“What would you do if it was your dog?”
Many veterinarians in small animal practices have heard this question from clients who are unsure about whether to choose a certain treatment or euthanasia. At a first glance the answer seems easy; just share your opinion backed by the relevant information. But when you take a closer look at the situation it becomes more complicated.
Firstly, the circumstances and ethical values of the vet and the client may differ, so what is right for the vet may not necessarily be right or relevant for the client. Second, the question may not really reflect a wish to hear what the vet would do, but rather be an appeal for help in making a hard decision. Engaging in such help may, however, bring the vet in conflict with ideas about good conduct.
Some argue that the vet knows better and is allowed to make decisions taking the interests of the animal into account. Others argue that client autonomy should be respected, i.e. clients should make informed decisions on their own, and all the vet should do is to provide the relevant information. And finally some others point to shared decision-making, where information and opinions are exchanged to reach an agreement. So how should the vet respond?
The challenges of decision—making
I wanted to take a closer look at situations where decision-making becomes a challenge. When does it become difficult for clients to decide?
There is almost no research on this scenario, so as a starting point I wanted to take a closer look at situations where decision-making becomes a challenge. When does it become difficult for clients to decide? And how do clients find that vets respond to their hesitation and perhaps requests for advice? Next, I wanted to discuss the ethical implications of the veterinarians’ role when they engage in such decision-making.
The dog owners I interviewed were a selected group. They had chosen to care for their ill or aged dogs and seemed to perceive their dogs as part of their family. The interviews also concerned the impacts on their own lives when providing demanding care, and they appreciated the attention given to the challenges they were facing.
It turned out that in some cases decisions were easier (relatively speaking), for example, if the dog’s welfare was really poor, all treatment options had been tried out, or the client was exhausted. Other situations created more of a grey area and made clients hesitant.
Here the challenges included the lack of a clear cut-off point if, for example, there was a slow deterioration or if good days alternated with bad. Why then choose euthanasia on one specific day rather than next week or month, or perhaps a long time ago?
In some cases clients felt unsure if their dog was suffering, and some were struggling with how to balance different concerns about both the dog and their own situation. Finally, for some clients taking on the responsibility for ending the dog’s life could be hard. It made them feel like a bad person, and they wanted the vet to share that responsibility.
The vets could thus help clients both by assessing the dog’s welfare and by engaging in decision-making.
The vets could thus help clients both by assessing the dog’s welfare and by engaging in decision-making. Also, supporting the client’s nearly made decision, legitimizing concerns about the impact on their own life and providing specific guidance brought relief. Clients were aware though, that the vet could influence their decisions in the process.
Influencing a client’s decision
So, clients may want vets to engage in the decision-making and vets may influence clients’ decisions. This is a challenge if one believes that clients should make informed autonomous decisions, which is currently advocated as best practice amongst veterinarians.
The first challenge is that the vet may need to be selective and simplify the information presented to the client, and in doing so may introduce a bias towards his or her own preferred choice.
The first challenge is that the vet may need to be selective and simplify the information presented to the client, and in doing so may introduce a bias towards his or her own preferred choice. A second challenge is that the vet may not have all the information which is relevant to the clients’ decision-making.
I did this work as part of a larger project on drawing the line for veterinary treatment. Here I found that follow-up studies on veterinary treatment rarely consider welfare in a broader context. So the vet may know the success rate and medical complications of a treatment, but not how the animal is expected to cope in its everyday life.
Furthermore, another part of these interviews showed that the impact on the clients’ own lives may be significant if they choose certain treatments. Clearly, these aspects need to be addressed, if the client should be fully informed before making a decision.
Finally, I question that simple autonomous decision-making is the ideal in all cases. What if the client wants to share the decision-making or to leave the decision entirely to the vet? It seems like this may sometimes happen anyway and there may be a need to develop models for handling such processes in practice.
This raises additional issues to consider, though. What if the vet and client disagree about the best way forward or the role of the vet in the decision-making? How does the vet avoid pointing the client in an unwanted direction? The ethical framework in veterinary decision-making clearly deserves further attention.