Survey of the frequency and perceived stressfulness of ethical dilemmas encountered in UK veterinary practice

The scale of the ethical challenges faced by veterinary surgeons and their perceived stressful consequences were investigated via a short questionnaire, completed by 58 practising veterinary surgeons. Respondents were asked to report how frequently they faced ethical dilemmas, and to rate on a simple numerical scale (zero to 10) how stressful they found three common scenarios. Fifty seven per cent of respondents reported that they faced one to two dilemmas per week, while 34 per cent stated they typically faced three to five dilemmas per week. The three scenarios provided were all rated as highly stressful with 'client wishing to continue treatment despite poor animal welfare' rated as the most stressful (median 9). The female veterinary surgeons gave two of the scenarios significantly higher stress ratings than the male veterinary surgeons. Stress ratings were not influenced by number of years in practice (which ranged from one to more than 25 years). The results show that veterinary surgeons regularly face ethical dilemmas and that they find these stressful. This has implications for the wellbeing of veterinary surgeons and supports the case for increased provision of training and support, especially for those who entered the profession before undergraduate ethics teaching was widely available.     

Veterinary surgeons' opinions on dog welfare issues

Objectives : To begin to determine the significance of various dog welfare issues as perceived by veterinary practitioners. Methods : Using an online questionnaire, respondents were asked how frequently they were made aware of 12 welfare issues and how important they felt each one was for each dog affected. Respondents were also asked how much they agreed with statements that the veterinary practitioners in their area, and the veterinary profession, should do more about each issue. Results : Responses were received from 59 practitioners. The most frequently noted problems were “obesity”, “chronic pain/poor mobility” and “breed‐related conditions”. The most important issues for each dog affected were “lack of treatment for suffering”, “abuse or active cruelty” and “malnutrition”. “Breed‐related conditions”, “obesity” and “behavioural problems” were the issues for which there was greatest agreement that veterinary practitioners should do more, both in their area and as a profession. Clinical Significance : This pilot study suggests that the veterinary profession believes that obesity, breed‐related conditions and behavioural problems are important concerns, and that more should be done about them. Although these results cannot be taken as definitive from a study of this size, it does provide a background for such further work involving companion dog welfare and the veterinary profession.     

Managing cats with cancer: An examination of ethical perspectives

ETHICAL ISSUES: Caring for cancer patients presents many ethical issues for veterinarians and other veterinary health workers. The issues that most veterinarians think of relate to management of the patient when the owners' preferences for treatment do not appear to be in the animal's best interest, as well as concerns about toxicities and about costs of veterinary services (advanced imaging, surgery, radiation therapy and chemotherapy). While not limited to the veterinary profession, we are more often faced with dilemmas about the appropriateness of palliative care and decisions about euthanasia than our medical colleagues. Equally important are the ethics of not treating patients, and the integration of unproven and alternative strategies into conventional care. A separate ethical issue arises from investigational therapies and research. Less often considered, but nonetheless relevant, are the ethics of suboptimal evaluation (staging) of patients prior to treatment, or of not informing owners about all the options available. CLIENT COMMUNICATION: Ethical veterinary care is intertwined with good client communication. Without good communication, it is impossible, for example, to gain informed consent; and without informed consent, the ethics of cancer treatment are uncertain. GOAL: This article, which draws in part on published research, where stated, and otherwise on the author's personal experiences/opinions and those of veterinary colleagues, is intended to provoke further thought and discussion on the ethics of caring for our cancer patients.     

Perceived importance and integration of the human-animal bond in private veterinary practice

OBJECTIVE: To determine perceptions of the human-animal bond (HAB) among veterinarians in private practice and evaluate how these veterinarians incorporate the HAB in their practices. DESIGN: Survey. SAMPLE POPULATION: 1,602 veterinarians in private practice in Washington state. PROCEDURE: Participants were contacted and asked to complete a survey. RESULTS: Response rate was 26% (415/1,602). Most respondents agreed that veterinarians will be more successful if they recognize and facilitate the HAB, that facilitating the HAB was important to their practices, that they actively evaluated the degree of bonding between clients and their animals, and that the bonding between a client and his or her animal affected the way they practiced medicine. However, > 50% of respondents did not train veterinary technicians and front office staff members in the HAB or encourage veterinary technicians or front office staff members to learn about the HAB. Fifty-one percent of respondents offered few or no HAB resources to clients. When asked to quantify the importance of 10 nontechnical skills associated with private veterinary practice, respondents ranked communication skills, ethical reasoning, and business management first, second, and third; the HAB was ranked fifth. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that for veterinarians in private practice in Washington state, there is a dichotomy between how important they consider the HAB to be in their practice and the degree to which they facilitate the HAB with regard to communication, training, and client resources. More research on the HAB is necessary to better understand what the HAB encompasses and its implications for private practitioners.     

Factors associated with client, staff, and student satisfaction regarding small animal euthanasia procedures at a veterinary teaching hospital

OBJECTIVE: To identify factors influencing satisfaction with procedures for small animal euthanasia and to compare the relative importance of those factors among clients, staff, and students at a veterinary teaching hospital. DESIGN: Survey. SAMPLE POPULATION: 18 nonclinical hospital staff members, 13 clinical staff members, 10 veterinary technicians, 19 veterinary students, and 91 clients. PROCEDURE: Participants were asked to complete a survey that was designed to assess satisfaction with various aspects of the euthanasia procedure. RESULTS: Overall response rate was 48% (151/313). Respondents most strongly agreed with the statements that clients should have the option to be present, that having a private place was important, and that employees should be trained to attend to the emotional needs of the client. When asked to place factors in order of importance, those that were ranked the highest included compassionate and caring attitudes of the hospital employees, the option for the client to be present during the euthanasia, and the client being informed and well prepared. CONCLUSIONS AND CLINICAL RELEVANCE: Overall, all groups (nonclinical staff, clinical staff, veterinary technicians, veterinary students, and clients) identified the same factors as being important in the euthanasia of a pet. Results may help facilitate healthy euthanasia experiences.     

Promoting discussions and decisions about dogs' quality-of-life

Objective : The objective of this paper is to report the formulation and preliminary testing of a participatory tool in order to encourage discussions and decisions about dogs’ quality‐of‐life. Materials and Methods : A tool was designed in which owners rated aspects of their dog’s quality‐of‐life. Two randomised controlled trials were conducted: one with a veterinary surgeon who was involved in the tool design, the second with other veterinary surgeons. In each, owners either were given the tool before a veterinary consultation or underwent normal consultations. After each consultation, owners were asked to report what they had discussed and what decisions they had made. Results : The study involved a total of 170 consultations, of which 91 were randomly allocated to the tool group and 79 into the control group. In both trials, using the tool was associated with a significant increase in the frequency of discussions. In the first trial, using the tool was also associated with an increase in the number of decisions made, but this was not found in the second trial with practitioners who were not involved in the trial design. Clinical Significance : These data suggest that the use of a participatory tool has the potential to enhance the effectiveness of consultations, especially if the practitioner is familiar with the tool design.     

The experience of dog bites: a survey of veterinary science and veterinary nursing students

AIM: To investigate the circumstances of dogs biting people in New Zealand. METHODS: Veterinary science and veterinary nursing students enrolled at Massey University in 2003 completed a questionnaire detailing their lifetime experience of dog bites and their opinions of dog control legislation. RESULTS: The response rate was 100%. There were 228 completed responses to the survey, and 87 (38%) respondents had been bitten by a dog. Most bites caused minor injury, but 17 (20%) required medical attention. Male respondents were more likely to have been bitten. The highest proportion of respondents (27; 31%) had been bitten while between 6 and 10 years of age, and the hand was the part of the body most often injured. Eighteen (21%) bites involved a stranger's dog, but most bites were by a dog known to the victim. Respondents from rural areas were three times more likely to have been bitten than city dwellers. The victim's home was the place where most (31; 36%) bites occurred. Male dogs were responsible for a larger proportion of bites (38; 44%) than females (24; 28%); respondents were unsure about the sex of the remainder of the dogs (25; 29%) that bit them. Protecting the home, play, accidents, rough handling and pain were identified as the common reasons for dogs to bite. Most (46; 52%) respondents did not believe legislation could have prevented their bite. Only four (5%) bites were reported to authorities. CONCLUSION: Rural dwellers, people with more experience of dogs, children <11 years of age, and male respondents were bitten by dogs most often. Only legislation relating to the fencing of dog owners' properties may have prevented a reasonable proportion (25; 29%) of the bites reported here.     

The experience of dog bites: A survey of veterinary science and veterinary nursing students

AIM: To investigate the circumstances of dogs biting people in New Zealand.

METHODS: Veterinary science and veterinary nursing students enrolled at Massey University in 2003 completed a questionnaire detailing their lifetime experience of dog bites and their opinions of dog control legislation.

RESULTS: The response rate was 100%. There were 228 completed responses to the survey, and 87 (38%) respondents had been bitten by a dog. Most bites caused minor injury, but 17 (20%) required medical attention. Male respondents were more likely to have been bitten. The highest proportion of respondents (27; 31%) had been bitten while between 6 and 10 years of age, and the hand was the part of the body most often injured. Eighteen (21%) bites involved a stranger's dog, but most bites were by a dog known to the victim. Respondents from rural areas were three times more likely to have been bitten than city dwellers. The victim's home was the place where most (31; 36%) bites occurred. Male dogs were responsible for a larger proportion of bites (38; 44%) than females (24; 28%); respondents were unsure about the sex of the remainder of the dogs (25; 29%) that bit them. Protecting the home, play, accidents, rough handling and pain were identified as the common reasons for dogs to bite. Most (46; 52%) respondents did not believe legislation could have prevented their bite. Only four (5%) bites were reported to authorities.

CONCLUSION: Rural dwellers, people with more experience of dogs, children <11 years of age, and male respondents were bitten by dogs most often. Only legislation relating to the fencing of dog owners′ properties may have prevented a reasonable proportion (25; 29%) of the bites reported here.     

Impact of euthanasia rates, euthanasia practices, and human resource practices on employee turnover in animal shelters

OBJECTIVE: To examine the effects of euthanasia rates, euthanasia practices, and human resource practices on the turnover rate among employees with euthanasia responsibilities at animal shelters. DESIGN: Cross-sectional original study. SAMPLE POPULATION: 36 shelters across the United States that employed at least 5 full-time employees and performed euthanasia on site. PROCEDURES: By mail, 1 survey was sent to each shelter. Surveys were completed by a senior member of management and were returned by mail. Questions assessed characteristics (eg, euthanasia rates) and practices of the animal shelter, along with employee turnover rates. By use of correlation coefficients and stepwise regression analyses, key predictors of turnover rates among employees with euthanasia responsibilities were investigated. RESULTS: Employee turnover rates were positively related to euthanasia rate. Practices that were associated with decreased turnover rates included provision of a designated euthanasia room, exclusion of other live animals from vicinity during euthanasia, and removal of euthanized animals from a room prior to entry of another animal to be euthanized. Making decisions regarding euthanasia of animals on the basis of factors other than behavior and health reasons was related to increased personnel turnover. With regard to human resources practices, shelters that used a systematic personnel selection procedure (eg, standardized testing) had comparatively lower employee turnover. CONCLUSIONS AND CLINICAL RELEVANCE: Data obtained may suggest several specific avenues that can be pursued to mitigate turnover among employees with euthanasia responsibilities at animal shelters and animal control or veterinary medical organizations.     

Understanding veterinary practitioners' decision-making process: implications for veterinary medical education

Understanding how veterinary practitioners make clinical decisions, and how they use scientific information to inform their decisions, is important to optimize animal care, client satisfaction, and veterinary education. We aimed to develop an understanding of private practitioners' process of decision making. On the basis of a grounded-theory qualitative approach, we conducted a telephone survey and semi-structured face-to-face interviews. We identified a decision-making framework consisting of two possible processes to make decisions, five steps in the management of a clinical case, and three influencing factors. To inform their decision, veterinary surgeons rarely take the evidence-based medicine (EBM) approach. They consult first-opinion colleagues, specialists, laboratories, and the Internet rather than scientific databases and peer-reviewed literature, mainly because of limited time. Most interviewees suggested the development of educational interventions to better develop decision-making skills in veterinary schools. Adequate information and EBM tools are needed to optimize the time spent in query and assessment of scientific information, and practitioners need to be trained in their use.     

A model euthanasia workshop: one class's experience at Tufts University

Performing euthanasia is likely one of the most challenging tasks a veterinarian faces. Four students at Tufts University School of Veterinary Medicine felt that they and their classmates needed additional training on this subject. They informally surveyed their classmates to determine what topics and formats the students desired. The findings were used to develop the Euthanasia Workshop at the university, a voluntary series of lectures and discussions on technical and emotional issues relating to euthanasia. The four students then informally surveyed 30 North American veterinary colleges to determine the scope of euthanasia training in other veterinary programs. They found that euthanasia, while often covered within other courses, is rarely taught as a stand-alone course.     

A Declaration of Helsinki for animals

ObjectiveThis article examines the ethical principles underlying the Declaration of Helsinki as an internationally agreed justificatory framework for human medical research. The aim of the analysis is to consider the potential usefulness of these principles for defining an internationally agreed ethical 'best practice' in clinical veterinary research (CVR). It is suggested that the specific ethical responsibilities of the clinician to protect the interests of their patient when conducting medical research may be translated into the veterinary setting. Through exploring risk and harm, unproven interventions, vulnerability and informed consent, the article identifies the ethical risks of CVR. It is shown that veterinary regulators in the UK and the European Union have addressed these concerns to varying degrees; however, disagreements over the appropriateness of specific CVR practices are identified. A commitment to collaborative exploration of the benefits and challenges of implementing a Declaration of Helsinki for Animals is proposed.     

Survey of complications and antimicrobial use in equine patients at veterinary teaching hospitals that underwent surgery because of colic

OBJECTIVE: To determine current practices regarding use of antimicrobials in equine patients undergoing surgery because of colic at veterinary teaching hospitals. DESIGN: Survey. SAMPLE POPULATION: Diplomates of the American College of Veterinary Surgeons performing equine surgery at veterinary teaching hospitals in the United States. PROCEDURE: A Web-based questionnaire was developed, and 85 surgeons were asked to participate. The first part of the survey requested demographic information and information about total number of colic surgeries performed at the hospital, number of colic surgeries performed by the respondent, and whether the hospital had written guidelines for antimicrobial drug use. The second part pertained to nosocomial infections. The third part provided several case scenarios and asked respondents whether they would use antimicrobial drugs in these instances. RESULTS: Thirty-four (40%) surgeons responded to the questionnaire. Respondents indicated that most equine patients undergoing surgery because of colic at veterinary teaching hospitals in the United States received antimicrobial drugs. Drugs that were used were similar for the various hospitals that were represented, and for the most part, the drugs that were used were fairly uniform irrespective of the type of colic, whereas the duration of treatment varied with the type of colic and the surgical findings. The combination of potassium penicillin and gentamicin was the most commonly used treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study document the implementation of recommendations by several authors in veterinary texts that antimicrobial drugs be administered perioperatively in equine patients with colic that are undergoing surgery. However, the need for long-term antimicrobial drug treatment in equine patients with colic is unknown.     

Euthanasia in the dog and cat

A survey was made of the euthanasia of dogs and cats in the Scottish Region of BSAVA. The reasons for euthanasia were classified and major differences were found between the two species in the numbers destroyed on veterinary, behavioural and convenience grounds. Methods of destruction and body disposal were also considered.     

A survey of public attitudes towards barking dogs in New Zealand

AIMS: To investigate public attitudes towards barking dogs in New Zealand in order to quantify the extent to which people perceive barking dogs to be a problem, to compare tolerance of barking with that of other common suburban noises, to assess the level of public understanding about the function of barking, to determine risk factors for intolerance of barking and to assess knowledge of possible strategies for the investigation and management of problem barking.

METHODS: A 12-page questionnaire was sent to 2,000 people throughout New Zealand randomly selected from the electoral roll. Risk factors for being bothered by barking were examined using logistic regression analysis.

RESULTS: A total of 1,750 questionnaires were successfully delivered; of these, 727 (42%) were returned. Among respondents, 356/727 (49.0%) indicated that frequent barking during the day would bother them while 545/727 (75.0%) would be bothered by barking at night. Barking and howling were ranked above other suburban noises as a cause of annoyance. Risk factors for being bothered by daytime barking were not being home during the day, not owning a dog, and considering a dog bite to be a serious health risk. Risk factors for being bothered by night-time barking were not being home during the day, marital status, considering dog bites to pose a serious health risk, and having been frightened by a dog. Overall, 510/699 (73%) respondents understood that barking was a form of communication.

Action likely to be taken by 666 respondents hearing frequent barking included notifying and offering to help the owner (119; 17.8%), complaining to the owner (127; 19.1%) or the authorities (121; 18.2%), or doing nothing (299; 48%). Possible responses by 211 dog owners if they had a barking dog included seeking help from dog trainers (59; 28%) or behaviourists (54; 26%), buying an anti-barking device (33; 15%) or getting rid of the dog (20; 10%).

CONCLUSIONS: Barking was considered to be potentially disturbing by respondents to this survey. Attitudes towards barking were most influenced by age, dog ownership, past experience with dogs and attitude towards dog bites. Public understanding of the possible reasons for barking and appropriate methods of managing the behaviour when it becomes a problem could be improved by better education and the provision of information through veterinary clinics and social media.     

Use of cytology as a diagnostic method in veterinary practice and assessment of communication between veterinary practitioners and veterinary clinical pathologists

OBJECTIVE: To determine the extent of use of cytology as a diagnostic method in veterinary practice and assess how veterinarians in practice communicate with veterinary clinical pathologists. DESIGN: Online survey. STUDY POPULATION: 870 veterinarians. PROCEDURES: An online survey was made available to members of the Veterinary Information Network from October 1, 2004, through December 1, 2004. RESULTS: Respondents reported obtaining a median of 7 cytology samples weekly (range, 0 to 100). On average, respondents reported that 48.1% of the samples they collected were evaluated in-house, 29.5% were submitted to a veterinary diagnostic laboratory, and 21.6% were evaluated in-house and then submitted to a diagnostic laboratory. Most respondents (89.2%) reported using cytologic assessments to guide additional testing, and most (80.3%) indicated that they found the comments section of the cytology report to be the most important section. When asked to indicate the importance of various factors in their decision to use cytology as a diagnostic method, respondents overwhelmingly indicated that accuracy was very important. The most common reasons for consulting with a clinical pathologist were to discuss a discrepancy between clinical and cytologic findings, to clarify a diagnosis, and to ascertain the pathologist's confidence in a diagnosis. Respondents expressed more confidence in results when board-certified clinical pathologists were examining cytology samples than when others were. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that improving communication between veterinary practitioners and veterinary clinical pathologists could enhance the diagnostic value of cytologic examinations and improve clinical decision-making.     

A survey of the diagnosis and treatment of canine exocrine pancreatic insufficiency

A questionnaire was sent to veterinary surgeons who had diagnosed exocrine pancreatic insufficiency (EPI) by assay of low serum concentration of trypsin-like immunoreactivity in 302 dogs. Two-thirds of cases were German shepherd dogs, in which EPI was found equally in males and females. The disease was also diagnosed in 33 other breeds, most commonly in crossbreeds, spaniels, small terriers and collies, and was more common in females. Detailed replies on 160 cases were returned; 79 dogs were alive and 41 dead, with the remainder lost to long term follow-up. The major reasons for death were euthanasia because of the cost, the prognosis, and failure to respond to treatment. An adequate response to treatment was obtained in 92 per cent of dogs. Uncoated preparations of pancreatic enzyme replacement were found to be more successful, and the use of dietary manipulation and antibiotics were frequently reported to be useful adjunctive therapies.     

Working practices of cattle foot trimmers used for footcare in dairy cattle compared with those of veterinary surgeons for treatment of lameness in large animal practice

A questionnaire was sent to 270 veterinary surgeons and 135 cattle foot trimmers, investigating their perceptions on lameness and associated pain, with particular emphasis on dairy cattle. Response rates were 58 and 51%, respectively, but the number of respondents fully answering each question varied. Cattle foot trimming methods, opinions on pain associated with lameness and methods used to control pain were investigated. Responses of both groups were compared. No veterinary surgeon attended more than 50 lame cattle per month. The 'Dutch Method' of foot trimming was always used by 47% of veterinary respondents and 89% of trimmers. Both groups considered lameness to be potentially painful. Orthopaedic shoes were used by 79% of responding veterinary surgeons and 97% of trimmers (P < 0.001) to alleviate weightbearing by diseased digits. Housing lame cows on straw was regularly recommended by approximately one-third of both groups. Around a third of veterinary surgeons used local anaesthetics when treating lame cattle. Only 27% used analgesics when treating lame cattle.