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Veterinary Ethics: 5 Challenges and Solutions in Modern Practices

Veterinarians face a lot of challenges in daily life while working for or heading up a practice. Some of those challenges are financial, some are emotional, some are temporal, and some, when you get down to it, are ethical.

Ethical challenges can be very difficult to navigate. One's personal ethics may or may not reflect the broader and more commonly accepted ethics in an industry and in society. The friction involved in making ethical decisions contributes to stress and anxiety, which in turn leads to burnout and other mental health challenges.

One thing about ethics in a role like veterinary care is that you don't necessarily have to go it alone. There's always guidance from both the broader community and from overall associations like the AMVA. What are some of the more common challenges you may face as a veterinarian, and how can you navigate them? Let's discuss.

Before we get too far, though, it's worth mentioning that there are no easy solutions to any of these challenges. Ethics are not pinned down or fixed. They're often contextual, they can change as our knowledge of medicine changes, and the equation can even be altered based on the progression of medical science and the increased (or decreased) availability of certain treatments.

The best any of us can do is this: make the best decisions you can at the moment, using the information you have and the resources available to you. And, perhaps more importantly, acknowledge that you are not – and cannot be – perfect. Sometimes, the choice you make may be wrong or may be proven wrong by future information. Beating yourself up over it only adds to stress, leads to a greater risk of burnout, and further harms future treatment of patients.

Conflicts of Interest

Perhaps one of the largest and most common ethical challenges anyone in a position of power faces is the prospect of a conflict of interest. As a veterinarian, your ostensible goal is to provide the most appropriate care to the animals under your charge. However, there are many who would take advantage of this.

A common scenario comes in the form of the manufacturers or developers of proprietary medical devices and treatments. These treatments may be good, or they may not; they may even be the best or the worst in their class. On occasion, they may not even work. One thing is sure, though; they will pay you a commission for each client who signs up to have said treatment.

This puts you in a difficult situation. On the one hand, you have bills to pay, and simply by recommending this treatment, you can make your own life more leisurely and lower stress. On the other hand, perhaps that option isn't the best for the patient, and recommending it over another more beneficial treatment could be detrimental to the overall health and longevity of the animal.

You are in a trusted position as a veterinarian. Your clients trust you to know what is best for their animals. When you recommend something, it comes with the weight of that trust behind it. When you abuse that trust, it harms not just that patient but your practice, your reputation, and even the industry as a whole. Systematic abuses throughout centuries have led to many harms, including things like the modern anti-vax movement, creating and perpetuating tangible harm.

In many realms, such as academic publications and studies, conflicts of interest are required to be disclosed. In individual treatment, it's harder to identify and disclose those conflicts. Yet it's one of the most common ethical dilemmas faced by modern veterinarians under pressure from corporate owners, medical device and treatment manufacturers, and marketers.

Financial Stress for Owners and Practices

A closely related ethical conflict is the friction between finances. As much as we don't like it, running a veterinary practice in the modern day is running a business. You need to keep profits in mind at all times and take steps to improve them, whether that's in proactive marketing, finding additional revenue streams, or adjusting prices.

It costs money to buy medical supplies, medications, equipment, and machines. It costs money to perform tests in-house, and it costs money to outsource those tests. Referring patients to other vets as specialists makes sense for the quality of care the animal receives, but the loss of revenue can hurt.

At the same time, millions of animals suffer every year from their owners being unable to financially provide appropriate care. Due to the costs, many animals are simply not taken to the vet when they should be. Many seek alternative treatments for expense-related reasons. Euthanasia is common for animals with treatable illnesses when the treatments are above a sustainable price point.

Thus, one of the foremost ethical challenges a veterinarian can face is where to set pricing. You need to be able to make enough money to continue to purchase supplies, pay employees, and provide treatment, but with the rising costs of everything and the widespread economic challenges faced by millions of people, the ability to afford that care slips.

Associated with this is the subset of clients who will make inadvisable financial decisions in prioritizing their animals. Is it ethical to recommend the best available treatment when that treatment can bankrupt the client, which can even lead to worse outcomes later if the treatment doesn't take?

This is an unfortunate situation that comes up far too often, and the complex mix of factors means it's an individual decision that must be made for each and every patient. Typically, the best avenue – and the one many vets choose – is to provide a variety of treatment options to allow the client to balance the factors and considerations on their own. Indeed, some will argue that it's not your choice to make.

You can also potentially alleviate this in a variety of ways. Above, we linked to our guide on improving revenue streams for your practice. Selling knowingly overpriced knickknacks in the lobby might seem kitschy, but when it subsidizes using a sliding fee scale for lower-income clients, it can be beneficial to pursue regardless.

Appropriate Care vs. Owner Rights

Another common dilemma in veterinary ethics is the push and pull of animals as property. It's rarely argued that animals can make their own medical decisions. The more difficult question is where the boundaries of decision-making lie.

A common scenario these days is the subset of pet owners who extend their own lifestyle choices to their animals. In particular, there are people who consciously choose to force their cats into a vegan diet. As we all know, cats are obligate carnivores and cannot thrive on a vegan diet. Or can they? Some studies suggest a carefully curated vegan diet may be healthier than a less curated meat-based diet.

Do you go with your gut and recommend a meat-based diet for carnivorous animals? Do you refuse to support a client who, in your view, doesn't treat their animal care appropriately? Do you do your best to treat them as you can without violating the lifestyle choices of the client? You have to balance what you know of best practices in veterinary care with respect for your clients and their wishes. You don't want to be the target of malpractice lawsuits, of course, but neither do you want to leave an animal suffering.

This is, again, another case-by-case situation. Animals clearly being neglected may need intervention. Animals with carefully balanced and nutritionally complete diets, even if those diets are non-standard, may still live healthy and exceptional lives.

This is also a case where ongoing study may contradict conventional wisdom. Should the above studies pan out, they may upend our knowledge of what the best diet is for our animals, and formerly ethical decisions may retrospectively be detrimental. Using your best judgment is all you can do; you can't know the future or the objective truth in many cases, after all.

Quality vs. Quantity of Life

Another common ethical dilemma faced in medical care – and this applies to human medical care as much or more than to veterinary care – is the balance between quality of life and quantity of life.

Often, for older animals (and people), quality of life begins to deteriorate. There's more pain, there's less mobility, and there are often cognitive impairments. There are ways, medically, to prolong life by treating symptoms. These can range from organ replacements and joint surgeries to medical infusions to dialysis and more.

At what point is the balance tipped? Prolonging the life of a beloved pet, an emotional support animal, or a close family member can be the knee-jerk choice for many. Yet if the expense, the intrusiveness of a procedure, or the rarity of desired outcomes all make it a poor choice, at which point should care be withdrawn?

This often varies based on culture. Those raised in the country, around the realities of difficult-to-obtain medical care, often are more comfortable making the decision to lay an animal to rest when they suffer. Others have a more difficult time making that decision. Moreover, norms vary around the world, and people from other global cultures have different perspectives.

Sometimes, the correct decision is that nothing more can be done. Sometimes, it's the advice that anything more, even if it prolongs life, will lead to a life of enough suffering that it's not worthwhile. Facing the most challenging clients is itself a key stressor in the lives of veterinarians, and this ethical quandary is a common reason why it occurs.

Self-Care vs. Animal Welfare

Veterinarians typically enter the field because they have empathy and emotional concern for animals. We want to provide the best care we can, to provide the best lives we can for the animals in our area.

At the same time, though, there's a limit to what we as individuals can accomplish.

Another frequent ethical dilemma faced by veterinarians is when to deny appointments or new patients. It never feels good to say your schedule is full and that you don't have space to see a patient because you know at the other end of that phone call is an animal with a potential issue that you could solve.

But there are only so many hours in a day, and only so much energy and cognitive ability you can muster in those hours. The more you try to do, the longer hours you pull without a break, the more likely you are to start slipping. Sheer exhaustion, burnout, emotional burnout, and compassion fatigue can all contribute to worse decision-making, less insight, and worse care.

If you burn out badly enough, there can be serious negative consequences. Your physical health can suffer, your mental health can suffer, and in extreme cases, self-harm. Suicide is an epidemic amongst vets for exactly this reason.

Yet, morally and ethically, you feel pressured to push yourself to provide as much care as possible.

There's no easy solution to this or any other ethical dilemma. You have to balance the factors and fight for the right perspective. After all, if your own ability to provide quality care suffers – or worse, you end up leaving the field entirely due to stress and burnout – far more patients suffer than just the few you otherwise refused.

This, at least, has a possible solution. Share the load. By easing the burden on yourself and your practice, you can provide more and better care to a greater population of animals in your area.

There are many ways to go about this. You can partner with other local veterinarians to share and refer patients to balance schedules and caseloads. You can hire more people for your own practice, from veterinary nurses and clinicians to help with the more common and low-stakes patients to other specialists to help you with the trickier cases.

You can also work with third-party consultants. That's what we do here at Hope Vet; our team of experienced veterinarians are available for second opinions and consultations quickly and easily. All you need to do is request a consultation. We're more than happy to help ease the burden when it comes to complex issues like internal medicine, neurology, dermatology, oncology, and more.

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