These interviewees wanted clearer guidance in decision-making, in particular concerning euthanasia. One factor in this was difficulty assessing animal welfare. I have no tools to assess how he is. Have we gone too far? Another factor was a feeling that the responsibility of the decision to euthanize was too big to bear alone, and thus the belief that the decision needed to be made together with the vet:.
This stronger kind of involvement by a veterinarian was sometimes seen in a positive light. Because I knew he had to be euthanized at some point. Thus, where interviewees felt uncomfortable about making the right clinical or ethical judgement, or unable to do so, the influence of the veterinarian could be significant — both in terms of what decision was made and when. Moreover, the veterinary influence sometimes provided emotional support to interviewees in handling the challenges they faced.
There are few actual studies on the veterinarian-client relationship, although much literature mentions the importance of this topic see [ 40 ] for a review.
This study reports the challenges as experienced from a client perspective, and more specifically, what clients encounter when they are faced with treatment choices and the possible euthanasia of their dog. This study shows that some situations left interviewees feeling hesitant in their decision-making. Veterinarians could facilitate and in some cases influence the decision-making in several ways. The interviewees expressed different perspectives on this—one being a wish for the veterinarian to be more involved in the decision-making.
These results are taken as a starting point for further discussion on the ethical implications for the role of veterinarians, when clients are faced with difficult decisions. The interviewees were selected for this qualitative study, and the results therefore allow conclusions only about clients with dogs and with profiles matching the criteria of selection.
Clearly, the general population of clients is much more diverse. Furthermore, not all findings apply to all interviewees. However, the results can be seen to demonstrate that decisions about treatment choices and euthanasia are more difficult in some situations than others, and then to provide an overview of the nature of such situations and the various ways in which interviewees experienced or wanted veterinary influence on their decision-making.
The interviews were conducted in Denmark, and it may be worth noting two points in relation to the legal framework in this country. Firstly, according to the Danish Animal Welfare Act veterinarians have a legal obligation to intervene if they are aware of an incurably ill animal that will experience unnecessary suffering if it is allowed to go on living, e.
Secondly, there is no legal structure to guide or secure how to get informed consent from clients. None of the interviewees reported any conflicts in relation to these legal issues, though. Cultural differences, if applying these results beyond Denmark, could be worth to consider as human-animal relations may be sensitive to cultural context [ 44 ].
Also, experiences may be different for clients with other companion animals than dogs. Additional interviews with the same individuals at different stages in the process would have provided a fuller picture. The results thus do not provide in-depth information on the decision-making process itself. The overall picture in this study of the difficulties and influences a client with a seriously ill or aged dog may experience is, however, still believed to be robust: that is, it sheds some light on this complex situation and can be used as a basis for further ethical deliberation.
One of the key factors in decision-making identified in this study is knowledge—about the disease, the treatment options, and animal welfare. The study showed that veterinarians play an important role as providers of such knowledge.
This raises questions about what knowledge is relevant if the client is to consent to a procedure on an informed basis, about who can provide what kind of knowledge, and about what level of detail is sufficient. The experience of veterinary influence described in this study, in turn, raises two points. The first is that veterinarians may influence decisions even when they make an effort not to do so. The second is that clients may want veterinary influence on decision-making. These points call for a closer examination of the notion of respect for autonomous decision-making and how decisions can be shared in practice.
No attention will be paid to situations in which client autonomy can be disregarded because animal welfare is at risk. The making of decisions by proxy may, of course, give rise to a special obligation to make decisions believed to be in the interests of the animal patient in question.
As no conflicts appeared, in this study, to jeopardize the interests of the animals in the decision-making, this issue will not be considered further.
Nor will legal aspects be addressed. The use of consent forms in veterinary practice has been encouraged [ 3 ], but it has been pointed out that ensuring that the client is properly informed is a vital part of informed consent [ 27 ], and that a signed consent form is not necessarily evidence of informed consent [ 49 ]. In this study, although the interviewees had made their decisions themselves and had agreed to procedures, it did not automatically follow that they truly understood all of the implications at stake.
The issue of informed consent is complex, but the objective of informed consent is that clients are provided with adequate information so they can make the right decision for their animal and for themselves [ 25 ] see [ 27 ] for a thorough discussion on informed consent. It has been argued that consent can never be fully informed, and that therefore what should be aimed for is relevantly informed consent [ 7 ]. But what is adequate informed consent [ 25 ] and what information is relevant?
Clearly, veterinarians need to keep up with medical knowledge to provide the necessary information to clients [ 50 ].
But in some cases there may be limited relevant information about the medical condition and treatment which can make the disclosure task difficult for the veterinarian and require that the veterinarian also informs the client of uncertainties regarding the treatment [ 28 ].
However, the veterinarian needs to address these issues too if the client is to be fully and relevantly informed about what a treatment option entails. This has been argued by others too [ 1 , 17 ], although it has also been pointed out that veterinarians may be better placed to assess animal welfare in other cases and are better informed about likely prognoses [ 17 ].
Perhaps a less ambitious level of information in informed choice and consent is more realistic in an everyday scenario. It may not be practically feasible to present all treatment options to clients [ 28 ], and it has been suggested that veterinarians should only offer reasonable options [ 33 ]. Furthermore, it may be argued that veterinarians should consider how much clients want to know [ 3 , 50 ], and that clients do not need to understand every nuance of a proposed treatment, but the information should be sufficient for the client to reasonably make informed decisions [ 27 ].
Thus, it may suffice that all available and reasonable options and known implications have been presented, and that the client feels sufficiently informed and agrees to the suggestions being made.
It still needs to be determined, however, what is considered reasonable. Full autonomy in decision-making may be challenged first by the limitations of knowledge just mentioned; and second, because of the worries, doubts and sadness clients may be facing at the time of decision-making, leaving them vulnerable to influence from an authority such as the veterinarian. In human medicine it has been argued that the right to choose does not mean a duty to choose [ 8 , 13 ], and in fact when they are ill it may be a relief to patients not to be making demanding autonomous decisions [ 7 ].
It appears that similar considerations, about the need to make decisions in a state of mental distress, may be relevant in veterinary medicine. In addition some interviewees had appreciated the way the veterinarian had helped them bring an end to a seemingly endless series of procedures that brought little if any improvement and ultimately only postponed the inevitable.
But to what extent is this compatible with the ideal of respect for client autonomy? It has been argued that human patients should be fully entitled, but not required, to take an active role in decision-making [ 60 ]. One could then argue, in the veterinary context, that client-autonomy is respected if and only if both levels are considered, i. This will allow the client to delegate some or all of the decision-making to the veterinarian, yet continues to give the client the option to veto a decision if he or she considers it unacceptable.
The findings in this study support the understanding that both clients and veterinarians are sources of relevant information, and that some clients would like greater involvement in decision-making. This suggests that the concept of shared decision-making may be the way forward in some cases. In human medicine, it has been shown that patients may have different preferences regarding the involvement of doctors in decision-making—that some want to make their own decisions, some want to share the decision-making, and some prefer to delegate responsibility to the doctor [ 11 ].
In fact, the whish for shared decision-making will depend on the context—e. These observations support the findings in this study, that in situations when there was no obviously best option, where interviewees felt hesitant about making decisions, veterinary involvement could well be both sought and appreciated by the interviewee.
Shared decision-making is not, however, a simple task in practice. Several issues have been identified in both human and veterinary medicine. In addition, it has been pointed out that wanting to participate in decision-making may be different from wanting to make the final decision [ 66 ].
These concerns are very similar to those expressed by interviewees in this study. Potential disagreements may also become an issue. The interests of the animal and the client are not always reconcilable [ 70 ], and the veterinarian may have his or her own interests [ 4 ]. Disagreements may arise over e. End-of-life care and euthanasia decision-making can be influenced by the ability of those involved to reach consensus [ 71 ], and veterinarians thus need to handle disagreements when engaging in shared decision-making [ 32 ].
It has been suggested that perhaps veterinary practice can learn from human medicine, e. In human medicine patients often want to share decision-making with their doctor [ 72 ]. Others suggest that veterinarians should inform clients of their personal view, and thus help clients even though they then risk influencing decisions made [ 31 ].
Some have argued that providing comfort for the human caregiver is a legitimate responsibility and goal in veterinary practice [ 74 ], and that it is acceptable to influence clients when they explicitly want to be influenced and animal welfare is respected [ 1 ]. Shared decision-making thus seems to offer valuable perspectives on how veterinarians can engage in decision-making, but several challenges still need to be addressed.
In addition to being a medical expert, the veterinarian may act as a support person and facilitator in decision-making [ 20 , 42 ]. Veterinarians may find that they need to offer emotional as well as informational and practical support [ 40 ], and clients may indeed expect this [ 75 ]. However, veterinarians may disagree with their clients about the best way forward [ 76 ], and professional codes of conduct may be insufficient to guide veterinarians on matters such as euthanasia and end-of-life issues [ 77 ].
There may thus be a need for more emphasis on skills in communicating with clients with terminally ill animals in the veterinary education [ 78 ], and the ethical issues addressed in this paper may assist development of useful frameworks. In human medicine it has been argued that the focus of medical ethics should be on respect for the wishes of the autonomous person, rather than respect for the autonomous choices [ 9 , 79 ], and it has been suggested to ask patients first who should be involved and how decisions should be made, before obtaining informed consent regarding what decision to make [ 72 ].
Similarly, when addressing treatment options requiring difficult decisions the veterinarian could explore what level and kind of involvement the client wants in the decision-making.
Perhaps a specifically designed consent form should be created, to clearly acknowledge that such agreements have been made. The approach of shared decision-making does, however, raise additional issues. How can such influence be made transparent? And how can the risk of the client being moved in a direction that goes against his or her own considered preferences be minimized? Finally, the idea of shared decision-making presupposes that both the client and the veterinarian agree to participate.
Therefore it is not enough that the client wants the veterinarian to be involved in the decision-making; the veterinarian also has to be willing to take on this role in order to produce the best outcome. The notion of shared decision-making, including the associated ethical issues, and a general development of the ethical framework in veterinary decision-making clearly deserve further attention.
This study showed that clients may encounter several challenges when they are faced with treatment choices and the possible euthanasia of their dog, and in some cases they want the veterinarian to be involved in the decision-making.
The idea of shared decision-making deserves special consideration. The ethics of influencing clients. J Am Vet Med Assoc. PubMed Google Scholar. Tannenbaum J. Veterinary ethics: animal welfare, client relations, competition and collegiality. Louis: Mosby; Google Scholar. Stewart MF. Companion animal death—a practical and comprehensive guide for veterinary practice. Edinburgh: Butterworth Heinemann; Rollin BE.
The use and abuse of aesculapian authority in veterinary medicine. Article PubMed Google Scholar. Morgan C, McDonald M. Ethical dilemmas in veterinary medicine.
Article Google Scholar. Autonomy and trust in bioethics. Cambridge: Cambridge University Press; Book Google Scholar. Principles of biomedical ethics. New York: Oxford University Press; Walker RI. Medical ethics needs a new view of autonomy. J Med Philos. Cornell KK, Kopcha M.
Client-veterinarian communication: skills for client centered dialogue and shared decision making. Shared decision-making in the medical encounter: what does it mean? What does this mean to you as an animal lover? It means you may not always get to work with your favorite animals. If you love snuggling with the cute, furry puppies and kittens, ask yourself if you would be just as willing to assist with an exam on a pet lizard or trudge through a farm field to help a sick calf.
You may even discover a love for an animal you never knew you liked. However, if you do have a strong preference for a particular type of animal, you can target your job search around clinics, hospitals, and other animal care facilities that specialize in that area.
If you like your day to be neat, clean, organized, and predictable, working in the veterinary field is not for you. Working in a vet office gives you a mix of interacting with the human owners and the animals.
This requires a great deal of flexibility and the ability to switch gears quickly without getting flustered or forgetting basic safety and procedures. The specific tasks a vet tech is allowed to handle, either alone or with supervision, often varies by state.
Here are some examples of tasks you might perform or assist with during a typical day as a vet tech:. Variety also comes in the specific location you work.
Those working in the veterinary field have several options including:. Working with animals and their human owners takes a great deal of patience and compassion. Strong people skills are just as important as a passion for and knowledge about animals. While many owners are pleasant and easy to work with, you occasionally come across people who are angry, frustrated, or confused.
Others may not understand the importance of good pet care. Part of the required people skills of this field is learning to deal with these types of customers to diffuse the situation and ultimately ensure the pet gets the best care possible. You also have clients who fail to follow the treatment plan. This complicates your job because you may see the same animal for the same problem, or the problem may get worse. Helping patients understand the importance of following the treatment plan is something you have to do in some cases.
A veterinarian shall be dedicated to providing competent veterinary medical care, with compassion and respect for animal welfare and human health. A veterinarian shall provide veterinary medical clinical care under the terms of a veterinarian-client-patient relationship VCPR.
A veterinarian shall uphold the standards of professionalism, be honest in all professional interactions, and report veterinarians who are deficient in character or competence to the appropriate entities. A veterinarian shall respect the law and also recognize a responsibility to seek changes to laws and regulations which are contrary to the best interests of the patient and public health.
A veterinarian shall respect the rights of clients, colleagues, and other health professionals, and shall safeguard medical information within the confines of the law. A veterinarian shall continue to study, apply, and advance scientific knowledge, maintain a commitment to veterinary medical education, make relevant information available to clients, colleagues, the public, and obtain consultation or referral when indicated.
A veterinarian shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide veterinary medical care.
A veterinarian shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. Creativity is a valuable characteristic of veterinarians. However, in order to make meaningful contributions, a rigid set of principles must first and always take priority.
There is that moment in almost every day as a veterinarian when you look across an exam table into the anxious eyes of a deeply concerned owner with a seriously ill or injured pet lying between you. Making a difference in your patient and client's lives is a great reason to be a veterinarian. All the veterinarians I know get excited about opportunities to learn something new. Most practicing veterinarians can relate to the description of a stressful day in the life of a vet.
Some detective work must be done to evaluate each case, and a key trait of a veterinarian is that they enjoy this challenge. While you may start out working for an established clinic, you have the option of starting your own practice, perhaps even a mobile practice , which greatly reduces startup costs. You can become a partner in an established clinic if they are looking to expand or if other vets are planning to retire. Most vets have a degree of flexibility in their schedules, particularly as they become more established.
Veterinarians never stop learning new things. Continuing education hours are required to renew your license to practice medicine, and most vets want to learn new techniques and innovations even when there is no official requirement. The industry constantly evolves, and it is important to keep up with the latest developments so you can provide the best possible care to your clients.
You can use your veterinary background to transition into a variety of roles with other organizations, such as veterinary pharmaceutical sales companies, feed companies, wildlife agencies, laboratories, academic institutions, or the military. Corporate vets, in particular, tend to earn top dollar and work normal business hours.
Veterinarians have the opportunity to lead a team of animal lovers including veterinary technicians , kennel attendants , and office staff. It makes a difference when all the employees at an office enjoy what they do for a living, and, in this line of work, people tend to be truly committed to helping animals. Veterinary medicine is by far the most popular dream job for animal lovers, and many kids start mentioning their interest in this career path at a very young age.
If you have the drive, the grades, and the desire to work with animals, veterinary medicine may be the perfect job for you.
Actively scan device characteristics for identification. Use precise geolocation data.
0コメント