AVMA Convention 2024 Daily News Sunday

Using ethical frameworks in emergency care

Ethical principles empower veterinarians to set boundaries and make informed decisions

Back to Convention Daily News

As much as a veterinarian wants to help every single patient, it simply isn’t possible to be responsible for every emergency, every time.

Dr. Barbara G. Crabbe, a member of the AVMA’s Council on Veterinary Service who helped with recent revisions to the Principles of Veterinary Medical Ethics (see story), presented the session “What Is the Veterinarian’s Ethical Responsibility in Responding to an Emergency?” on Friday at AVMA Convention 2024 in Austin, Texas.

“I think the veterinary profession's contract with society expects us as veterinarians to protect the health and welfare of animals, and this expectation does include the provision of care to relieve suffering in an emergency,” Dr. Crabbe said.

Veterinarian examining dog in hospital
“While it's clear we have an ethical duty, responding to every emergency isn’t realistic or sustainable,” says Dr. Barbara G. Crabbe. She gave the presentation “What Is the Veterinarian’s Ethical Responsibility in Responding to an Emergency?” on Friday at AVMA Convention 2024 in Austin, Texas.

However, veterinarians often face challenges in meeting these obligations. By using frameworks for ethical decision-making, veterinarians can determine the appropriate course of action when faced with an emergency.

Dr. Crabbe holds a master’s degree in bioethics from the Neiswanger Institute of Bioethics at Loyola University’s Stritch School of Medicine in Chicago and is currently enrolled in its doctoral program.

Previously, she was a private practitioner and owner of Pacific Crest Sporthorse, a general equine practice in Oregon. During her 30 or so years in practice, Dr. Crabbe wrestled with numerous ethical dilemmas.

Sometimes she would spend days worrying about the fact that she couldn’t get to an emergency for one reason or another. Since then, she has become passionate about helping fellow veterinarians avoid this kind of moral distress, which she says is contributing to burnout in the profession.

“The first thing I think we can do is help veterinarians understand that we do have a duty to provide care, but there are times when it is an ethically justified decision to turn away a patient even in an emergency,” Dr. Crabbe said.

Utilitarianism

Utilitarianism is the doctrine that an action should aim to have the most benefit for the greatest number of people. Dr. Crabbe explained, “An example surrounding the provision of emergency care is if we can accept that excessive emergency demands are (one) reason why veterinarians are leaving the profession.”

If enough veterinarians leave for that reason, that would reduce the number of veterinarians available to provide care and could harm patients and clients.

“We can use that as a utilitarian argument to put boundaries that limit our emergency availability,” Dr. Crabbe said.

Establishing boundaries could mean providing emergency services only to patients with an existing veterinarian-client-patient relationship, limiting availability during nonworking hours, and keeping a separate work phone.

Veterinarians should also impose limits in situations when the care required is beyond the scope of the their expertise, the client is threatening, there is a lack of necessary resources, or safety concerns exist.

Balance of beneficence vs. nonmaleficence

Beneficence is the principle of doing good, while nonmaleficence is the principle of doing no harm.

Balancing these principles against each other can be helpful in determining whether or not to respond in a given situation. Put another way, when does the good outweigh the bad?

For example, a pet is presented to an emergency room on a busy night when the veterinary team is stretched to capacity. In this situation, the good that may come with treating the new patient is outweighed by the potential harm of diverting resources away from critically ill patients and causing unnecessary stress on team members.

Casuistry

Casuistry is using case-based reasoning to solve an ethical dilemma. It relies on common sense and experience. The known outcome of paradigm cases helps predict the outcome of more complex, active cases.

An example of a paradigm case would be if a veterinarian was presented with a dog experiencing continuous seizures, a clear-cut emergency. The paradigm case on the other side would be a dog that had one seizure and then recovered. Taking an active case and putting it somewhere in between those two helps determine where on the spectrum it might fall.

A 2001 study of general practitioners, “Casuistry as bioethical method: an empirical perspective” in the journal Social Science & Medicine, concluded that most health care providers naturally rely on case-based reasoning to solve ethical dilemmas.

“We have to support the mental health of practitioners who are currently dealing with emergency decisions by providing them with tools for ethical decision-making so that they can feel ethically justified when establishing boundaries for their availability,” Dr. Crabbe said.