Über verschiedene Arten von tierlichen Patientinnen und Patienten – Reflexionen über tierärztliche Verantwortung
Berliner und Münchener Tierärztliche Wochenschrift 133
© Schlütersche Verlagsgesellschaft mbH & Co. KG. 2020
Veterinarians are confronted with very different expectations regarding the treatment of animals which might cause moral distress since veterinarians could experience such differences as moral inconsistencies. The discourse of animal and veterinary ethics runs the risk of even exacerbating this problem, because the perspective is often mainly animal-centred tending to neglect the social embedding of veterinary practice. Bernard Rollin, a pioneer of veterinary ethics, contends that veterinarians should take on leadership in effecting ethical change. However, though veterinarians can certainly contribute to improving conditions for animals, their moral distress could be increased if they are not mindful of the social conditionality of their responsibility.
An awareness of the scope of responsibility can contribute to mitigating moral distress. (1) Being a patient presupposes that an animal is recognisable as a patient at all. This “recognisability” is not only dependent on the animal itself, wild animals or vermin usually do not become patients. (2) Animals recognised as patients are framed differently as patients. Relationalism as an ethical theory can explain that different relations to animals form different kinds of patients and determine the scope of veterinary responsibilities. While in companion animals the emphasis predominantly lies on welfare, in livestock animals productivity is crucial, too. (3) Veterinary practice is certainly not fully determined, there is always a certain range of possible and sometimes antagonistic treatments within a particular field of human-animal relations. (4) These differences are a crucial resource for possible ethical change as they can serve as clues for clients to rethink the necessities and the rightfulness of their treatment of animals. Thus, veterinarians should be aware of their socially conditioned, yet important responsibility for ethical change.
Tierärztinnen und Tierärzte sind mit sehr unterschiedlichen Erwartungen hinsichtlich der Behandlung von Tieren konfrontiert. Dies kann zu moral distress führen, weil sie diese Unterschiede als moralische Inkonsistenzen erleben können. Der gegenwärtige Diskurs der Tier- bzw. veterinärmedizinischen Ethik könnte dieses Problem sogar noch verschärfen, weil die Perspektive oftmals eine vorwiegend tierzentrierte ist, die dazu tendiert, die soziale Einbettung der tierärztlichen Praxis außer Acht zu lassen. Der Pionier der veterinärmedizinischen Ethik Bernard Rollin behauptet, dass Tierärztinnen und Tierärzte eine führende Rolle im Hinblick auf ethische Veränderungen übernehmen sollten. Doch obwohl sie selbstverständlich zu einer Verbesserung der Bedingungen für Tiere beitragen, könnte sich ihr moral distress noch erhöhen, wenn sie sich der sozialen Bedingtheit ihrer Verantwortung nicht bewusst sind.
Ein Bewusstsein des Rahmens der Verantwortung kann zur Reduktion von moral distress beitragen. (1) Patient oder Patientin zu sein, setzt voraus, als solche überhaupt anerkennbar zu sein. Diese ‚Anerkennbarkeit‘ hängt nicht nur am Tier ‚an sich‘, Wildtiere oder Schädlinge werden normalerweise nicht zu Patient oder Patientin. (2) Als Patient oder Patientin anerkannte Tiere werden unterschiedlich als solche gerahmt. Relationalismus als ethische Theorie kann erklären, dass unterschiedliche Beziehungen zu Tieren unterschiedliche Arten von Patientinnen bzw. Patienten bilden und den Rahmen für tierärztliche Verantwortung bestimmen. Während bei Haustieren zumeist das Wohlergehen im Mittelpunkt steht, ist bei Nutztieren Produktivität auch wesentlich. (3) Tierärztliche Praxis ist selbstverständlich nicht völlig determiniert, es gibt immer eine gewisse Bandbreite an möglichen, einander manchmal widerstreitender Behandlung von Tieren innerhalb eines bestimmten Feldes von Mensch-Tier-Beziehungen. (4) Diese Unterschiede bilden eine wesentlich Ressource für etwaigen ethischen Wandel, zumal sie als Anhaltspunkte für Klienten und Klientinnen dienen können, die Notwendigkeit und Rechtmäßigkeit ihres Umgangs mit Tieren zu überdenken. Tierärztinnen und Tierärzte sollten sich also der sozial bedingten, aber wichtigen Verantwortung für ethischen Wandel bewusst werden.
The general aim of this paper is to put veterinary responsibility into perspective. The point of departure is the following experience: After a talk on the question of recognising animals as patients held at a conference on veterinary ethics, a veterinarian in the audience asked me straightforwardly why this question could be significant for ethical considerations of veterinary practice. For her, all animals she encounters in her small animal practice would be patients and treated equally. This would even apply to feral animals if they were brought to her, provided that there is decent knowledge with regards to the treatment.
Yet, this begs the questions which animals are brought to veterinarians at all and what the horizon of expectations regarding the treatment is like, since not all diseased or injured and, thus, suffering animals become patients, and not all patients are treated in the same way. The question emerges whether an exclusively animal-centred perspective is adequate for veterinary ethics without denying that the animal as a patient is at the centre of veterinary interventions. At first glance, whenever a veterinarian is confronted with a diseased animal, she is obliged to take care of this individual to the extent possible. However, veterinarians are confronted with different animals and with significantly different expectations when they encounter animal lovers and their companion animals, farmers and their animals as economic resources, lab scientists and their data providers etc. These expectations (and needs) have an impact on the way and extent a veterinarian can care for an
Exactly this diversity of expectations and the different scopes of treatment are one main source of moral distress within this profession. The emergence of moral distress in veterinary medicine is predominantly understood as an outcome of experienced contradictions between the individual conscience and requirements or expectations that do not conform to personal convictions (Rollin 2006, Fawcett et al. 2018). Yet, Kälvemark et al. define moral distress (in the context of ethics in nursing) as follows: “Traditional negative stress symptoms that occur due to situations that involve ethical dimensions and where the health care provider feels she/he is not able to preserve all interests and values at stake” (Kälvemark et al. 2004, 1082). So, these authors do not trace moral distress back to blatant contradictions between morally right decision and institutional and economic constraints but to various (maybe antagonistic) ethical demands and vexed ethical problems that do not necessarily imply one clear solution (ibid., see also Morley et al. 2019). I want to argue that a major source of moral distress in veterinarians is the expectation that we can gain consistency in veterinary practice – albeit I do not deny that these inconsistencies are a significant moral and psychological problem.
Many scholars in the fields of animal ethics and veterinary ethics adhere to the paradigm of moral individualism, which insinuates that our obligations to animals are solely rooted in their individual characteristics and needs. Yet, this paper methodologically proceeds from relationalism in animal ethics (which emphasises the moral significance of social relations to animals) rather than from moral individualism. As I will point out, the scope of ethically justifiable veterinary treatments is predetermined by the differential social recognition of animals as patients and not only by individual needs. Awareness of variegated fields of practice in various fields of human-animal relations on the part of veterinarians, but also on the part of ethicists involved in the relevant debates, is a valuable resource for a decrease of moral distress. Such distress often results from an exclusively animal-centred perspective and ethical demands for equal treatments of animals, which is not mindful of these differences. In a relationalist perspective on veterinary practice, differential treatments become understandable as reliant on different social framings of animals and their health-related problems instead of being discarded as unjustifiable inconsistencies. Such awareness can contribute to the veterinarians’ better understanding of the scope, possibilities and limits of responsibility of treating animals and of effecting ethical change within these different fields of veterinary practice.
First, it is crucial whether an animal is recognisable as a patient at all, and is, thus, presented to a clinician, diagnosed and treated. This is a first step to show that veterinary treatment cannot exclusively be determined by an alleged animal per se. The vast majority of wild animals as well as synanthropic animals (animals living – albeit not domesticated – in the vicinity of humans such as rats, pigeons or sparrows) eventually regarded as vermin will most likely never be presented to a clinician. Preventive interventions for unidentified and unowned animals, like neutering feral cats in urban areas, might be regarded as an – though important and not extremely rare – exception within veterinary practice. Therefore, I consider such practice as going beyond the scope of this paper.
Second, if an animal is recognisable as a patient, there is a variety of social roles or framings of animals. Linked to these roles, differential pragmatic and moral expectations towards veterinarians emerge, although there is the allegation that veterinarians should care first and foremost for animal health and welfare. But some animals are, for example, regarded as family members whose well-being matters to us, others are data providers and the validity of data has to be guaranteed, and others are regarded as milk, egg or meat providers so that productivity, food security and public health are at stake (Huth et al. 2019). Thus, balancing different vulnerabilities, expectations, values and principles is a vexed practical and ethical issue within veterinary practice. Such balancing takes place against the backdrop of socio-economic structures that implicitly or explicitly predefine the options for veterinary interventions.
This can be illustrated by the examples of farmed animals in contrast to companion animals. To begin with the former, both humans and livestock animals are embedded in broader horizons of food chains and commerce, regimes of biosecurity and productivity (ibid.). Similarly, both humans and companion animals are embedded in broader practices and norms of breeding, training, diet etc. (Sandøe et al. 2016, 22). To illustrate this point, we can refer to the emergence of “One Health” in the last decade. As a “new professional imperative” (AVMA 2008, 3), One Health is intended to raise the awareness for the mutual dependency of animal and human health and their shared dependency on the environment. This is not only the case in zoonotic diseases (which are primarily the starting point of the emergence of One Health as a concept) but also in health problems that relate to a shared, detrimental lifestyle as has recently been pointed out by Sandøe et al. (2014). However, this concept runs the risk of concealing (a) tensions between different health-related interests and vulnerabilities that become visible, for instance, in the practices of combatting infectious diseases through (prophylactic) culling and (b) different notions of diseases in different contexts; fertility disorders, for example, play significantly different roles in cats and in dairy cows (Huth et al. 2019). So, veterinarians (like animals and owners) are embedded in broader socio-economic fields that determine how “one” treats animals. The possibilities of treatment as well as of critique of current practices are conditioned by broader structures. However, animal ethicist and pioneer of veterinary ethics Bernard Rollin is but one scholar who identifies ethical change as a major responsibility of veterinarians (Rollin 2006, 45). The suspicion emerges that such a “responsibilization” (Butler 2009, 35) of individual veterinarians runs the risk of exacerbating moral distress in the face of differential needs and expectations as it insinuates that veterinarians can change conditions unconditionally.
Third, both, the owner and the veterinarian, are predetermined in their decisions and actions by a particular social framing of animals (as companion animals, livestock animals, etc.), but within this framing there are again different perspectives and treatment options. The companion animal might be dominantly conceived of as a family member and people might put in quite an effort and bear high costs for cure. But while some pet owners are willing to pay for high-tech medicine for severely ill dogs or cats (Springer et al. 2017), others ask for euthanasia if the animal shows mild health problems (Rollin 2006). While some livestock farmers who face tight margins nevertheless consent to costly treatments of their animals, others feel compelled to decide according to economic calculations only (Hinchliffe et al. 2017). This shows that the borders of a particular frame leave room for deliberation and individual decisions. Within a particular frame, veterinarians indeed have options and, thus, as experts, a particular responsibility for animal health and welfare and to counsel and support owners in their ethical decision-making.
Fourth, to put responsibility into picture is a contribution to reducing moral distress, which often arises from neglecting the conditionality of veterinary responsibility. By the same token, it becomes visible that a critique of treatments of animals should be sensitive and responsive to already existing moral intuitions and particular contexts, which involve economic constraints, traditional opinions, but also a common awareness of animal vulnerability and sentience.
Becoming a patient
In what follows, I want to point out that it is not only the individual animal and its capacities that determine whether an animal can be a patient in veterinary medicine at all (and, furthermore, how it is to be treated). Canonical animal ethics is often regarded as the crucial starting point of the current establishment of veterinary ethics (Rollin 2006, Fawcett et al. 2018). Veterinary ethics is not an entirely newly emerged (e.g. Tannenbaum 1993), yet still a nascent field while animal ethics has now been recognised as an independent field of research (with strong impacts on popular debates) for almost five decades. Even though there is no doubt that veterinary ethics can and should benefit from animal ethics, I want to argue that there is a mainstream within the debates that might be misleading for veterinarians and could even exacerbate their moral distress, which often arises from the fact that they are confronted with differential and controversial expectations. This (not entirely uncontested) mainstream is frequently called moral individualism (Crary 2010, May 2014, McMahan 2005) and follows a particular logic: There are specific capacities that are considered as morally relevant in humans. This could be the ability to suffer, but also self-awareness (Singer 2011) or the capacity to have sufficiently complex experiences and to consider oneself as an “experiencing subject of a life” (Regan 2004). Research in, for example, ethology or cognitive biology has shown that many animals share capacities with humans which are conceived as morally significant. Clearly, livestock animals and companion animals frequently do not differ in regard to these capacities. Consequently, animal ethicists often argue that we are morally obliged to treat equals (in terms of their capacities) equally as this is a basic ethical principle (Singer 2011).
However, following exclusively this line of argumentation and adopting an exclusively animal-centred perspective in veterinary ethics runs the risk of neglecting crucial social and moral structures that determine veterinary practice (Huth 2020). Making individual capacities into an absolute, we lose important prerequisites to ethically evaluate the differential veterinary treatment of animals used for food, as research objects etc. other than in terms of illegitimate discrimination. Some theorists simply discard our multi-layered practices in relation to and notions of animals as logically and morally inconsistent (Joy 2011, McMahan 2005, Singer 2011). Consequently, this account must actually insist that veterinary medicine should become preferably all-inclusive, that means that all animals – livestock animals, companion animals, but also feral animals etc. – should be treated equally because of their shared ability to have negative experiences due to disease. Such an account of animal and veterinary ethics, which emphasises equal treatment in a complex world of different social fields in which animals play different social roles, can even exacerbate moral distress. Moral individualism suggests that veterinarians are obliged to treat animals consistently according to their characteristics or capacities and are responsible for effecting change and defying overarching socio-economic structures that predetermine the scope of possible veterinary interventions. This seems to be an ethical burden, which might appear unbearable for many veterinarians – with significant psychological implications (Montoya et al. 2019). Therefore, an analysis of differential “disease situations” (Hinchliffe et al. 2017, 14) that involve different needs, vulnerabilities, economic constraints, public health concerns and regimes of biosecurity could lead to a more open, multi-faceted ethical deliberation, drawing upon a variety of co-existing and sometimes antagonistic norms and values. Thereby, the ethicist can contribute to understanding the scope and limits of the responsibility of the individual veterinarian.
The philosopher Judith Butler has coined the concept of “recognizability” (2009, 4) to point out that the recognition of vulnerability is sustained and preceded by social structures that saturate our perceptions, affective responses and dispositions for actions (ibid., 5). Let us take the example of rats. Some are kept as pets, some are lab animals, and some are conceived of as vermin though all share the same capacities, needs and aetiologies. Within the framework of moral individualism, there would be the moral obligation to treat them equally according to their equal biological equipment. However, such an account of veterinary ethics neglects that veterinary treatments are reliant on specific situations and contexts that precede moral decision-making and justifiable responses to animals. It is crucial to be aware of the fact that animals are differentially recognisable as patients. Correspondingly, there is a social pre-determination of the scope and limits of veterinary interventions and responsibilities. I want to contend that it is precisely not the animal per se which turns an individual into a patient; an exclusively animal-centred perspective neglects the complex topography of social fields in which we relate to animals.
Focusing in the first instance on the question of becoming a patient at all, Clare Palmer’s (2010) version of ethical relationalism can serve as a valuable starting point. Palmer introduces an account of animal ethics that acknowledges different moral obligations in the face of different human-animal relations and contexts. While actually mindful of the fact that we cannot easily divide animals in domestic and wild animals (e.g. because some non-domesticated, synanthropic animals live in vicinity to humans and are therefore affected by our behaviours), she nevertheless argues that there are different kinds of obligations towards different, easily distinguishable kinds of animals. To illustrate this, she starts her book with the comparison of wildebeests that drown when crossing waters and domesticated horses that are undernourished and lack sufficient veterinary care (ibid., 1–2). Palmer argues that we would adopt a “laissez-faire stance” in the face of the wildebeests, thus, we would not consider ourselves as obliged to assist and save them even if they drown in large numbers. However, there is certainly an obligation of “non-maleficence”, that is not to inflict unnecessary harm on these animals (ibid., 74). Yet, provision of health care for wildebeests and other feral animals is beyond commonly recognised human duties. But in the case of domestic horses, moral obligations clearly exceed non-maleficence and embrace assistance or beneficence, too. Drawing on Robert Goodin’s account of vulnerability, Palmer argues that the close relation to and dependency on humans constitute the duty to care and guarantee health care (ibid., 91–95). This reveals that moral obligations towards animals are not necessarily determined by the animals’ characteristics and capacities only.
However, Palmer more or less restricts her considerations to the plain contrast between wild animals and domestic animals. This seems, though convincing in the example she gives, quite simplistic. First, there are more possible differentiations between various kinds of animals. We encounter companion animals, livestock animals, liminal animals, lab animals etc.; all of them are highly dependent on humans due to breeding lines, captivity, etc. But the recognisability of animals as patients is much more complex and shows a finely detailed differentiation between various kinds of animals. Second, as will be analysed in the upcoming section, the differential nature of our moral responsibilities is not solely rooted in dependency, albeit dependency is usually morally significant.
Let us take again the example of rats. We can indicate that the different framings and social relations to different kinds of rats determine the scope of responsibilities in general and of veterinary responsibilities in particular. It is even not the recognition of a moral status that turns an individual into a patient (Thurner et al. 2018). We could easily acknowledge that rats, like wildebeests, are sentient beings that have moral status and share and acknowledge the laissez-faire intuition in the face of drowning animals. There is a broad common sense that we do not or only occasionally have positive obligations of beneficence – including health care – towards feral animals. Sewer rats do usually not turn into patients (exceptions would prove the rule). Not even their killing is the task of a veterinarian (like in cases of culling or euthanasia) but up to a vermin exterminator. At the same time, the killing of rats as vermin is sometimes even regarded as a welfare strategy to avoid fear and suffering in the animals (Gremmen 2017, 260). Thus, people recognise the sentience of sewer rats, but they are virtually not recognisable as patients in veterinary medicine. Therefore, it is social frames that lead us to regarding an individual as a patient or not, and if so, in different ways (see the upcoming section). Such a frame is not a specific kind of representation that manages or fails to understand a vulnerable animal as a patient, either doing justice to the individual or not. A frame is a specific sort of bringing a particular kind into being (Hinchliffe et al. 2017), in our case of “producing” a patient. Veterinary responsibility presupposes and is embedded in social structures that determine if and how and animal is recognisable as a patient; therefore, veterinary responsibility is not exclusively animal-centred but also socially conditioned.
What kind of patient?
Both being a patient at all and the form of being a patient hinge on “disease situations” (ibid., 14), which can be understood as the manifestation of multiple processes that exceed individual sites (ibid., 54). Food chains, the circulation of food in commerce, public health issues of transmission or the practice of regarding companion animals as family members – all these factors constitute a structure of habitual practices of perceiving and treating animals, which is constitutive for multiple forms of responsibility. Paraphrasing Charles Rosenberg’s analysis of framing disease (Rosenberg 1997, xiii), we can assert: An animal is at once a biological entity, a generation-specific repertoire of verbal constructs reflecting our relations to the animal, an occasion of and potential legitimation for public policy, an aspect of the social role and individual identity, a sanction for cultural values, and, crucially, a structuring element in veterinarian-patient interaction (cf. Huth 2020). It is beyond the scope of individual veterinary responsibility to simply determine if an animal is a patient and in what respect this patient is to be treated.
It is well known that there are significant divergences in the treatment of patients in veterinary medicine. The provision of high-tech medicine like fMRI (functional magnetic resonance imaging) pictures for diagnosis, the use of prostheses, blood donations (in dogs) and even renal transplantations (in cats) have become more or less frequent in small animal practice (Ashall et al. 2017, Schmiedt et al. 2008, Springer et al. 2017). In contrast, a dairy cow with a diagnosed renal failure will most probably be euthanized. Nevertheless, it would appear strange to contend that a diseased cow is not, or to a less extent, a patient for the veterinarian. So, being a patient in veterinary medicine – in contrast to human medicine – can have different meanings with different ethical implications (Huth 2018). This reveals that animals and their health-related needs are framed and targeted in different ways in veterinary practice. While companion animals are often treated with high effort and costs to regain or sustain their well-being, livestock animals are not exclusively treated with regards to their well-being but also to sustain productivity (see below). The expectations on the part of the owner, but also social expectations differ significantly.
Rollin distinguishes between two models of veterinarians: the paediatrician model and the model of the mechanic, asserting that 90 per cent would opt for – or consider themselves as adhering to – the first one (Rollin 2006, 27). This mirrors a more or less exclusively animal-centred perspective in Rollin. The animal’s well-being and health (including its survival even if the animal is suffering) would be – if the paediatrician is the role model for the veterinarian – the only or at least the highest target and the limit of shared decision-making of owners and veterinarians. However, there is a significant difference between human medicine and veterinary medicine regarding the consideration of the animals’ needs and interests. Without fully dismissing Rollin’s argument, it is crucial to point out that veterinary practices are multi-faceted and, compared to human medicine, differentially framed. There is a basic common sense to recognise and be responsive to the animals’ vulnerability; our moral intuitions are at odds with radical forms of reification of animals. But even though we generally tend to recognise sentience in all animals, we face the fact that there are different kinds of patients in veterinary medicine – in contrast to human medicine.
In what follows, I will discern two exemplary forms of being a patient to illustrate different scopes and limits of veterinary practice; as noted, there are also other kinds (such as laboratory animals, zoo animals, backyard animals etc.). Awareness of these particular scopes and limits of responsibility can contribute to a decrease of moral distress. As noted, Rollin argues that veterinarians are in charge of effecting ethical change, but lacking awareness of the limits of effecting such change, they could easily find themselves tilting at windmills – with detrimental implications for their mental health.
Beneficence for companion animals
Beauchamp and Childress (2009), the founders of so-called principlism in biomedical ethics, consider beneficence and non-maleficence as basic principles (together with justice and the respect for autonomy). Beneficence is the obligation to assist and take care for health; thus, it embraces and exceeds the obligation not to inflict unnecessary harm, which is mirrored in the principle of non-maleficence. Therapy decisions for companion animals are considered advocatory decisions (with respect to this, Rollin makes an important point when introducing the paediatrician model) that correspond to the supposed well-being of the patient (Huth et al. 2019). Accordingly, veterinary interventions are guided by the experienced illness. Biomedical ethics distinguish between illness, disease, and sickness. Illness is the subjective lived experience of suffering, disease is the objective deviance from a physiological normality, and sickness is the socially recognised state of being sick implying the right not to work, to the provision of health care etc. (Hofmann 2002).
Therapies often include the provision of sophisticated and expensive high-tech medicine such as MRI or complex surgeries. But also the decision to perform euthanasia is supposed to be guided by welfare (in contrast to convenience euthanasia); here, the paediatrician model is stretched to its limits (Huth et al. 2019).
Non-maleficence or beneficence for livestock animals?
In this frame, individuals are to some extent conceived of as production units, yet, crucially, not on the basis of malicious reification performed by irresponsible individuals but due to a particular socio-economic framing of livestock animals with implications to their being a particular kind of patients. Consequently, there are veterinary interventions that are only or mainly performed to eliminate physiological obstacles for productivity and do not or less focus on illness and wellbeing (ibid.). This cannot be identified with an exclusive emphasis on beneficence.
Let us take the example of the bovine ovarian cyst. It is often diagnosed in the absence of clear clinical signs (cf. Jeengar 2014, 64), it causes neither pain nor does it pose a threat to the cow’s life. Although it is not an illness in the aforementioned sense, it is regarded as pathological and treated because it poses a threat to the lactation performance as it impairs fertility. Relevant recommendations for treatment, thus, frequently focus on the quickest way to regain fertility (ibid.). However, this does not mean that veterinarians and owners are morally permitted to entirely ignore the cow’s vulnerability beyond productivity. Although this intervention prima facie might not be in the cow’s alleged health-related interests (as it does not suffer from the cyst and as she will not have a long-lasting impairment of fertility), it is clear that there is an obligation to minimise suffering, perform careful surgery and provide responsible postoperative care. Thus, it becomes clear that these animals are patients and not mere production units a mechanic has to fix.
Another example is mastitis, a painful inflammation of the mammary gland in dairy cows, which leads to diminished productivity and experienced illness at the same time. However, even a paper on the veterinary treatment of mastitis entitled “Assessment and management of pain in dairy cows with clinical mastitis” (Leslie and Petersson-Wolfe 2012) starts with the statement that mastitis presents a major economic problem – and does not put emphasis on the cow’s suffering. A fortiori, the cow’s experience is left aside in papers that primarily focus on strategies to regain productivity: “Mastitis, an inflammatory reaction of the mammary gland that is usually caused by a microbial infection, is recognized as the most costly disease in dairy cattle. Decreased milk production accounts for approximately 70% of the total cost of mastitis. Mammary tissue damage reduces the number and activity of epithelial cells and consequently contributes to decreased milk production” (Zhao and Lacasse 2008, 57).
Generally, the treatment of livestock animals is oftentimes a compensation for suboptimal keeping conditions or the breeding for increased productivity. The breeding of the past decades has significantly increased the susceptibility to bovine ovarian cysts or mastitis. At worst, animals that develop these diseases are regarded as collateral damage: “The productivity of those who cope outweighs the loss associated with those who cannot” (Rollin 2006, 42). But this does not go uncontested; it is neither socially approved nor legal to treat animals without any consideration of their assumed experiences, as mere production units without recognising them as patients. Livestock animals are not radically reducible to mere objects. This is visible in the widespread criticism of industrial farming in general, but also of practices like tail docking, debeaking or dehorning, which frequently occur in livestock farming. Any infliction of suffering or the termination of life is to be justified, hence, we distinguish between “necessary” and “unnecessary” infliction of pain and other kinds of suffering. But the distinction between necessary and unnecessary obeys different criteria than for companion animals due to different sorts of economic constraints.
Clearly, we can see a tendency to reduce the treatment of livestock animals ultimately to the avoidance of supposedly “unnecessary” harm. Even though this does not display a full-blown care attitude in the sense of beneficence, it is also not a radical reification because it embraces the weighing up of the invasiveness of interventions against economic needs. Moreover, there are obligations to care (beneficence), as one would consider the farmer liable for consulting a veterinarian when a cow shows signs of a disease that has no impact on productivity. The livestock animal frame does not represent a mere laissez-faire attitude. But we can see that the care attitude shows an internal differentiation, which is socially determined and not solely dependent on individual decisions. Thus, I consider it too simplistic and an overemphasis on individual responsibility to contend, as Rollin does, that veterinarians have to decide whether they give their primary allegiance to animals or clients (Rollin 2006, 27).
Addendum: Kinds of patients and kinds of diseases
Obviously, there is a connection between the different kinds (or frames) of patients and the framing of veterinary interventions as necessary, adequate or overblown (e.g. renal transplantations in cats in contrast to cows). So far, we have seen that the different kinds of patients manifest themselves in different treatments. In addition, the question emerges whether the definitions of diseases are also reliant on the socio-economic structures, which frame animals as (particular kinds of) patients. To illustrate this point: Jeengar (2014) points out that “the term ‘Cystic Ovarian Disease’ no longer seems appropriate and should be replaced by the term ‘Cystic Ovarian Follicle (COF)’ which does not necessarily implicate a state of disease” (Jeengar 2014, 64). Nevertheless, he reflects on different kinds of treatment to regain fertility. It is likely that, in companion animals, temporary deviations from a statistical physiological normality without suffering would not be regarded as diseases with an implied need for treatment. In turn, to give an example, diabetes mellitus is an increasing health problem in cats and dogs that has become an issue in scientific research (Greco 2018). In contrast, there is no literature on fattening pigs or dairy cows with diabetes mellitus as they usually do not get old enough to develop this disease and as this is not recognised (or recognisable) as a health issue in these animals. This reveals the interplay between diagnosis and treatment in veterinary medicine and particular fields of animal keeping with their socio-economic implications.
One kind of patients – different perspectives and practices
In what follows, I want to point out that there is usually an internal differentiation of viewpoints and practices within a particular framing of a kind of patient. Therefore, labels such as “companion animal”, “livestock animal” and the connected “disease situations” do not fully determine the expectations towards veterinarians and the legitimacy of veterinary interventions. Thus, my analysis of the social framing of veterinary practice should not be misunderstood as a full determination of animal keeping and veterinary practice. The following considerations will focus on companion animals to illustrate this variety of perspective and also how this wiggle room can have significant detrimental ethical and psychological implications for veterinarians. Actually, one could assume that moral distress emerges first and foremost in the fields of laboratory and livestock animals as the infliction of pain and the use of animals for particular purposes are, at first glance, not at stake in pet keeping. But clearly, there are health- and welfare-related issues also for companion animals that are not easy to cope with for veterinarians. I use three examples to exemplify pertinent difficulties. In the next section, I will focus on the positive side of this internal differentiation and argue that precisely this variety of perspectives is also a crucial starting point for veterinarians’ attempts for effecting ethical change.
(1) Companion animals are considered as beings whose vulnerability is actually particularly recognisable, as family members and/or as private property (Rollin 2006). Shared lifestyles of humans and animals can have pernicious consequences for animal health. Sandøe et al. (2014) report that obesity in cats and dogs is increasing as a result of shared problematic nutrition habits. Rollin reflects on a case of significant weight loss in a dog that belongs to an anorectic person (2006, 247–248). Though also laypeople usually know about the correlation between nutrition and health, attempts to effect change can be experienced as an invasion of privacy and as questioning personal lifestyles. A fortiori, negotiating with people who are not able or not willing to recognise their obesity or people with severe psychiatric disorders (the anorectic person) requires psychological skills (which are usually not part of the veterinary training) and can cause considerable moral distress, at least, if the veterinarian’s perspective is the one of advocating for the animal “against” the owner. The owners might block out or deny the fact that their animals have health-related problems that are rooted in their own behaviour. In turn, it is well known that companion animals can significantly contribute to human health (Wells 2009), as they can be an incentive for being more active or as the human-animal bond is a psychological resource for the owner; thus, a conflict of values, vulnerabilities and needs emerges.
Generally, not only in these examples, interfering in human-pet relations can easily be understood as an interference with the private sphere and strong emotional bonds and might go against well-intentioned practices and habits. Moreover, some owners explicitly consider their pets as property and stress their property rights. The animals’ legal status as property can be a difficulty experienced by veterinarians. Convenience euthanasia of animals because of mild behavioural problems is but one very telling example of this difficulty (Fawcett et al. 2018, Mullan et al. 2017, Rollin 2006). At the same time, there are cases in which an owner is not
willing to consent to euthanasia although the veterinarian is convinced that this would be the only humane option.
(2) Cruel breeding practices are a crucial source for moral distress in small animal practice (Mullan et al. 2018, Sandøe et al. 2016). Generally, aesthetical preferences on the part of the owner can overrule animal well-being and a veterinarian’s conscientious decisions because, as noted, animals are often regarded as properties. Legal regulations do not ban breeding lines that lead, for example, to the brachycephalic syndrome. We lack unanimous consensus about the exact limits of ethical breeding, although there are attempts to gain more clarity about these limits (Mullan and Fawcett 2018, 496). Treating pugs that show symptoms of the brachycephalic syndrome is beneficial for these animals as they suffer from respiratory problems. However, it can also be conceived of as benefiting from and support for these breeding practices. Ultimately, refusing to treat brachycephalic dogs, for example, can lead to loss of compliance of owners or even of clients. This kind of powerlessness (in the case that there are no legal prohibitions) or uncertainty can cause profound moral distress for the veterinarian.
(3) There is the problem of well-intentioned, yet problematic treatments of animals. Folk misinformation – for example “rub his nose in it if he makes a mess in the house” (Rollin 2006, 51) – or anthropomorphising animals (i.e. confusing animal needs and preferences with human needs and preferences) are but two examples of maltreatment, which is actually well-intentioned. Owners sometimes treat animals in all conscience yet eventually use blatantly wrong strategies (ibid.). Arguing against these opinions and actions can be regarded as questioning deep convictions and entail backlashes. In these cases, the role of the veterinarian as an expert is thwarted by alleged traditional knowledge that might be conceived of as more reliable than a supposed “fashion” in veterinary medicine. Awareness of this difficulty and responsiveness to the owner’s perspective can be useful for communication and, thus, for the further treatment of the animal.
Effecting change within particular frames
As I have already noted, Rollin contends that veterinarians should take on “leadership in effecting change” (Rollin 2006, 45) in the overall treatment of animals.
In his view, a prerequisite to fulfil this task is to be aware that veterinarians should not see themselves according to the model of the mechanic but rather to the one of the paediatrician. Yet, at the same time, one could even claim that veterinarians are hench (wo)men of the hegemonic social conditions. This applies to all frames of veterinary medicine. To put it pointedly: The professional in small animal practice indirectly supports the breeding of brachycephalic pugs when offering a costly surgery that mitigates the clinical signs of the brachycephalic syndrome. Veterinarians in the field of livestock take their “‘rightful place’ on the farm” if they are “to embrace and assist intensification” (Woods 2013, 9).
In this last section, I want to point out the implications of a conditioned responsibility on the part of veterinarians. The conditionality of veterinary responsibility does not eliminate possibilities (and thus responsibilities) of effecting ethical change in particular situations within broader socio-economic contexts. As noted, it would be too simplistic to regard the different kinds of patients as stable, homogeneous and consistent categories. It would be naïve to assume that in the frame of companion animals, it is always the shared intention to do everything to sustain the animals’ well-being in any case. In turn, animal experiments instrumentalise individuals for human purposes and often imply the infliction of pain or termination of lives; but the controlled conditions under which animal experiments are performed within legal regulations can result in intensive veterinary care for the animals with, in the long run, beneficial outcomes for their health. This is not meant to play down the harm done to animals in experiments but to indicate that it would be one-sided to assume a lack of care and blatant maltreatment of lab animals in sharp contrast to companion animals. Consequently, it becomes visible that there is not only an internal differentiation in the concept of the patient in veterinary medicine but also an internal differentiation in the various forms (frames) of being recognised as a patient.
The influence that veterinarians as experts for the health and well-being of animals could exert on individual and collective behaviours has to be rooted in awareness and responsiveness to particular frames and contexts. I want to argue that pertinent attempts can be best understood as what philosophers in the Critical Theory call “immanent critique” (Huth 2020, Stahl 2017). This concept is meant to describe a sort of critique – and, furthermore, positive advice – that makes use of the already existing ethical intuitions and practical implications of a broadly shared practice.
First, Rollin is right when he points out that there is a general opposition to cruelty to animals (Rollin 2006, 28), which can be regarded as a crucial source
of the veterinarians’ educational function (ibid., 52). Pet owners, farmers or researchers usually do not intend to be “cruel” to animals, that is inflicting
pain without considering it as “necessary” or treating the animals irresponsibly (exceptions prove the rule and betray psychological difficulties). Therefore, it is likely that people are basically willing to accept advice if they consider it comprehensible and within the scope of the possibilities they see for themselves. The veterinarian could be successful in effecting change if they are trying to make this “necessity” a subject of discussion, while being mindful that this necessity is a matter of particular perspectives and contexts.
To give an example, practices like dehorning or tail docking in livestock animals can be revealed as considerable interventions in the bodily integrity of the individual, and the question can be raised whether and to what extent this is a necessity in the proper sense. Similarly, individual practices in companion animal keeping might be revealed as contradicting animals’ needs or preferences despite of owners’ conscientious treatments, but this has to appeal directly to the owners’ conscience (without pointing the finger), being mindful of the particular perspective, perceived constraints and circumstances. It has a preventive effect against moral distress to be aware of the different obstacles
for animal welfare and practical constraints that we face in the different frames described above. This awareness is not an abdication of responsibility but a prerequisite to acknowledging the scopes and limits of veterinary responsibility – particularly for effecting ethical change.
Second, veterinarians would tilt at windmills if they tried to convince individuals to act in blatant opposition to established socio-economic structures and connected economic constraints, shared habits, alleged common sense knowledge and shared social ethics within a particular group (say farmers or dog breeders). Effecting change can thus be a matter of processes which aim at an empowerment of animal keepers to change their practices within the possibilities they can see for themselves (Huth 2019). This proceeding can make use of the mentioned internal differences within a particular frame. To show that there are always possibilities to treat animals in alternative ways than previously done might trigger rethinking on the part of the owner. This might not effect radical changes within a short period of time but may at least result in mitigating the negative impact in processes on the welfare of animals in all frames of animal keeping. Moreover, even if the immediate effect of such an empowerment might be dissatisfying, the initiated process could be prolonged and spread to other individuals in a community, be it a community of dog breeder, farmers or others. In such a best case scenario, the client might even serve as a multiplier of the veterinarian’s attempt to effecting ethical change.
The aim of this paper has been to analyse veterinary responsibility to effect ethical change in the treatment of animals. The starting point has been Bernard Rollin’s claim that this was a major task of veterinary practice. But if veterinarians are not aware of the scope and limits of this responsibility, they run the risk of exacerbating the moral distress they have to cope with in their professional life.
Many scholars in veterinary ethics draw from canonical animal ethics. The mainstream in this academic field is moral individualism. In this view, the source of moral obligations towards an animal is their individual characteristics, mostly cognitive capacities and sentience. However, if we adopt such an animal-centred perspective in veterinary ethics and veterinary practice, the socio-economic and socio-cultural contexts of human-animal relations are neglected. Therefore, I argued that relationalism is a more adequate starting point to reflect on veterinary responsibilities. First, particular social frames predetermine if an animal becomes a patient at all. While rats kept as pets or as lab animals are recognisable as patients, rats considered as vermin are not. Second, if an animal is recognisable as a patient, it can be a particular kind of patient. This has significant implications for the kind of diagnosis and the kind of treatment performed. While for livestock animals, diagnosis and veterinary interventions often target sustenance of productivity, the ultimate aim for companion animals seems to be individual well-being. However, in both cases the animal remains a patient and is not reduced to a mere production unit, but they are different kinds of patients. Third, there is open space for different perspectives and different treatments of animals within particular frames of patients, for the better or for the worse. Fourth, exactly these various possibilities form the basis of veterinary responsibility. On the one hand, the vast majority of animal owners regards animals as sentient beings and is thus inclined to treat these animals responsibly and in all conscience. Therefore, they might be open for advice, which are comprehensible and feasible within their perspective. On the other hand, different perspectives and possibilities within particular frames are the basis for questioning alleged practical constraints (“necessities” for the infliction of pain or suboptimal keeping conditions) and showing alternatives to different treatments of animals.
I owe gratitude to two anonymous reviewers who provided many really helpful comments to significantly improve the structure and argumentation of this paper.
Conflicts of Interest
The author declares no conflicts of interest.
The author declares that he has met common international ethical guidelines concerning good scientific practice in the course of writing the above work.
Address for correspondence
Messerli Research Institute
Unit of Ethics and Human-Animal Studies
University of Veterinary Medicine, Medical University of Vienna and University of Vienna
1210 Vienna, Austria
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