Veterinary medicine, as the distinctive medical discipline we know today, emerged during the nineteenth century as an adjunct to agriculture. Animals were valued for the food or fiber they provided or for the work they performed, and the veterinarian's role in society was to keep the animals healthy so they could serve people's needs. Even after anticruelty laws had become widespread by the late 1800s, and the horse doctor became the dog doctor with the growth of companion animal practice in the mid-twentieth century, the veterinarian's ethic remained unexamined and substantive ethical issues officially unacknowledged.
Unlike medical doctors, whose engaging of ethical issues can be traced back to Hippocrates, veterinarians did not have a historic tradition of professional ethics to draw on. Until the late 1970s, the field of veterinary ethics focused primarily on issues of business etiquette and professional relations. The Code of Ethics of the American Veterinary Medical Association (AVMA) addressed such areas as referrals to other veterinarians and whether it was "ethical" to have a large insert for one's practice in the Yellow Pages. Social changes, such as the emergence of the animal-welfare/ rights movement and its impact on public consciousness, helped catalyze consideration of the complex of ethical concerns that face the veterinarian.
Two people acted as gadflies to the profession in this important period: Michael W. Fox, a veterinarian with the Humane Society of the United States, and Bernard E. Rollin, a philosopher at Colorado State University. Fox and Rollin published articles in influential journals (Fox, 1983b; Rollin, 1978, 1983) that pointed out the need for systematic examination of the ethical concerns of the veterinary profession. Fox also wrote letters to the Journal of the AVMA on this theme (Fox, 1983a). In 1978, Rollin inaugurated the first regular, required, full-term course in veterinary ethics at the Colorado State University College of Veterinary Medicine. Both Fox and Rollin wrote books on animal welfare and rights. Rollin, in addition, had taught and published in human medical ethics, and he was sensitive to the differences between the problems of human medical ethics and those of veterinary medical ethics. In particular, owing to his extensive work in the moral status of animals, Rollin was aware that veterinary medicine had not yet addressed its moral obligation to animals. By the end of the 1980s, veterinary interest in the ethics of the profession had developed enough to warrant publication of a textbook on the subject by Jerrold Tannenbaum of Tufts University (1989).
The Veterinary Oath and Its Moral Dilemmas
When the veterinarian graduates from veterinary school, he or she is administered the veterinarian's oath, which includes a promise "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" (see the Appendix, Volume 5). The veterinarian is immediately faced with a fundamental ethical dilemma: to whom does he or she owe primary loyalty, the owner or the animal? In a 1978 article, Rollin used the examples of a pediatrician and a car mechanic to illustrate the two possible choices. When the repairs on a car are more costly than the car's value, the owner can simply tell the mechanic to "junk" it or not do the repairs; there is no such choice in a necessary surgery or treatment of a child (Rollin, 1978). The pediatrician is ethically (and legally) obligated to act as advocate of the child's well-being. On the other hand, the basic current legal status of animals is that they are property, although their sentient qualities have been the basis of limited protection provided by so-called welfare laws (in the United States, primarily local anticruelty ordinances and federal laboratory animal laws).
In addition to the responsibilities they have to the animal and the owner, veterinarians must weigh practice judgments in light of the needs of society in general ("public health"), peers, and themselves as well. As the oath also states, "I will practice my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics. I accept as a lifelong obligation the continual improvement of my professional knowledge and competence" (Appendix, Volume 5). In the face of often conflicting interests of animal, owner, society, profession, and self, the individual veterinarian is often presented with situations that require complex ethical judgments (Rollin, 1988). The traditional minimalistic animal ethics proscribing cruelty, from which anticruelty laws derived, are not adequate to mid-twentieth-century uses of animals such as confinement agriculture or testing and research, which were not matters of cruelty yet caused significant suffering in pursuit of profit and scientific knowledge (Rollin, 1981). In seeking a new animal ethic, society began to apply the notion of rights, which protect human nature from being submerged for the sake of general welfare, to animals in order to protect their fundamental interests as dictated by their nature (or "telos"). The veterinarian came to be considered a natural animal advocate. As society elevated to the status of animals by applying a rights ethic, the status and effectualness of the veterinarian began to increase (Rollin, 1983).
Laboratory-Animal Legislation: Effect on the Profession
One area—laboratory-animal medicine—has had its ethical obligations to animals articulated by law because of societal concern for animal welfare. Before the 1985 Amendment to the Animal Welfare Act, which originated as a Colorado state bill written by Rollin and others, and the National Institutes of Health Reauthorization Act of 1985, which turned animal use "guidelines" into regulations, researchers enjoyed carte blanche in the use of animals. The pursuit of knowledge, or "advancement of medical knowledge," had completely trumped consideration of animal pain, suffering, or distress, and laboratory-animal veterinarians were relegated to the role of keeping animals in good enough shape to serve their research purposes. The legislation that was passed in 1985, as well as the original Animal Welfare Act of 1966 and other amendments to that act, was a direct result of societal response to well-publicized atrocities in research and testing activities and the correlative demand for assurance that animals' interests were protected.
Laboratory-animal veterinarians, because of animal-protective legislation, now fulfill the most unambiguous role of all veterinarians regarding animal well-being: They are obligated by law to act as animal advocates, to assure that pain and suffering do not occur or are minimized by proper medication, that proper animal care is provided, and that humane euthanasia is performed. The veterinarians are aided by Institutional Animal Care and Use Committees, which review research or testing protocols for humane considerations before studies may commence and provide regular monitoring of facilities.
Although the role of the veterinarian has been defined by society in law for the laboratory-animal veterinarian, this has not occurred in other areas of veterinary medicine in which owner interest and animal interest may conflict. The small-animal veterinarian is often faced with ethical decisions based on these conflicts. Examples include cosmetic or behavior-altering surgery and orthodontic intervention for cosmetic reasons. In general, these procedures could be considered in the interests of the animal only if the animal were afflicted with a condition that was causing or was likely to cause it pain or distress. Dewclaw removal—dewclaws can catch and tear when dogs run through rough terrain—or repair of malocclusions like base-narrow lower canines, in which the offending tooth or teeth can drive into the upper palate, can easily be justified as in the animal's interest. Cosmetic surgery that causes the animal to conform to standards of style (e.g., ear cropping) or surgery that is used to curb "objectionable" behavior (e.g., declawing of cats, devocalizing of dogs) can be viewed as causing pain and distress to the animal for frivolous human reasons. Likewise, straightening teeth that are functional to provide a perfect bite for the show dog could be considered unnecessary.
Many veterinarians refuse to do purely cosmetic surgery, and consequently they lose clients. Other small-animal veterinarians believe they owe their major loyalty to the owner. They may argue that providing the service of cosmetic surgery enhances the animal's value, emotional as well as monetary, to the owner. Still other veterinarians will provide behavior-altering surgeries, such as declawing, after first pursuing, with an owner, honest attempts at retraining or other options. They may justify their actions by saying that the owner would otherwise get rid of the pet or that they are fostering the continuation of a rewarding relationship for both pet and owner.
Surgically neutering (spaying or castrating) dogs and cats to prevent sexual behaviors and overpopulation of pets is well accepted by North American society, but (especially for dogs) is largely rejected in other countries in favor of owner responsibility in administering contraceptives and controlling pets. Many small-animal veterinarians readily neuter cats and dogs, assuming that the discomfort of the surgery is of less import than the enhancement of the desirability of the pet to the owner (the elimination of objectionable sexual behavior, for instance) and the elimination of the chance of unwanted pregnancies; in addition, there are health advantages to neutering.
Some Equine-Practice Concerns
The equine veterinarian is under similar tension, only more so. Lameness is the most frequent complaint of horse owners, as the horse's usefulness requires a smooth and efficient gait. The equine veterinarian is often pressured to provide painkilling medication or surgery to cut the nerves to the feet of race or performance horses because of lameness. In some respects this is a compassionate action, as the animal is rendered fully or relatively free of pain. However, there are cases in which eliminating painful sensations may cause the animal to use and seriously injure a limb. Pressures to administer performance-enhancing drugs, or to look the other way when objectionable training techniques may be used, may be severe for equine veterinarians. Veterinarians may also be called on to perform purely cosmetic surgery, such as tail docking or tail "breaking" for an artificially high tail carriage. Unfortunately, horses are generally of little entertainment or economic value if they do not "go sound," or conform to an ideal of beauty.
A Look at Food-Animal Medicine
Food-animal veterinarians have always been placed in a position of tension between the interests of animals and the interests of producers. In traditional agriculture, which prevailed as an "extensive" (as opposed to "intensive") endeavor until the mid-twentieth century, the tension was mitigated to some extent because producers generally did well economically only if they provided for the health and welfare of their individual animals. With the rise of confinement agriculture, however, new considerations have entered into the picture, and producers can prosper—in fact, may make the most profits—even if numerous individual animals suffer from poor health or die. For instance, feedlots may utilize diets that cause digestive and liver disease in a certain percentage of animals, but that loss will be more than compensated economically by the weight gain in the remaining animals. Furthermore, the use of antibiotics, vaccines, growth promoters, etc., have permitted selectivity in meeting animal needs and the separation of economic productivity from animal well-being. Animals can thus suffer in areas not related to economic productivity, yet producers can do well. Since the advent of intensive agriculture, veterinary concern for individual animals has tended to be replaced by a "herd health" philosophy to serve the livestock industry.
In confinement operations, a certain death loss is expected from the animals, whether from contagious or socalled production diseases, which are caused by handling, artificial environments, selective breeding, population density, or nutrition in the operation. Veterinary care in confinement operations usually covers only animals that are expected to recover without costing more in money and labor than the animals' market value. In sheep feedlots, a common daily chore is picking up dead or moribund animals. Discovering which animals are sick, separating them from their group, and treating or euthanizing them is often considered too expensive to support. In complete confinement houses for swine, animals are fed antibiotics because respiratory disease is so prevalent owing to high ammonia levels. To combat fighting in tight quarters among feeder pigs, their tails are amputated so the animals cannot wound each other by tail biting. Mastitis and footrot in dairy cattle are production diseases caused by the enforcement of high milk yields while the cattle are maintained on dirt lots. The average dairy cow is worn out and culled in four or five years, less than half of the expected useful lifetime fifty years ago.
Agrarian values of husbandry have been abandoned in much of present-day agriculture, affecting how the veterinarian may conduct his or her profession, because whereas a small farmer once maintained a modest lifestyle by caring for a few individual animals, a corporation now looks at profit margin only. Even in the more traditional agricultural activity of cattle ranching, economic considerations militate against veterinarians' controlling the pain of such activities as branding, dehorning, and castration. Thus the modern food-animal veterinarian faces a variety of conflicts arising out of tension between economic considerations on the one hand and animal health and welfare considerations on the other.
The Veterinarian and Euthanasia
Even if the veterinarian's inclination is to act as an animal advocate, he or she may be thwarted by the owner's wishes, because of the legal status of animals as chattel or property. Occasionally a veterinarian is faced with a situation in which a pet is suffering without hope of recovery, as in terminal cancer, but where euthanasia is not an option because an owner refuses to authorize it. Many veterinarians quietly euthanize such animals as a humane act in spite of its illegality; but a more direct approach, utilized by veterinarians who often deal with death and the consequent grief of owners, is to discuss the inevitable with clients beforehand and exercise a humane ethic by requesting the clients to agree to euthanasia if certain clinical signs, like unremitting pain or inability to eat, arise.
A more common delay of euthanasia occurs when a food animal is kept alive despite suffering to maximize income. This scenario is most often seen in large, commercial operations, where, for instance, a sow with a fractured leg or a cow with a cancerous eye could be kept alive without expensive treatment until parturition or weaning of offspring. It is interesting to note that the laboratory-animal veterinarian is required by law to euthanize when faced with hopeless animal suffering, while the private practitioner is hamstrung by laws of private property in situations that do not constitute cruelty under the law.
The most obvious and rewarding use of euthanasia— killing without causing pain or distress—is to end an animal's suffering due to unremitting illness or fatal injury. However, there are other uses of euthanasia, such as end points for research, humane slaughter for meat, and humane killing of unwanted pets by pounds, shelters, or veterinarians. The AVMA Panel on Euthanasia periodically updates and publishes its report on euthanasia. The report examines methods of killing and labels as unacceptable those that cause animals to suffer. For instance, the report accepts an overdose of anesthetic, which causes an animal to become unconscious before dying, but condemns an overdose of paralytic drug, which causes motor and respiratory paralysis and suffocation in an alert animal.
Many small-animal veterinarians are confronted with requests for "convenience" euthanasia—euthanasia of healthy pets for owners who have rejected the implied contract of care they incurred when they acquired the pet. Some veterinarians avoid these ethical dilemmas by refusing categorically to perform any "convenience" euthanasia, even though they know that the owner may choose a nonhumane alternative, such as abandonment. Others accept such animals on the condition that they be allowed to find a home for the animal as an alternative to euthanasia; this route obviously requires time, effort, and probably expense on the part of the veterinarians but helps to satisfy their obligation to the animal.
Accepting an animal for euthanasia, and then not performing it, however, is a breach of contract and indefensible on legal grounds. One interesting dilemma that has challenged equine veterinarians is insurance companies' requirement that expensive horses be euthanized if they are rendered unfit by accident or illness for an insured purpose(e.g., racing, breeding, or showing) even if these animals are otherwise capable of a pain-free, or even useful, existence. When enormous sums of money are at stake, consideration of the animal's interests tends to disappear.
Veterinarians and Anticruelty Laws
Animal cruelty laws are notoriously lax. Most allow conviction only in cases of purposeful abuse, and in any case generally result in insignificant fines. However, the veterinarian may be able to make a difference in the lives of animals by reporting and testifying in animal abuse cases. Reporting a client for battering his dog or starving his horses or other stock, when all efforts at education and persuasion are exhausted, may be the only means of protecting animals. In taking a stand as an animal advocate, the veterinarian may experience a loss of clientele and income, thereby placing personal interest in conflict with animal and client interests.
The Veterinarian's Obligation to Society
The veterinarian's obligation to society can also be the occasion for conflicts relating to self or business interests. The most straightforward example may be the protection of society from contaminated animal-source foods. Hormonal and medicinal additives to feed, or treatments of individual animals with medications, can result in residues in meat and milk. These products, if allowed for food animals, have government-mandated withdrawal times before slaughter or milking. Sometimes products used in animal production are not approved for any food animal administration. Yet because of poor planning, inattention to withdrawal times, or attempt to defraud, producers may send contaminated animals or their products to market. The underlying motive is usually profit. If a veterinarian discovers that a producer is feeding an illegal additive, or if, for example, a heifer is sent to slaughter before the withdrawal time of the penicillin she was given, the food-animal veterinarian has a public-health obligation—an obligation to society—to report the client despite professional confidentiality concerns. The loss of one client may be the least of the financial impact of such an ethical choice; other potential or actual clients may avoid association with the veterinarian because of fear of also being turned in, as some illegal practices in the food-animal industry may be widespread, especially in a given region.
The laboratory-animal veterinarian's career can be seen as a service to society, in that he or she provides clinical support or scientific information for the advancement of scientific knowledge. Despite his or her legal mandate as animal advocate, the veterinarian may experience personal conflict in areas of pain or disease research; for example, studies that involve the most animal suffering may also provide the most useful information for the betterment of humans and animals alike. The laboratory-animal veterinarian must also come to grips with the fact that virtually all of his or her patients will be killed at the end of a study.
The zoo or wildlife veterinarian serves societal interests in areas of animal conservation and wildlife management. Incarceration, as in a zoo, is not generally in individual animals' interests, but captive breeding programs may be needed to preserve a valued species. Similarly, situations may arise in which a disease is introduced into study animals to determine pathophysiology or treatment for that species or similar groups. The use of wild animals in research, especially when capture is a part of the research design, has been severely criticized by animal welfare and rights groups because of unacceptably high numbers of "stress" losses of animals used in the studies.
Policing the Profession: Obligations to Peers
The veterinarian, like practitioners in other professions, may have to take an ethical or legal stand regarding the practices of his or her peers—as, for example, when one gives testimony in a malpractice suit. Certainly a person's choice in business practices and commitment to medical standards indicate the quality of his or her moral fiber and loyalty to the profession. It is not unusual for veterinarians to sever professional or personal ties with other veterinarians over professional standards, although it is rare for them to make allegations of malpractice or business malfeasance of other veterinarians. This course is largely left to state boards of veterinary medicine, which respond to complaints by the public. Reluctance to speak out against professional misconduct by other veterinarians is not unique to this profession. A certain degree of prudence must be exercised by professionals to avoid unfairly slandering a colleague without knowing the entire story; for instance, a client's account of a veterinarian's actions may be biased and medically naïve. Many veterinarians also believe that exposing misconduct puts the entire profession in a bad light, even if the public would likely have a positive regard for "policing the ranks." Veterinarians, like other professionals, are allowed a fair amount of leeway in regulating themselves, since they are presumed to know the issues better than laypeople. Failure to self-police can result in loss of autonomy, with rules initiated and governed by people who know little about the profession, such as legislators.
The Veterinarian's Obligation to Self and Personal Values
The veterinarian's obligation to self is best fulfilled by examination of and adherence to his or her professional and personal values. Some veterinarians believe the veterinarian's only or major loyalty should be to the animal. Most veterinarians probably enter the profession with a desire to protect animal health and relieve animal suffering, without an understanding of competing interests. A fuzzy or unexamined ethic may lead to compromising professional decisions. Veterinary schools have responded to the need for ethical training in their curricula, with the understanding that veterinary students need intellectual tools to examine their own ethics throughout their professional lives.
Veterinary Ethics Today
The profession is by no means monolithic in its attitudes, but the AVMA and other veterinary organizations have gradually begun to take official positions on animal issues. A number of practitioners' organizations, including the American Society of Laboratory Animal Practitioners, the American Association of Bovine Practitioners, the American Association of Equine Practitioners, and some state veterinary organizations, have taken animal-welfare positions or have held symposia or meetings pertaining to issues of concern to them. Advocacy groups, such as the Association of Veterinarians for Animal Rights, have emerged. The Animal Welfare Committee of the AVMA has encouraged the association to take published positions on a variety of companion animal, exhibit and performance animal, research animal, and agricultural animal issues. Although some positions are weak and tentative (mainly on agricultural issues), many are specifically protective (e.g., condemning use of the steel-jawed trap and recommending to the American Kennel Club and breed associations that ear cropping be dropped from standards and that dogs with cropped ears be prohibited from showing). The AVMA also sponsors an annual Animal Welfare Forum, in which veterinary educators, animal advocates, philosophers, and others examine the need for animal-welfare reform within the profession.
Given that the formal articulation and organized study of veterinary ethical issues are new, the field has made a good deal of progress. In the future, we can expect the emergence of more sophisticated treatments of many of the issues we have articulated. With society's expectations that the veterinarian serve as mandated animal advocate (as evidenced by the aforementioned laboratory-animal laws), veterinarians will doubtless be in the forefront of emerging social concerns about animal use and treatment.
m. lynne kesel (1995)
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