Vet ethics: the application of pressure

The COVID-19 pandemic has put unprecedented pressure on veterinary clinics. Many smaller clinics and larger vet hospitals and emergency centres have—often for the first time in their histories—gone on bypass, temporarily closed, or severely restricted their hours.

Sometimes a complete absence of staff (e.g.  due to physical or mental illness or quarantine) has left clinics with no option but to close. At other times, closure of the hospital has been a choice or deliberate decision, precipitated by difficulties arising from reduced staff numbers and very high caseloads.

There can be differences in judgment between clinics about when closing or going on bypass is warranted. Furthermore, divergences in judgment can occur between members of the same clinic.

For example, practice owners may order employees to fit in all or nearly all clients who call or arrive at the clinic, whereas employees (vets, nurses, receptionists) may sometimes think this is a mistake.

This raises the question of when it is justified to shut down a practice or to go on bypass— that is, to limit the number of clients seen and to turn patients (even quite sick ones) away. During COVID-19, the medical profession has also confronted such difficult ethical issues.

What factors should go into ethical decision-making about choosing to close or go on bypass? To my mind, veterinary clinics and hospitals should carefully consider several ethical factors.

First, there are duties to patients (and clients). Normally, patients who are turned away may be seen by another clinic. Yet one of the unprecedented aspects of this pandemic is that veterinarians and nurses have sometimes been in severely short supply, even in big cities.

That situation is less of a problem when it comes to providing routine procedures like vaccinations (though the temporary lack of such services can also sometimes lead to medical problems). The more pressing moral issue, of course, concerns animals that need to be seen more urgently and may have painful or life-threatening conditions.

However, when medical staff are extremely tired and overly busy, the quality of medical care can decrease. Therefore, the harms to patients caused by turning some of them away need to be balanced against the harms caused by taking on too many cases.

Second, there are duties to veterinary personnel. A clinic that closes or goes on bypass may put additional pressure on neighbouring practices. This can be unfair and is another reason why the decision needs to be made carefully.

On the other hand, remaining open or electing to see all (or almost all) veterinary cases can be unfair on the vet personnel in certain circumstances. An excessive caseload can cause exhaustion and worsen personal health in a profession already deeply troubled by stress and mental illness.

Too high a caseload can also drive another acute problem our profession faces: job attrition. Such consequences clearly can harm staff members themselves. In turn, veterinary attrition can harm patients, clients, and the longer-term success of the practice.

Third, there is the need for the business to remain viable. When a practice faces too much financial pressure, it may be forced to shed staff, reduce the quality of care, or close permanently.

There is a difference, however, between remaining viable and making profits during a once-in-a-century health crisis by capitalizing on the additional veterinary work. The impact on staff, patients, and clients caused by permitting onerous working conditions must be factored into the ethical decision.

Clearly, given the weighty considerations involved, the decision may be quite difficult to navigate. People may also disagree from case to case. Nonetheless, a better justified decision about closing or going on bypass can be made from careful consideration of the above factors.

Simon Coghlan

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