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When I reviewed the types of ethical challenges documented in the veterinary literature in the form of hypothetical scenarios (many of which were submitted by veterinary team members and drawn from their own experiences), we found all kinds of challenges – from managing client financial limitations, to how to manage an error, what to do when clients breach animal welfare legislation, and decision making around euthanasia, to broader questions about which forms of animal use are acceptable https://pubmed.ncbi.nlm.nih.gov/35051086/.
Ethically challenging situations are super-common in veterinary settings – whether you’re working in mixed practice, general practice, referral settings, academia, research and development, wildlife conservation, non-Government organisations or even the Government.
We may experience transient stress, but it generally goes away. Sometimes we really struggle to make and implement what we feel is the ‘right’ decision – and we may not ever be sure. Or we may feel that no matter which decision we make, we compromise our values. Or we may feel that, because of various factors, we cannot act in alignment with our values. This leads to moral distress and in severe cases, moral injury.
Ethics rounds are structured team debriefs about ethically challenging situations. I describe it as a sort of ‘morbidity and mortality rounds’ with a focus on ethical decisions. Like M&M meetings, they are confidential, with a focus on exploration and learning rather than blaming.
Also referred to as moral case deliberation (MCD), ethics rounds were first used in human healthcare settings, primarily to improve the patient experience. However, it was also noted that such discussions could help team members improve their ethical reasoning and potentially mitigate moral stress (stress arising from ethical challenges) and moral distress (distress that arises when you find yourself acting against your own values or feeling that you are unable to act in alignment with your values).
Literature from human healthcare tells us that ethics rounds can be beneficial at the level of the patient, through improved patient care and improved interaction between the health care team, patient and family members.
At the level of the healthcare team, ethics rounds can lead to increased ability to identify and communicate about ethical challenges, improved awareness of our own behaviour and thinking, increased ability to postpone moral judgement (until we have all of the required information, or at least as much as we can get), improving listening and conflict management, better understanding of the perspectives of others (especially colleagues), better multi-disciplinary cooperation, and acceptance of moral discomfort. In addition, it creates a safe space for ethical disagreement. Potentially, ethics rounds can also provide emotional relief and validation (‘oh, you’ve been through that too!’, ‘I’m not the only one’). Ideally, it gives participants strengthened confidence in navigating ethical challenges.
Finally, at the level of the organisation, ethics rounds can:
For example, let’s say one of the common ethically challenging situations encountered in a veterinary workplace is client financial limitations. If an organisation does not have a policy on managing these, it can make it very difficult for veterinary team members to manage those situations. This is something that the organisation can address.
It’s the first question asked at every drug launch: ‘what are the adverse effects?’. And it’s an important question to ask about all interventions.
Before you jump into ethics rounds, there are some key factors to be aware of.
Ethically challenging situations can be emotionally charged. If you have been in a situation where you feel your core values have been challenged, or you feel you’ve acted in a way that doesn’t reflect those values, it can be upsetting to recall, let alone share that experience.
A study by Leonie Richards and colleagues reported that while veterinary team members really appreciate being able to talk to their colleagues, they also fear being negatively judged by them https://jvme.utpjournals.press/doi/10.3138/jvme.2019-0013 .
Some people may be uncomfortable participating, particularly in the context of conflict, workplace bullying or due to hierarchies.
Ethics rounds should be voluntary, and carefully facilitated so that all participants feel comfortable engaging. We’re working on developing a facilitator training program for veterinary team members (watch this space).
There is now some evidence suggesting that ethics rounds may benefit veterinary teams. We used the Euro-MCD 2.0, an instrument first developed to measure the impact of moral case deliberation or ethics rounds on health care workers, to measure the impact of ethics rounds.
We held 23 virtual ethics rounds in total, involving 213 individuals, 89 of whom responded to pre and post- ethics rounds surveys. The majority of respondents were female (81%), most were veterinarians (59%), followed by other veterinary team members such as practice managers and animal attendants (21%), veterinary nurses or animal health technicians (12%) and veterinary students (9%). The age of participants ranged from 20-73 with a median of 41.
After participating in a single, virtual (thank you, COVID) session of ethics rounds, veterinary team members had improved scores in the domains of moral competence and moral teamwork (you can read the complete results here: https://www.frontiersin.org/articles/10.3389/fvets.2022.922049/full.
What matters of course is what happens outside of ethics rounds. We need more data to establish whether and to what extent ethics rounds can improve veterinary work places.
What kinds of ethically challenging situations are faced by your team?
What approaches have you used to address ethical challenges in the workplace?
Share them in comments section below.
Anne Quain is a companion animal veterinarian and a lecturer at the Sydney School of Veterinary Science. She is a member by examination in the animal welfare chapter of the Australian and New Zealand College of Veterinary Scientists and is a Diplomate of the European College of Animal Welfare and Behaviour Medicine in Animal Welfare Science, Ethics and Law. She co-authored the book Veterinary Ethics: Navigating Tough Cases with Dr Siobhan Mullan, and is the author of numerous academic publications including peer-reviewed journal articles and book chapters. Her research interests include animal welfare and ethics. In addition, Anne was co-editor of the Vet Cookbook, an initiative to promote mental well-being in veterinarians, nurses and others working with animals.
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