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PRACTICE ADVICE
TOOLS TO HELP YOU COPE WITH “ETHICS EXHAUSTION”
Has a client ever asked you to perform a
procedure on their animal that you felt was
unethical?
The more controversial procedures such as
cosmetic surgeries, are perhaps easier to
decline these days with the public becoming
more focused on animal welfare issues and
groups lobbying for these types of medically
unnecessary surgeries to be considered
unlawful. But what if the request is for a
procedure that is not necessarily deemed
an animal welfare issue? For example, what
if a client asks you to do a minor surgery to
improve the way their show dog’s eyelids look
to better meet conformational standards?
Or perhaps a breeder declines your
recommendation to have a puppy spayed
when you repair an umbilical hernia because
they want to breed the dog? Since umbilical
hernias can be congenital, should you agree
to this? How do you handle a convenience
euthanasia situation? What if the client is
demanding a drug, for example an antibiotic,
which is not indicated for the patient’s
condition?
If a long-time “good” client is making the
request to perform what you believe to be
an unethical/unnecessary procedure would
it change how you approach the situation?
What if your boss said you had to?
Ethical dilemmas can also occur based on
how a practice is run. Is a sterile surgical
pack used for more than one surgery? Are
untrained staff members performing tasks
that can put patients’ safety at risk?
The College recently published the Guidance
on Professionalism for Veterinarians. The
guide reminds us, among other things, that
we as veterinarians hold ourselves and our
colleagues to a high standard of ethical
conduct as outlined by the core values in the
College’s Code of Ethics. We are to act in our
patients’ best interest and recognize animal
health and welfare first. However, there are
other factors we need to be aware of that may
result in taking an action that is inconsistent
with our ethics. These include such things
as the client’s beliefs and requests, clinic
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protocols, business pressures, job security,
and guilt.
We may worry that if we don’t perform a
procedure we consider unethical, less
qualified people will, which could result in
more pain and suffering for our patient, or
that we will be asked to euthanize the animal
instead. These situations create an ethical
dilemma because we are uncertain about the
right course of action.
When we are faced regularly with taking
actions that are incongruent with our
ethical views, we can eventually reach the
point where we no longer try to resolve the
dilemmas. Over time, we feel more helpless
and justify our actions by believing we have
no choice and it isn’t our fault. Our ethics
have not necessarily changed but a learned
helplessness has set in.
Sonnya Dennis, DVM, DABVP has coined the
term “ethics exhaustion”, which is “fatigue,
emotional distress and a lack of will to
continue to act in a way that is consistent
with what you believe is the ethical thing
to do.” Ethics exhaustion can contribute to
depression, burnout and compassion fatigue.
Part of professionalism is maintaining our own
health and well-being to provide competent
care to our patients. So how do we prevent
ethics exhaustion?
There are several ways we can address ethics
exhaustion. For example, it is important to be
in a practice where the team shares similar
ethical values and the policies and protocols
reflect these views. This puts us in a position
to feel better able to act in a way that is
consistent with our beliefs. When faced with
the client who requests a procedure that we
deem to be unethical in the circumstance,
we would handle the situation as we would
any other interaction with a client and patient:
assess the patient, give recommendations
and provide client education.
If we decline to perform the requested
procedure as it is not in the patient’s best
interest and recommend alternative courses
of action, then it is up to the client to accept
or decline the recommendation as part
of the informed consent process. We can
decline to perform a requested service that
we feel is unethical, would be of detriment
to the patient’s health and welfare, or against
accepted standards of care and regulatory
obligations. It may not be the easiest
conversation to have, but for our patients’ well-
being and our own, it is one worth having.
For further information on ethics exhaustion
and ways to prevent it, please review Dr.
Dennis’ publications.
Code of Ethics
The Code of Ethics is a unique and
important document among College
publications. The Code of Ethics
belongs to the veterinary profession
as a reflection of both professional
aspirations and client expectations.
Guidance on Professionalism for
Veterinarians
The College’s newest publication
for veterinarians, Guidance on
Professionalism for Veterinarians,
includes the definition of veterinary
professionalism and elements to assist
veterinarians in upholding their social
contract with the public.