Managing conflicting ethical concerns in modern small animal practice—A comparative study of veterinarian’s decision ethics in Austria, Denmark and the UK

Abstract

Small animal veterinarians frequently have to manage conflicting interests. Beside the key consideration of the patient’s interests, small animal veterinarians are often challenged to consider not only client’s emotional needs, but also their own personal aspirations to provide quality patient care and to make a good living as a professional. Further, veterinarians have an interest in continuous professional development and the use of the newest treatments, which may influence their decision-making process. Based on published work, we hypothesize the existence of four decision ethics orientations that veterinarians can use to manage potentially conflicting concerns. These are: the patient-focused, the client-empathetic, the client-devolved and the development-oriented decision ethics orientations. We surveyed small animal veterinarians in Austria, Denmark, and the UK using a questionnaire (N = 648), and successfully identified the four decision ethics orientations in all three countries. The patient-focused and client-empathetic decision ethics orientations are salient in all countries, whereas Danish and UK veterinarians are slightly more client-empathetic and client-devolved compared to their Austrian colleagues. Across countries our findings show that experienced and older veterinarians tend to be more client-empathetic. Younger and less experienced professionals are more development-oriented compared to their older and more experienced colleagues. In contrast to other studies investigating ethical issues in small animal practice, we found no evidence that gender plays a decisive role in the tendency towards any decision ethics orientation. We also show that veterinarians with a higher client-empathetic orientation and development-orientation more often discuss the possibility of health insurance with clients who do not have it. The present study provides a first empirical insight into how veterinarians manage challenging expectations and ethical concerns as part of decision making in modern small animal practice.

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].…”

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

“…However, pet insurance premiums may not be affordable for many pet owners. It is possible that the growth of pet insurance has been driven by increased costs associated with AVC [ 69 ]. At the same time, increased costs of veterinary care drive up the cost of pet insurance premiums [ 46 ].…”

“…Springer and colleagues hypothesised the existence of four ethical decision orientations utilised by companion animal veterinarians when managing ethically challenging situations. One of these, “development oriented”, prioritises a veterinarian’s own desires to advance veterinary practice [ 69 ]. Development-oriented veterinarians agreed more strongly with the statements that “veterinary medicine should offer the same diagnostic options as human medicine”; “it is important to promote the advancement of small animal medicine for future patients” and “it is important for the veterinary profession to keep developing innovative methods, even though it is impossible to predict possible complications” [ 69 ].…”

“…One of these, “development oriented”, prioritises a veterinarian’s own desires to advance veterinary practice [ 69 ]. Development-oriented veterinarians agreed more strongly with the statements that “veterinary medicine should offer the same diagnostic options as human medicine”; “it is important to promote the advancement of small animal medicine for future patients” and “it is important for the veterinary profession to keep developing innovative methods, even though it is impossible to predict possible complications” [ 69 ]. While attitudes to the rapid development of diagnostic and treatment options varied between countries (for example, UK veterinarians were less development oriented than those in Denmark or Austria), this may reflect other factors, such as being more accustomed to mandated continuing professional development (CPD) [ 69 ].…”

“…Less experienced and younger veterinarians were more likely to be development oriented. This may reflect their relatively recent training and exposure to AVC in university teaching hospitals [ 69 ], or other factors such as a less nuanced understanding of standard of care, inability to predict unintended consequences of AVC, or a combination of these. It is possible that the development-oriented veterinarian may prioritise AVC over the interests of their patient.…”