Study: Ethical dilemmas and moral distress are widespread in veterinary field

From not being able to provide the care the patient needs, to being asked to provide futile treatments, veterinarians face complex ethical conflicts on the job in the absence of training on how to appropriately handle them. (Orawan/stock.adobe.com)A study investigating moral distress in North American veterinarians has determined it to be a pervasive problem in the profession. The study was published in the October 2018 issue of the Journal of Veterinary Internal Medicine.

According to the study's authors, veterinary medicine's “complex ethical structure”-in which veterinarians have obligations to pets, pet owners, other veterinary professionals and society as a whole-often places them in “situations where the right course of action isn't clear.” This happens, they continue, because “these obligations conflict either with one another, with the veterinarian's own moral standards, or both.” The result? Moral distress.

To conduct the study, researchers surveyed 889 U.S. and Canadian veterinarians to find out whether they experienced certain ethical dilemmas on a regular basis and what the impact was on practice life. Here's a snapshot of what respondents said:

• 32 percent of veterinarians said they often have conflicts with clients about how to proceed with care, and 53 percent said they sometimes have such conflicts.

• 68 percent said they address these conflicts by discussing them with colleagues, while 15 percent said they do nothing.

• 45 percent said they are sometimes asked to do something that feels wrong, and 6 percent said it happens often.

• 24 percent said they sometimes comply with these requests, and 7 percent said they often comply.

• 63 percent said they sometimes or often can't do what they feel is right, and in such situations, 78 percent said this causes moderate or severe distress.

• 79 percent said they sometimes or often have clients request treatments they consider futile.

• 78 percent said they sometimes or often feel conflicted or upset by a client's refusal to do what they believe is in the patient's best interest.

• 29 percent said they sometimes or often receive what they consider to be inappropriate euthanasia requests, and in such cases, 63 percent said it causes them or their staff moderate or severe distress.

The results of the study demonstrate that ethical conflict and moral distress are widespread in veterinary medicine and that most veterinarians have had little to no training on how to cope, the authors conclude-more than 70 percent of respondents said they'd received no instruction in either conflict resolution or self-care.

“For years, my colleagues and I suffered, mostly in silence, with the stress of our work,” says lead study author Lisa Moses, VMD, DACVIM, research fellow at Harvard Medical School's Center for Bioethics and senior staff veterinarian at the MSPCA-Angell Animal Medical Center in Boston in an article from the Center for Bioethics. “Our study confirmed what I suspected-namely that ethical conflict causes a lot of stress and, specifically, moral distress in veterinary practice, and my colleagues often don't have the tools to deal with it.”

The authors of the study hope their research brings attention to the issue and note the possibility that tools used to address moral distress in human healthcare professionals could be adapted to the veterinary field.