of moral and legislative restrictions
rather than there being a limitation on available technology.
Interestingly, the development and use of a very similar technique,
namely stem cell technology, has been given a novel impulse recently
and is related to the much debated and contraversial topic of xenotransplantation
(organ transplantation between species). The development of xenotransplantation
arose because the demand for donated human organs and tissues for transplantation
far outweighs their availability, there is a practical bottleneck to
the development of transplantation therapy. It is well known that pigs
are the most likely candidate animals to serve as donors of organs and
tissues for human patients, but animal welfare organisations have objected
to this novel 'instrumental' use of them that bears no relation to meat
production. They claim that the animals' welfare would be adversely
affected by keeping them under the required Specific Pathogen Free (SPF)
conditions. However, this argument is not really valid because pigs
can be kept very comfortably under these conditions, so long as cost
is not an issue. There are also technological and biosafety problems
that must be solved prior to the experimental clinical application of
organs in human patients. In addition to overcoming the immunological
barriers that exist between species and lead to the rejection of transplanted
organs, there are other aspects of xenotransplantation that require
extensive research [4]. The first
is the proper functioning of an organ after transplantation, including
its physiological compatibility and longevity, and the second is the
putative risk of activating retroviruses from their dormant state in
the genome of the donor animal. The latter is estimated to be the most
complex problem because of its possible epidemiological significance.
Many of the biological problems presented by xenotransplantation, ignoring for a moment the ethical dilemmas, could be overcome by instead using the more sophisticated stem cell technology. The potential uses of this technology are immense and have been quickly recognised by the biomedical industry. For instance, the corporate policy of one British biotechnology company, already involved in xenotranspantation developments, switched immediately to human stem cell technology after the country changed its legislation on the use of human embryonic material in research to enable more extensive experimentation. Briefly, the technology involves the removal of nuclei from a patient's cells and their transfer to enucleated fertilised ova. The cells are then cultured under very specific conditions that lead to their differentiation into the type needed to treat the failing organ. The technology is dependent on nuclear transfer and generates omnipotent embryonic cells, which means it is essentially the same as the method for cloning humans. Thus, the prudence gained over the cloning of animals appears to have evaporated rapidly. In addition, the human embryonic material required to further develop stem cell technology can only come from human embryos, which introduces numerous ethical dilemma's concerning research with material that has or had the potential to develop into a unique human, even though the intention now is to restrict the use of embryos to only those 'left-over' after women have received infertility treatment.
In conclusion then, the cloning of animals has been, and continues to be, a much debated topic because of its potential application and misuse in man. However, the development of this and related technologies, like stem cell technology, also has the potential to be enormously beneficial to man. As a result, key aspects in the ethical debate on the cloning of animals are now being considered with considerable urgency.
Animals and humans have a different moral status
Extrapolation from situations relevant to animals to similar ones
involving man, and vice versa, is not only invalid but also a weak point
in any discussion on ethics or policy. Moral standards within a community,
and the legislation resulting from their establishment, are of much greater
importance. For example, it is generally accepted that farm animals are
slaughtered for their meat. This does not mean that the intentional killing
of people is similarly deemed acceptable. Thus, the moral basis of a society,
as defined by its laws, determines the differential treatment of animals and
humans. Because science and technology know no geographical barriers,
industrialised and many developing countries share the same research potential.
Therefore, protection of the well being and integrity of man and animals requires
international harmonisation of all relevant legislation.
It is not easy to consider all elements necessary to design a research policy. The ultimate aim of a project should not be the sole justification for its execution; thought must also be given to the consequences
of the research and the way in which the results might be used. Ideally, this
process should be carried out by peer review and should include discussions with
'educated' lay people, who are likely to be less biased in their
analysis of a project and, therefore, will offer a wider perspective on the research
under consideration. In general, it is only the use of animals in specific
research projects that is subjected to ethical review and not the consequence
of the research project's results. During the last decade, the ethical review
of animal experiments has become an established policy in many countries.
Members of the ethical committees tend to be multidisciplinary and include
scientists, experts on ethics and lay people. These committees are not consulted,
however, on strategic decisions for research policy. They simply review individual
projects or experiments and rely on prior scientific evaluation to determine the
quality and significance of the research itself. Their main function is to assess
whether the experimental design and procedures use a minimum number of animals
and inflict minimal harm upon them. This evaluation system is very effective at
improving the treatment of laboratory animals but is not instrumental in strategic
decision-making for the planning of research programmes.
Veterinary hygiene and public health
Finally to return to the direct responsibilities of the veterinarian, the subject of veterinary
hygiene should be addressed. Some of the major contagious animal diseases have
important economic consequences and must be eliminated from a population at
almost any price, one example being foot-and-mouth disease that affects many
ungulate species. There are other animal diseases, such as anthrax, that are important because they cause disease in man even though they are not important animal pathogens.
With the tremendous increase in international trade and travel, the risks of disease
are no longer restricted to states or even continents. Air travel enables transportation
around the globe within 24 hours. The more enterprising tourists travel increasingly to
remote areas which may harbour species that provide a disease reservoir, particularly
those diseases with a sub-clinical carrier state in wild fauna. It is quite possible that a
veterinarian will be the first person confronted with an animal infected with an agent that is of
great threat either to other animals (population) or to human (public) health. There
is, of course, a legal obligation to report suspicious cases to the authorities, however, drastic measures are likely to follow and so should be anticipated beforehand. It would be quite impossible to 'explain away' reports of a suspected
case of disease that subsequently results in negative findings. If this were to happen, substantial damage would be inflicted upon the owner of the animals,
not only economic but also social and emotional. Recent outbreaks of classical swine
fever and isolated cases of BSE have not only demonstrated how animal products may be
boycotted by consumers, leading to a drastic fall in their market value, but also
how difficult it is for farmers to cope with the isolation of their farms or
destruction of their livestock. And it is not only the farmers who are affected in these cases; there will be many businesses with direct economic links to the farms which will also suffer. Thus, the consulting veterinarian is in a very awkward position
and must decide exactly what to do, how to do it and when to do it. Of course, there is no dilemma the moment a case becomes confirmed by strong evidence or an established diagnosis. However, it is the initial decision of whether to submit samples for analysis or to report the case to the authorities that is most difficult, knowing that there might be substantial damage caused by a misinterpretation either way.
Below is a list summarising the factors that play a role in the ethical evaluation of policies and actions on suspected cases of animal diseases:
Animals' interests:
incidental - the benefits of clinical treatment versus destruction
structural - the absence of epidemic diseases in the population
Owners' interests:
short-term - the risk of drastic animal hygiene precautions and the loss of autonomy on decisions made about the animals. In most instances, direct economic loss is fully or partially compensated
long-term - the absence of economically important animal diseases within the population to which the animals belong
Veterinarians' interests:
consideration for the health and wellbeing of animals
relationship with the client
responsibility towards public health
responsibility towards economic value of a product, such as beef
Interests of an animal population:
absence of animal diseases that might become epidemic and jeopardise the continuity of the population
Public health interests:
risks to workers or consumers
availability of nutritious and safe foodstuffs at a reasonable cost.
Economic interests:
availability of animal products at a reasonable cost continuity of business for primary producers and related businesses
Concluding remarks
By now, it should be clear that the average practicing veterinarian meets
ethical dilemmas on a day-to-day basis. The term 'dilemma' implies that
generally accepted moral standards, or formal rules and regulations, do not
provide clear guidance towards a morally just solution. There is an ever-increasing
awareness of animal welfare amongst the general public and an increasing notion
that animals represent a moral subject 'in their own right', quite independent
from their usefulness
to man. Thus, the professional dilemmas faced by veterinarians are becoming more
complicated and although moral intuition is indispensable it is not sufficient to
solve these complex problems. Consent on ethical aspects of commonly occurring
dilemmas should give rise to the adoption of a collective policy, which can then
be formalised legally when it is considered necessary. However, novel dilemmas
cannot be solved in this way which is when the 'professional' must be capable
of dealing with the situation. The interests of all parties concerned, including
those of the animal(s), should be considered carefully and then discussed with
other professionals and with lay people, to give the debate a wider
perspective. This process of informed decision-making requires skills, not
only prior knowledge, which the veterinary profession should make an effort
to acquire.
Finally, the development of decision-making schemes clearly enhances the
quality of communication because there is a protocol to follow, which may be
described to anyone who questions the conclusion. The overall result is
greater justification of any moral decisions made.
References
1. Animals in Philosophy and Science: Recognizing the
intrinsic value of animals, Beyond animal welfare, M. Dol, M. Fentener
van Vlissingen, S. Kasanmoentalib, T. Visser, H. Zwart, Eds. Van Gorcum,
Assen, The Netherlands (1999).
2. Rollin, B.E. (1989). Veterinary and animal ethics.
In: Law and ethics of the veterinary profession. Ed. J.F. Wilson. Priority
Press Ltd, Yardley, PA, USA.
3. Wilmut, I., Schnieke, A.E., McWhir, J., Kind, A.J.
and Campbell, K.H.S. (1997) Viable offspring derived from fetal and
adult mammalian cells. Nature
385: 810-813.
4. Cozzi, E. and White, D.J.G. (1995) The generation
of transgenic pigs as potential organ donors for humans. Nature
Med. 1: 964-966.
© 2000 Veterinary Sciences Tomorrow