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VeterinaryProfessionalEthics

TanyaStephens

Thispaperisachapterin AppliedEthics:StrengtheningEthicalPracticesEd:PeterBowden,TildeUniversityPress,2012 andallcitationsshouldbetothepublishedversion. Thebookmaybeorderedonlineat: http://www.tup.net.au/publicationsnew/Applied_Ethics.aspx

VeterinaryProfessionalEthics
This chapter is written in the year when veterinarians around the world are celebrating the 250th anniversary of the founding of the veterinary profession in Lyon, France in 1761. Claude Bougelat, a French barrister and Commissioner Inspector of the Stud Farm at Lyon, through his work with horses and with the cooperation of human surgeons, noticed striking and useful similarities between thehumanandanimal machine. Following an audience with King Louis XV, he was successful in creating the first school for the teaching of veterinary medicine (The World Congress on Veterinary Education,2011,Lyon). From the outset, it was clear that Bougelat intended these new animal doctors to be regarded equally alongside the other medical professions. His ideals regarding the veterinary profession were nobly stated in the Rules for the Royal VeterinarySchools'(1777): The doors of our Schools are open to all those whose duty it is to ensure the conservation of humanity, and who, by the name they have made for themselves, have won the right to come and consult nature, seek out analogies and test ideas which when confirmed may be of service to the human species. (Translation from Harris,2011,p.1) The links between veterinary medicine and the service of humanity are as pertinent as ever, despite a number of key differences existing between Bougelats world and the professional context in which the majority of veterinarians now practise. While the eighteenth century veterinarian was primarily concerned with the maintenance of the agricultural economy,thetwentyfirstcenturyveterinarianhasamuchwiderrangeofrolesandresponsibilities.Anumberoffactors have added greater complexity to the profession, including the rise of intensive livestock production, technological advancements, genetic engineering, development of laboratory animal research, a growth in the status and economic value of companion animals, and a growing appreciation of the human/animal bond. Concurrently, the growth of environmental consciousness and increasing community concerns about animal welfare have precipitated a change in the way many animals are viewed. In our contemporary context, therefore, veterinarians are often called upon to make ethicaldecisionsinareasandwaystheyhavenotdonesopreviously. This chapter will deal with the professional ethics of veterinarians. While animal ethics refer to the moral issues surrounding the use of animals, veterinary ethics are concerned with how veterinarians make decisions and act as professionals for the provision of veterinary care. In this process of professional decisionmaking, veterinarians will frequentlyneedtoconsiderissuesofanimalethics,buttheirprofessionalethicsnecessarilyincludeandgobeyondthese concerns(Tannenbaum,1989).ThechapterwilldrawonandexpandTannebaumsfourbranchesofveterinaryethics. DescriptiveVeterinaryEthics OfficialVeterinaryEthics AdministrativeVeterinaryEthics NormativeVeterinaryEthics DescriptiveVeterinaryEthics Descriptive veterinary ethics refer to the actual ethical views of members of the veterinary profession regarding professionalbehaviorandattitudes.(Tannenbaum,1989,p.29). TheoathrecitedbygraduatesinVeterinarySciencefromtheUniversityofSydneyattheirgraduationisanexpressionof suchdescriptiveethics: "I solemnly swear to practise veterinary science ethically and conscientiously for the benefit of animal welfare, animal and human health, users of veterinary services and the community. I will endeavor to maintain my practise of veterinary science to current professional standards and will strive to improve my skills and

knowledge through continuing professional development. I acknowledge that along with the privilege of acceptance into the veterinary profession comes community and professional responsibility. I will maintain theseprinciplesthroughoutmyprofessionallife." OfficialVeterinaryEthics Official veterinary ethics refers to official veterinary standards adopted by veterinary professional organisations. For example, the Australian Veterinary Association (AVA) has an extensive Code of Professional Conduct. Its stated aim is to present and promote a body of ethical principles to guide veterinarians conduct and includes stipulations aimed at maintaining the integrity and cohesion of the veterinary profession. It is the intention of this Code to ensure that veterinarianswhobelongtotheAVAstrivetoactinaccordancewiththeCode. Thefirstexpectationofthecodeis,alongwithseveralofthesubsequentguidingprinciples,Alwaysconsiderthehealth, welfareandrespectfultreatmentofanimals.(AVA,1997) AdministrativeVeterinaryEthics Administrative veterinary ethics refer to the moral standards imposed on veterinariansby administrative governmental bodies. (Tannenbaum, 1989, p.8). Unlike the prescriptions of the AVA, or other professional organisations, administrative veterinary ethics are enshrined within and enforceable by the law. There is state and territory legislation inplaceinAustraliaregardingtheregistrationofveterinariansandguidelinesforveterinarypractice.Relevantlegislation governsveterinarianstoensurecompliancewithcodesofconduct.Forexample,inNewSouthWales,thepurposeofthe VeterinaryPracticeAct2003andassociatedRegulations2006arestatedas: Promotethewelfareofanimals;ensureconsumersarewellinformedastocompetenciesrequiredofveterinary practitioners; ensure acceptable standards are met by veterinary practitioners to meet public interest and national/internationaltraderequirementsand;providepublichealthprotection. NormativeVeterinaryEthics Normative veterinary ethics are described by Tannenbaum (1989) as the activity of looking for correct norms for veterinary professional behavior and attitudes (p. 8). Of the four branches, Tannenbaum insists that normative veterinary ethics are of the greatest significance. Indeed, it goes to the core of what it means to be a professional veterinarian because this branch of ethics requires the greatest level of autonomy and personal decisionmaking on the partoftheveterinarian.Tannenbaumhassummarisedtherelationshipbetweenthefourbranches: Official veterinary ethics is especially useful in approaching normative veterinary ethics. The official rules indicate what ethical questions the profession has found most pressing, and they contain specific answers to many of these questions. Descriptive veterinary ethics, too, will reveal the concerns of the profession, and can help the draftees of official and administrative rules understand what standards might be necessary, and whetherproposedrulesarelikelytobeacceptedorresisted.(Tannenbaum,1989,p.9) ETHICALISSUESUNIQUETOTHEVETERINARYPROFESSION Thisuniquenessisdueprimarilytothefactthatveterinarianshaveastheirfirstprioritythecareoftheanimal,apriority that may at times bring them into conflict with economic interests or the interests of the animals owner. Rawles (2000) hasaccuratelydescribedthisrole: "In short, veterinarians are not just at the front line, they are also on an ethical highwire, constantly balancing their concern with animal welfare against the demands of the industries, clients and practices they work for, withoutnecessarilyhavingbeengivenanytraininginhowtodothis(pp.1516) The ethical dilemmas that exist as a result of the veterinarians unique triangular relationship with the animal and its owner have been well documented, particularly by Main (2006), Rollin (2006) and Williams (2003). Veterinary decision

makingattemptstobalanceallthreeintereststhoseoftheanimal,theownerandtheveterinarianwhichcanleadto conflictsofinterest. Animal health and welfare are the core objects of the profession. In addition to balancing the complexity of interests involved in animal care, veterinarians are called upon to assess animal welfare. Animal welfare science is well established. (Webster, 2005; Broom and Fraser, 2007; Grandin, 2009). The generally accepted definition of animal welfare is expressed in the Australian Code of Practice for the Care and Use of Animals for Scientific Purposes as an animalsqualityoflifebasedonanassessmentofananimalsphysicalandpsychologicalstateasanindicationofhowthe animal is coping with the ongoing situation as well as a judgment about how the animal feels. Dawkins (2008) defines animalwelfareobjectivesasbeingmetby"animalsthatarehealthyandhavewhattheywant". Webster (2005) was instrumental in establishing a systematic approach for the evaluation of Animal Welfare, the so called "Five Freedoms". These are: freedom from thirst, hunger and malnutrition; freedom from discomfort; freedom from pain, injury and disease; freedom from fear and distress; and freedom to express normal behaviour. However assessing animal welfare is not always easy even for the veterinarian. It is widely recognized that assessments of animal welfare involve a number of assumptions that are ethical in nature. (Tannenbaum, 1989; Sandoe and Christiansen, 2008). Examples of ethical dilemmas based on recent communityconcerns about geneticdefects in dogs serve to illustrateone oftheveterinarianscomplexrolesandresponsibilitiesinregardstoanimalwelfare.Dogsthathavebeenselectivelybred for their breed or aesthetic characteristics can carry genetic defects that affect their general health and welfare. English Bulldogs, for example have been bred so they often cannot give birth naturally as the broad heads of the puppies make caesariansnecessary.Inthiscase,shouldtheveterinarianperformacaesarian?Orshouldtheveterinarianinsistthat,ifa caesarian is performed, the bitch be desexed at the same time to prevent the continuation of such a genetic defect? Similarly,Pugsarebredinsuchawayastobeliabletosufferfrombrachycephalicobstructiveairwaysyndrome.Shoulda veterinarian operate on Pugs so that they can breathe or suggest euthanasia or desexing to prevent breeding? Sadly, owners are likely to not be aware of or appreciate the welfare significance of selection for the brachycephalic (short muzzle) phenotype in dogs (Packer UFAW, 2011). Prior to being faced with such a difficult situation, should the veterinarian be actively engaged in educating pet owners and breeders about the detrimental effects of some selective breedingpractices?Isthistheroleoftheveterinarian? It is certainly not always obvious how a veterinarian should act in a given situation. Each and every day in practice veterinarians are faced with making ethical decisions and all of these decisions are potentially open to criticism by the owner, other veterinarians, society, professional veterinary boards, lawyers, insurers and others. It is apparent, therefore, that "in many ways, the professional life of veterinarians is more complex, and more likely to provide opportunitiesforconflictthanthelivesofotherprofessionals."(Brennan,2008) The importance of animal welfare in Australia is illustrated by the support given to the Australian Animal Welfare Strategy (AAWS), a national program aimed at promoting animal welfare in Australia. (http://www.daff.gov.au/animal planthealth/welfare/aaws/online) ANETHICALDILEMMA The following ethical dilemma is adapted from that published in the AVJ (Australian Veterinary Journal) August 2010. An initiative of AVAWE (Australian Veterinarians for Animal Welfare and Ethics) it is based on a similar feature in the British Veterinary Association's "In Practice". The Dilemma and response, written by members of AVAWE, are based on researchintocurrentlegal,professional,ethicalandanimalwelfarestandards. Sheba,anEthicalDilemma(MaastrichtandStephens2010) Sheba was a nine year old female desexed German Shepherd. She was the much loved pet of Rhonda, a recently separatedwomanwithanadultfamily.RhondahadnoticedthatShebaseemedtobelosingweightandwasnoteating as much as she normally did but initially assumed that it was an age thing. After a few months however, Rhonda was

becoming anxious because Sheba was also losing her enthusiasm for life, did not want to go for a walk or a ride in her carandseemedtoexperienceperiodsofrealdiscomfortassociatedwithwhatsoundedlikemoaning. ShetookShebatohervethopingtogetatonicforherandreturnhertoherpreviouslyhappyself.Thevisitdidnotgo ashopedhoweverandafteranovernightinhospital,afullexamination,Xrays,anultrasoundandsomebloodtests,the vet advised that Sheba was seriously unwell and needed to have a laparotomy as she appeared to have an enlarged liver and the most probable cause was cancer. The surgery was to remove the affected liver and, if possible, leave sufficientviablelivertoenableShebassurvival.Therisksforthesurgerywerehighasweretheyfortheoutcome. ThiswasanenormousshockforRhonda.Shewasnotatallpreparedforthepossibilityofherbestfriendfacingsurgery letalone,dying.ShegavepermissionforthesurgerytooccurandafteratearfulfarewelltoSheba,wenthometoawait theresult. Severalhourslaterthetelephonerang.Thevetdidnothavegoodnews.Theliverwasalmostfullyaffectedbycancerand therewasnopossibilityofsurvival.ThevetadvisedthatShebashouldbeeuthanasedwithoutwakingupfromsurgery. Rhonda said no. She wanted to take her home and allow her to die at home with her. Despite everything that the vet could say about post operative pain, slow recovery from surgery, pain associated with the continued cancer growth and guaranteeddeteriorationofSheba,Rhondawouldnotagreetoherbeingputdown. The vet recovered Sheba from the anaesthesia and surgery, put her onto appropriate analgesia and after forty eight hours in hospital, sent her home. Sheba survived another six weeks. It was not a comfortable six weeks for her as she not only healed very slowly from the surgery, but experienced considerable pain, even suffering as the effects of cancer consumed her. It is more difficult to say if Rhonda was any betterprepared for thedeath ofherpetwhen itdidhappen, butsomehowshefeltbetterbecauseatleastshehadnotbeentheexecutioner. Thequestionis,wasthisanacceptableoutcome?Whatifanything,couldhavebeendonebetter?Wasthewellbeingof the dog address appropriately? What were the drivers for the decisions that were made for both the owner and the veterinarian? Response This situation is common and will become more so as animals are increasingly spared from the motor vehicle accidents andinfectiousdiseasesofpreviousyearsandhencebecomepronetoageassociateddiseasessuchascancer. Arguably, the veterinarian handled this situation poorly and his failure to take responsibility for his patient resulted in Shebassuffering. Although, legally, companion animals are classified as a chattel and objects of private property rights, legislation for the protectionofanimalsrecognisesthatanimalssufferwhenilltreatedandthereforehaveintrinsicinterestswhichmustbe protected regardless of their property status, in other words there is a limitation of personal property rights in order to benefittheinterestsofanimals. Furthermore,thebasicprincipleofprofessionalconductforaveterinarypractitionerisaprimaryconcernforthewelfare ofanimals. The rather unique triangular relationship veterinarians have with owners and their pets (much like the relationships between pediatricians, children and their parents) can lead to difficult ethical dilemmas. We can easily see in this case that the veterinarian was concerned about the owners feelings and has wrongly abrogated his professional responsibilityontotheownerattheexpenseoftheanimalswelfare. To avoid this situation developing, euthanasia should always be discussed from the beginning of treatment for diseases like cancer and owners should be encouraged to make decisions based on the understanding that they, rather than the veterinarian, are sparing the animals from prolonged suffering. In this case the veterinarian had not undertaken the

necessary preliminary spadework with the owner to secure a humane outcome. Sheba should have been fare welled by the owner before the surgery and euthanased on the operating table when the laparotomy revealed an inevitably fatal prognosis. The veterinarian should have insisted, and even invoked animal welfare laws if the owner was intransigenttothissuggestion. Relationshipswithanimalownersshould,ideally,notbeallowedtoreachthisstage.Sadlysomeclientsdontknowwhen toletgoandperhapsinthiscaseShebarepresentedadeadparentortherecentlossofthepartner.InthisrespectRollin (2006) has commented If society will not accept prolonged suffering in an animal for biomedical reasons (that is, reasons that benefit humanity in general), it will surely condemn the owner who keeps a suffering animal alive for egotisticreasonsbecauseheorshecannotbeartoletitgo. As animal owners become more knowledgeable and demanding, veterinarians may be tempted to abrogate their professional responsibility onto the owner. This is already a growing trend in human medicine where Society now believeseverymedicalproblemrequiresadiagnosis,andthusatest,andeverydiagnosisatreatmentregardlessoflikely efficacy, appropriateness or cost. In this, doctors have abrogated responsibility for decision making to patients or their relatives. This approach explains why a large proportion of the burgeoning US health care budget is spent on patients in theirlastfewweeksoflife(O'Leary2010) Of course advances in veterinary medicine have allowed us to offer better treatment options to prolong life but it is essential that we remember that the veterinarian is the trained professional, not the client, and that acting as a professionalgeneratesandmaintainstrustbetweentheprofessionandsociety. Aesculapianauthority The Sheba dilemma presented above raises the issue of Aesculapian authority (from the Greek/Roman God of Medicine,Aesculapius,calledbyHomerablamelessphysician). A veterinarians awareness and use of their (rightly earned) Aesculapian authority is an indispensable element of their profession.Theabilitytodeployitisessentialtothemaintenanceofveterinaryprofessionalismandthetrustthatsociety has placed in the veterinarian. Rollin (2006) has a great deal to say about Aesculapian authority. As Rollin explains, Aesculapian authority is the most powerful authority in society. Using Siegler and Osmonds (1974) analysis of human physicians,RollinassertsthatAesculapianauthorityoperatesinthesamemannerforveterinarians.InshorthesaysThe authority derives from a combination of traits: sapiential (that is, special wisdom and knowledge); moral (deriving from the overwhelming moral imperative to heal, relieve suffering, and retard death); and charismatic (derived from the fact that medicine is still related to magic in the eyes of the scientifically and medically naive, that is, most people). Rollin writesthatfullAesculapianauthoritycanandshouldbeinvokedforthebenefitoftheanimal. THEETHICALISSUESSURROUNDINGEUTHANASIA Euthanasia is described as the humane killing of an animal, in the interests of its own welfare, to alleviate pain and distress. (Australian Code of Practice for the Care and Use of Animals for Scientific Purposes, 7 th Edition, 2004, National HealthandMedicalResearchCouncil,AustralianGovernment). The issue of euthanasia, in particular, sets veterinarians apart from other professionals. The killing of animals creates unique and acute stresses for the veterinarian, stresses that are frequently underestimated or ignored by the general public. There is an abiding tension in the use of killing by veterinarians; it is totally unacceptable to kill a healthy animal at the mere demand of a client (perhaps because of minor behavioural issues or because they are moving house and cannot take their pet with them), as it is equally unacceptable to not euthanase an animal that it is suffering and in severe pain or distress. In actual fact the capacity to euthanase a suffering animal can be seen as a privilege for veterinarians.Ontheotherhandaveterinarianwhorefusestokillahealthyanimalthatisnolongerwantedandinstead referstheanimalandownertothepoundmakesadecisionthatitislegitimateforsomeoneelsetoundertakethistask. In the 1980s Rollin identified a problem he named "moral stress" (Rollin, 1987). Moral stress arises from the tension betweentheaimofveterinarians(toprotectandsustainthelifeofanimals),andtherealityofthepracticeofeuthanasia

(calling upon veterinarians to kill animals). This is particularly acute in the case of veterinarians and other animal care providers, who are faced with the task of killing healthy, but unwanted animals, such as those in pounds, shelters and research laboratories. Rollin (2011) argues that moral stress "is a unique and insidious form of stress that cannot be alleviatedbynormalapproachestostressmanagement". Rollin suggests this insidious stress apparent in the profession, may be partly responsible for the higher than average suicide rate among veterinarians. It has been shown that veterinarians are four times more likely than the general population to commit suicide in several countries. (Bartram 2010, Platt 2010). Bartram suggests that "the veterinary profession'sroleinprovidingeuthanasiaandsofacilitatinga'gooddeath'maynormalizesuicidewithdeathperceivedas arationalsolutiontointractableproblems' Although a review of suicide in Australian Veterinarians from two States found no evidence of increased rates of suicide (JonesFairnie 2008), Australian studies have shown that workplace stress and poor psychological health are common in theprofession.(Smithetal2009;MeehanandBradley2007;Hatchetal2008;Fritschietal2009). CONTEMPORARYETHICALISSUES The advent of a postmodern mindset has had serious implications for the standing of science in general, and veterinary sciencehasnotbeenimmune.Atitsextreme,postmodernismviews scienceassimplyoneamongavarietyofsubjective explanations for the way we perceive the physical world. As a result, science is downgraded to mere opinion, and scientists professional voices are diminished. One consequence of this postmodern context is the emergence of complementary and alternative veterinary medicine (CAVM). These alternatives to veterinary medical science pose a serious threat to the maintenance of ethical standards within the profession since they are not based in the scientific methodsandrigourexpectedfromaprofessionalbodyofpractitioners.Inanextensivebookexaminingtheusefulnessof CAVM,RameyandRollin(2004)haveposedsomehighlypertinentquestions: Is it acceptable for a professional to do just anything under the guise of good intentions? Or do they have an obligation to show that we're actually doing something helpful for the animals for which we care? If they do have such an obligation, then clearly, they must separate safe treatments from unsafe, and effective from ineffective to a large extent, they have, and alternatives to scientific medical practice have consistently been foundwanting. Rollin (2006, p 95) states that "society expects medicine to be science and evidencebased, and charters veterinary medicine accordingly, going on to argue that it is therefore a violation of veterinary medicine's moral obligation to society to do otherwise." Webster (2005, p 203) comments that "society at large shies away from the stern discipline of evidencebasedscientificreasonintothemushyembraceofsuchthingsashomeopathyandherbalmedicine". The continued use of 'therapies' that have been shown to be worthless is clearly not in keeping with the scientific basis and expectations of the profession. Such actions have animal welfare and ethical implications. Is it unethical to charge fortherapiesknowntobeworthless?Andwhatoftheanimalinpainthatisofferedacupunctureonly?Acupuncturehas been shown to have no efficacy in animals and the effect in humans is most likely due to the placebo effect that cannot be replicated in animals (Ramey and Rollin, 2004; Ramey, 2001; Page, 2010; Harbacher et al, 2006; Sanderson et al 2009). The use of CAVM in the profession has the potential to affect adversely the regulation and hence the professional standing of veterinarians. (Ramey 2003). Unlike veterinary associations in the UK, USA and New Zealand, the AVA has two special interest groups devoted to CAVM. These groups have generated some fierce debate in the profession as evidenced by the letters to the Australian Veterinary Journal over the years. Not surprisingly CAVM has failed to gain recognition from specialist and scientific veterinary associations in the USA and the EU or the Australian and New ZealandCollegeofVeterinaryScientists. The practise of CAVM may thankfully be waning. An encouraging sign is the removal of continuing education points for manyCAVMcourses,includingacupunctureintheUSA.

PROFESSIONALETHICSVSBUSINESSETHICS Ascompanionanimalownershiphasincreasedineconomicvalue,andgiventhepreponderanceofveterinariansworking in small practices, there has been a surge in the promotion of veterinary medicine practice as a business. This has inevitablyledtoatensionbetweentheprioritiesofveterinaryprofessionalismandthoseofabusinessagenda.Indeed,a goodbusinessmanagerwilloftenbeverydifferenttoagoodprofessional.AsBrennan(2008)hasobserved: "Finding a competitive advantage in the market, for example, may involve misleading the opposition, patenting trade secrets and skills and doing other things that may not be in the best interests of customers and other businesses. By contrast, good professionals will normally share specialist skills and knowledge with each other andwillalwaystrytoacttoachievewhatisintheirclients'andpatients'bestinterests. Codes ofprofessional conduct are oftendesigned to ensure that where such conflicts occur, the interests of the patient, orthesafetyofthepublic,havepriorityovertheneedsofthebusiness. The vast majority of veterinarians (73%) are in private practice operating in a business setting, where, unlike their counterparts in human medical practice, they attract no government subsidy for their services. In such a setting they have a grave responsibility to ensure that professional ethics inform business decision making and that expenditure of theirclientsiswellandeffectivelydirected. AnissueofincreasingimportanceinthebusinesssettingofveterinarypracticeinAustraliaistheburgeoningnumbersof veterinarians coupled with a corresponding diminishing in the number of domestic animals. There are currently seven veterinary schools in Australia (despite the2003Frawley report intoRural Veterinary Services concluding thatthere was no immediateneed for a fifth veterinary school) with an increase ofgraduatesby50% expected from 2008 to2018. The falling animal ownership in Australia is documented by the ACAC in their 2010 report. (Australian Companion Animal Council 2010). As Baguley (2011) comments "this..will challenge the relationship between companion animal veterinarian supply and demand from increasing numbers of veterinary graduates and the pressures on veterinary practiceownerstoachieveimprovementsinlabourproductivity". Various other issues that impact on the professionalism of veterinary practice include: the rise of specialization (with potential loss of a skilled general workforce); the corporatisation of practices; nonveterinarians owning practices; the developmentofmoreexpensivedrugsandtechniques;betterinformedclientsthataremorelikelytobecritical. ETHICALISSUESASSOCIATEDWITHTHECOSTSOFVETERINARYSERVICES Increasinglycompanionanimalsareseenas"membersofthefamily"andthereisanexpectationfromownersthattheir petsareentitledtothesamelevelandaffordabilityofhealthcareashumanmembersofthefamily.Indeed,veterinary feesareoftencomparedtothoseofGeneralPractitioners,yet,unliketheaverageGP,theveterinaryhospitalmust provide(withnogovernmentassistanceorsubsidies)nursingcare,drugs,expensiveequipmentsuchasXRaymachines, autoclaves,etc.andbeds(cages,actually!) Thegulfbetweenexpectationsandcostscanleadtoethicaldilemmasfortheveterinarian.Inparticular,eachandevery daytheveterinarianisfacedwithmakingdecisionsaboutlevelsofservice.Theymustseektostrikeabalancebetween providinganaffordableserviceforanimalowners,withappropriateequipmentandmedicines,whilstmaintaining sufficientfinancialreturnstoensuretheviabilityoftheirbusiness.Withinthismatrix,thereisalsothecommon communityexpectationthattheveterinarianwillprovideafreeserviceforstrayanimals,nativeanimalsandbirdsaswell asforthepetsoflowincomepetowners.Veterinariansmaystrugglewiththeethicsofmeetingthisexpectationwhilst alsomaintainingafinanciallyviablepractice.Thisisaseriousdisincentiveforveterinarianstoprovidefreeservicesand maybeanincentivetoprovidecutrateandpossiblyinadequateservices. Atthesametimeasthecostsofmaintainingawellequippedandstaffedveterinaryhospitalrisetomeetgrowingclient demands,theemergenceofafterhoursandspecialistveterinaryserviceshavecreatednewandinterestingethicalissues foraprofessionwhichispredominantly(andhistorically)ofageneralistnature.Thereisaconcern,forexample,that veterinariansingeneralpracticemayincreasinglyreferdifficultcasestoaspecialistcentreandtheremaybeaclient's

perceptionthataspecialistwoulddoabetterjob.Thiscreatesgreatercostsfortheclientatthesametimeasimpacting onthegeneralistsskillsetandincome. ANIMALABUSEANDNEGLECT Anotherareaofethicaldecisionmakingwhichaffectsveterinariansisthatofanimalabuseandneglect.Thisisthe subjectofanotherAVAWEEthicalDilemma(TipladyandLawrie2011). InAustraliathereisnomandatoryrequirementforveterinarianstoreportanimalabuse,howevertheAVAhasguidelines whichstate."Veterinarianswhosuspectcrueltyshouldreportittotheresponsibleauthority.Thefirstpriorityof veterinariansattendingtheseanimalsshouldbethewelfareoftheanimal.Thedutyofcaretheveterinarianhasforthis patientshouldextendbeyondtheimmediateinjuryandincludepreventionoffurtherabusetothepatient".Thismay includeveterinariansseizinganimalsunderanimalcrueltylegislation.Veterinarianshaveanethicalobligationtoreport crueltytoanimalsdespitetherisksinvolved. Thisethicalobligationtoreportabuseismadenotjustfortheanimalswelfarebutbecauseofthewellresearched connectionbetweenanimalandchildabuseanddomesticviolenceandsociopathictendencies.Ithasbeen demonstratedthatthereisacomplexinterrelationshipbetweenanimalandchildcrueltyandacorrelationbetween animalharmandotherformsofpsychosocialdistress.(KellertandFelhouse,1985;Arkow,1994;Linzey,2009;Merck, 2009;AscioneandArkow,1999;HackettandUprichard,2007). AsurveyofAustralianveterinariansassessedtheirknowledgeaboutandattitudestowardsabuseofhumansandanimals (GreenandGullone2005).Overhalftherespondentsagreedwiththestatements'Peoplewhoabuseanimalsaremore likelytoabusetheirspouses',Peoplewhoabusetheiranimalsaremorelikelytoabusetheirchildren'and'Veterinarians haveamoralresponsibilitytointervenewheretheysuspectanimalabuse'. Asurveyofreportsbywomenofanimalabusebytheirpartnerand/orchildreninAustraliawasundertakeninacase controlstudybyGulloneetal(2004).Twogroupswerestudied,onewithahistoryoffamilyviolenceandonewithout. Statisticallysignificantdifferenceswerefoundbetweengroups.46%ofpartnershadthreatenedtoharmpetsinthe familyviolencegroup,comparedto6%inthecontrolgroupand53%ofpartnersinthefamilyviolencegrouphad harmedorkilledpets,comparedto0%inthecontrolgroup. VETERINARIANSANDTHEETHICSOFANIMALEXPERIMENTATION All Animal research in Australia is governed by the Australian Code of Practice for the Care and Use of Animals for Scientific Purposes 7th Edition (in the process of revision). The purpose of the Code is to ensure the ethical and humane careanduseofanimalsusedforscientificpurposes. Under the Code institutions or individuals using animals for research or teaching must first obtain permission from an Animal Ethics Committee (AEC). One of the members of an AEC has to be "a person with qualifications in veterinary scienceandwithexperiencerelevanttotheactivitiesoftheinstitution". In this way veterinarians undertake an essential role in research and teaching involving animals. Veterinarians bring a unique perspective to an AEC. They are able not only to act as advocates for the animal but have scientific training to allow them to understand the justification of the proposed research and to make suggestions regarding the use of variousdrugs.Thisisparticularlyimportantwhenresearchinvolvesusingpainfulproceduresandtheveterinarianonthe committeemaybetheonlyonewithexpertiseinthisarea. Although veterinarians have always been involved in research and have been members of AECs for many years, a growingnumberofveterinariansarenowbeingemployedinresearchinstitutionsasanimalhousemanagersandanimal welfareofficers.Veterinariansarealsoemployedinvariousgovernmentanimalwelfareunitswheretheyareinvolvedin

the inspection of animal research and breeding establishments to ensure compliance with the Code. They play a central roleintheformulationoflegislation. The use of animals in research is not something that is universally accepted. Its opponents tend towards the animal rights view that researchusing animals is always wrong.Sucha view however cannotbe justified asit overlooks the fact thatagreatdealofresearchonanimalsisundertakenforthesakeofanimalsandfortheeliminationofanimalsuffering. The abolition of Rinderpest is a good example. This scourge of cattle over many centuries, thanks to research and the development of a vaccine, has now been eliminated just this year. This is not only good news for cattle but those in our world whose only source of sustenance and wealth are their livestock. It should not be forgotten in this debate that the human animal needs to be in the ethical matrix for making ethical decisions about animal health and welfare. (Mephan 1999,Mephan2006,Webster2005). Thereisnodoubtthatanimalresearchhasbroughtenormousbenefitstothehealthandwelfareofanimalsandhumans. Research however has to be justified. The moral debate regarding animal experimentation requires a cost/benefit analysis. The predicted scientific or educational value of the research must be weighed against the potential effects on the welfare of the animal. Veterinarians are uniquely equipped in this regard. They play a crucial role in animal experimentation by ensuring that the research should aim to deliver vital benefits with sound animal welfare. The veterinary role in animal research is discussed in considerable depth by Webster (2005), Tannenbaum (1989), Rollin (2006)andSandoeandChristiansen(2008). MAINTAININGETHICSINTHEPROFESSION Veterinariansclearlyneedtoinitiatethediscussionofethicsintheirownprofessionandnotwaitforotherstodoitfor them.ThemaintenanceofethicalstandardswithintheveterinaryprofessioninAustraliaisbeingattendedtoona numberoffronts.Twosuchfrontsareworthyofspecialmentionhere. Teaching: The everwidening range of ethical issues affecting veterinarians needs to be well understood by our students and graduates.Tothisend,itispleasingtonotethatprofessionalethicsisnowincludedintheveterinarycurriculumofmost veterinary science degrees. The teaching of ethics was found to lag well behind that of other professions. As well as professionalethics,animalethicsistaughtinmostveterinaryschools,oftenalignedwiththeteachingofanimalwelfare. (HazelandCollins2011) Specialinterestgroup: In Australia the Australian Veterinary Association has had a special interest group, AVAWE (Australian Veterinarians for AnimalWelfareandEthics)forsomeyears.Itsmembershipwasoriginallydrawnfromtheranksofveterinariansinvolved in research and animal ethics committees but now consists of veterinarians with a wide range of interests. The group provides a forum for the discussion and dissemination of information on the ethical use of animals through its newsletter.Since2008AVAWEhasorganizedlecturesonprofessionalethicsatAVAconferencesaswellaspresentations toveterinarystudents. CONCLUSION The need for veterinarians to act in an ethical manner is just as important today as it was when the profession was founded 250 years ago. This need exists, perhaps even expanded, as the complexity of the ethical environment in which veterinariansnowworkisconsiderablygreater. Despite the known stresses associated with the practise of veterinary science on a day to day basis, daily engagement withethical"dilemmasalso makestherolemoreinterestingandchallengingthanperhapsotherprofessions.Infactit's arewardingaspectofthejobtobeconfrontedwithanddealwiththeseeverydayethicalissues.

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