Welfare and ethics part one: quality of life and assessment

Transcription

1 Vet Times The website for the veterinary profession Welfare and ethics part one: quality of life and assessment Author : Jill Macdonald Categories : RVNs Date : July 1, 2013 Jill Macdonald DipAVN(Surg), RVN, FHEA, MBVNA, discusses welfare and ethical issues, through exploration of a fictional case scenario Summary ANIMAL welfare and ethics is a vast and complex topic that encompasses and underpins many aspects of veterinary care. Veterinary professionals deal with a multitude of welfare and ethical situations on a daily basis, and many considerations may need to be addressed to reach decisions and advise our clients. A variety of influential factors may be examined and can be of assistance when thinking through a problem or dilemma with a welfare and ethics aspect. This article will use a scenario as a basis to explore some areas for reasoning a difficult case, including how this exploration may assist in the decision-making process and in approaching difficult conversations with clients. The purpose is not to offer definitive solutions, but to suggest areas for deliberation when faced with complex ethical situations. In part one, considerations for the presented case are outlined, together with the assessment of welfare and quality of life. The next article will look at values and beliefs, human welfare factors and communication. Key words animal welfare, five freedoms, quality of life, ethics, FAWC DILEMMAS and situations incorporating welfare and ethics issues are regularly encountered by veterinary nurses who work both within and outside the practice 1 / 11

2 environment. It is likely these situations are often dealt with, and conclusions reached, without the opportunity for full consideration of the details. This can lead to stress for those staff involved, and the worry that a different approach could, or should, have been employed. Additionally, as professionals with responsibility for our actions, it is imperative we apply structure and thought to our decision-making processes, and ensure we offer ourselves, our colleagues and our clients the opportunity to make informed decisions. With respect to the scenario outlined in Figure 1, many factors and considerations may have an influence and should be addressed to achieve an appropriate outcome in terms of both patient care and approaching the difficult discussion with the client. This two-part article will expand on, and discuss, some of these considerations. Considerations Patient/clinical Animal welfare. Degree of injury/complications and prognosis for this patient. Likely long-term outcome for the patient. Opinion of the vet in charge of the case. Animal s temperament/demeanour/lifestyle. Client/owner/agent Client s wishes. Emotional attachment. Financial situation. Knowledge and experience. Practice Other staff members opinions of the case. 2 / 11

3 Practice policy/protocol on dealing with similar cases. Practice facilities/scope. Personal Personal beliefs and values. Experiences with similar cases. Emotional attachment. Undoubtedly, further points will spring to mind when deliberating this case, and this list is not exhaustive. Animal welfare While many factors may influence the approach taken to nursing care and the advice given to clients, welfare is the first step. Animal welfare and provision of care to promote the welfare of our patients will generally be the top priority for the veterinary nurse (Figure 2). The RCVS Code of Professional Conduct for Veterinary Nurses (RCVS, 2012) is clear on this, stating: Veterinary nurses must make animal health and welfare their first consideration when attending to animals. Attempting to objectively assess welfare in a patient such as our RTA cat, however, is not straightforward. If the five freedoms concept (Table 1) is used as a framework, most of these conditions would be difficult to meet and/or maintain by choosing to continue treatment, depending on patient response. It may be reasoned that it is often necessary to cause short-term distress or welfare compromise to improve long-term welfare whether through giving a booster vaccination or performing major surgery. However, how do we balance the suffering an animal endures now against the life it may gain as a result of the treatment? Certainly in a case such as that outlined in Figure 1, where the outcome is highly unpredictable, this is difficult to say the least. Use of the five freedoms (Table 1), both to assess welfare outcomes (that is, the result of the inputs) and to address welfare inputs (that is, what we can do to attempt to improve welfare), is certainly a positive step in systematically evaluating welfare and in the determination of actions we can take to improve it. Table 2 demonstrates a basic assessment conducted using the five freedoms, and serves to highlight how difficult it may be to achieve them during the application of medical care to an injured animal. As briefly covered, many nursing and medical interventions can be applied to this patient, such as 3 / 11

4 ensuring adequate nutrition and fluid status, use of an indwelling catheter, pain management and human contact if the animal s temperament desires this (Table 1). However, it cannot be disputed that a patient such as this will suffer discomfort and distress, and does not comprehend on any level why it is in this situation. As Rollin (2006) states in his commentary Euthanasia and quality of life, there is no evidence, either empirical or conceptual, that they [animals] have the capability to weigh future benefits or possibilities against current misery (Table 2). We could ask whether an animal has a life worth living, from its point of view? (FAWC, 2011), and while this seems a sensible question, it is, of course, fraught with potential complications, such as subjectivity and anthropomorphism and, again, unpredictability of outcome. A quality of life (QoL) assessment is a helpful tool when examining the QoL a patient has during treatment, and in the longer term. It also provides a logical approach to discussing the treatment options, including euthanasia, with the client. This approach could involve evaluating the QoL for the patient during the term of hospitalisation and treatment and in the longer term, for example the potential disabilities the patient may experience for the remainder of its life, such as permanently reduced hindlimb function. It would also be important to gain the context of the normal life the patient had before the trauma for example, was this a very active, outdoor cat, or an animal that had a more sedentary, indoor lifestyle? An animal s temperament is also a factor, since some animals appear to tolerate hospitalisation and suffer less stress in this environment than other patients. QoL assessment is also commonly used to assist with decision-making in terminally ill animals, such as oncology patients. Methods of systematically assessing QoL have been developed, such as the HHHHHMM (hurt, hunger, hydration, hygiene, happiness, mobility and more good days than bad days) scale (Villalobos, 2011; Figure 3). Communication and empathy with respect to the client is discussed in part two of this article, but an empathic approach to the animal is, of course, also a key aspect of welfare assessment. While it is rather difficult to appreciate the situation from a cat s (or any other animal s) perspective, we can use empathically driven thoughts to ask ourselves questions about an animal s well-being. The owner, who is more aware of how an animal responds to certain situations, may also be well equipped to apply this empathic approach to evaluating an animal s welfare, well-being and/ or suffering. Conclusions So, in this article, we have outlined some considerations for the example case, and have looked at the use of welfare assessment and quality of life to evaluate a patient. In part two we shall look at values and beliefs, human welfare factors and communication. The author invites comment and feedback on this article; jill@oncoreepd.co.uk 4 / 11

5 References and further reading Companion Animal Welfare Council website. Available at: [accessed 12/02/2013]. Farm Animal Welfare Committee (2011). Five Freedoms (online; updated March 31, 2011). Available at [accessed 12/02/2013]. Main D, WSPA (2003). Concepts in Animal Welfare: Welfare Assessment and the Five Freedoms [DVD resource] University of Bristol, World Society for the Protection of Animals. Updated by Hewson C (2007). Rollin B E (2005). Ethics of critical care, Journal of Veterinary Emergency and Critical Care 15(4): Rollin B E (2006). Euthanasia and quality of life, Journal of the American Veterinary Medical Association 228(7): 1,014-1,016. Royal College of Veterinary Surgeons (2012). Code of Professional Conduct for Veterinary Nurses (online document), available at: supporting-guidance/ [accessed 12/02/2013]. Various authors/contributors (ongoing). Everyday Ethics, In Practice [available at: Villalobos A (2011). Quality-of-life assessment techniques for veterinarians, Veterinary Clinics of North America: Small Animal Practice 41(3): Reviewed by James Yeates BSc, BVSc, DWEL, DipECVS (AWBM), PhD, MRCVS 5 / 11

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8 Figure 2. Animal welfare must always be the first consideration for veterinary nurses. Photo: CANSTOCK PHOTO INC. 8 / 11

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10 Figure 3. Consideration of quality of life is an essential factor when evaluating welfare. Photo: CANSTOCK PHOTO INC. TABLE 1. The five freedoms (FAWC, 2003) 10 / 11

11 TABLE 2. Basic welfare assessment of the hospitalised patient in Figure 1, including brief consideration of inputs for improving welfare // 11 / 11 Powered by TCPDF (