Managing conflicting ethical concerns in small animal practice
Whilst looking after the interests of a patient is a key priority for veterinary staff, there are many factors that may influence a vet’s clinical decision making. There are client considerations such as financial resources and emotional needs, personal aspirations to provide quality patient care and for personal development, and finally the desire to have a fulfilling yet balanced work life. At times these considerations may be conflicting and challenging to manage, for example, in the case of a client who has limited financial resources that prohibit the vet from providing a standard of care that they would consider best practice.
A new study, titled “Managing conflicting ethical concerns in modern small animal practice – A comparative study of veterinarian’s decision ethics in Austria, Denmark and the UK”, hypothesised that during a consultation, vets draw on four decision-making strategies, or ‘decision ethics orientations’ (DEOs) to balance potentially conflicting issues. The researchers did not suggest that vets predominantly focus only on one DEO, rather they were interested in how individuals balanced the four concerns, all of which are relevant to varying extents in most cases. The four DEOs were defined as:
- Patient-focussed: the primary focus is the best interest of the patient during the decision-making process;
- Client-empathetic: there is greater focus on recognising and being empathetic to the clients’ emotional needs, wishes and personal circumstances;
- Client-devolved: the focus is on providing the client with information about all available diagnostic and treatment options to allow the client to make the final decision, whilst distancing themselves to an extent from the client’s personal needs or problems;
- Development-oriented: the focus is on providing optimal patient care and contributing to the advancement of veterinary medicine.
Small animal vets in Austria, Denmark and the UK were surveyed using a questionnaire distributed by the small animal veterinary associations in each country (n=648) – including the BSAVA in the UK. The data were analysed to identify the four hypothesised DEOs, and to identify to what extent socio-demographic and practice specific-factors affect the reliance of each of the four DEOs within each country.
The four DEOs were successfully identified in all three countries. The results of the survey identified some clear and significant differences between the countries with regard to practice-specific factors:
- More UK-based vets were working in corporate-owned practices compared to Austrian and Denmark-based vets;
- Vets working in independent practices in the UK had a higher score for the patient-focused DEOs than vets working in corporate-owned practices;
- Female respondents in the UK were less development-oriented than their male colleagues;
- Less experienced vets in the UK were more oriented towards client-devolved DEOs than their colleagues with more than 20 years of experience.
When data from all countries were pooled and multivariate linear regression analyses were utilised to check whether the country differences remained after controlling for socio-demographic factors, findings indicated that the vet’s country of work, work experience and age have a particular influence on the client-empathetic, client-devolved and development-oriented DEOs:
- Older vets and more experienced vets were more inclined towards the client-empathetic DEO than younger or less experienced colleagues;
- UK and Danish vets had significantly higher client-empathetic DEO scores than their Austrian colleagues;
- UK vets were less inclined towards the development-oriented DEO than Austrian or Danish vets;
- Younger vets, less experienced vets and male vets were more development-oriented than older, more experienced or female vets.
This is the first empirical study investigating how vets manage challenging expectations and ethical concerns as part of clinical decision-making in small animal practice. The proposed DEOs are not exhaustive, and future research should focus on whether other aspects relevant to the decision-making process could be included.
Springer S, Sandøe P, Grimm H, Corr SA, Kristensen AT and Bøker Lund T (2021) Managing conflicting ethical concerns in modern small animal practice – A comparative study of veterinary decision ethics in Austria, Denmark and the UK. PLoS ONE, 16 (6): e0253420.