Bioethics Forum Essay
Veterinarians Often Provide Futile Care. Doing So Comes at a Cost
Most pet owners probably don’t give much thought to their pets’ doctors, but the care veterinarians provide can exact a toll on their own health. Like medical doctors and nurses, veterinarians experience moral distress and burnout because of the ethical conflicts they face on the job. We have been studying ethical conflict and moral distress among veterinarians for several years, and we have new findings on the causes and suggestions for addressing them.
Ethical conflict and distress among veterinarians are common and widespread. In the first study of this problem in North America, two of us–Lisa Moses and J. Wesley Boyd—surveyed almost 900 veterinarians. Sixty-nine percent of them said they had felt moderate to severe distress about not being able to give animals what they thought was the right care. One of the most surprising findings was that requests for, and the provision of, “futile” care caused more distress to veterinarians than any other clinical situation, including owners asking to have their pets put to sleep because they can’t–or are unwilling to–pay for treatment. Study participants considered care to be futile when further or ongoing treatment wouldn’t improve the outcome and would result in further pain and suffering on the part of the animal patient.
We have witnessed requests for futile care firsthand and seen the extraordinary toll that they can take on members of the entire veterinary care team. These cases make us feel that we are harming patients by continuing to treat them and causing needless suffering. An example was the geriatric orange tabby cat, who after spending days recumbent and barely responsive in an oxygen enriched cage, was scheduled to have another round of chemotherapy for his metastatic cancer, against his veterinary oncologist’s and palliative care veterinarian’s advice.
To explore futility more deeply, our colleague Nathan Peterson led a more recent survey of veterinarians. Of the 477 who responded, 99% reported encountering futile care at some point in their career and 42% said that it occurred often (more than six times a year) within their practice. The reasons offered most often for providing futile care included allowing time for an owner to be present for euthanasia, satisfying an owner’s request that all treatment options be exhausted, and the owners not understanding the severity of their pet’s condition. Even though a large majority (76.2%) of respondents agreed or strongly agreed that providing futile care sometimes benefited the owners in some way and a majority were sympathetic to the owners’ feelings, providing futile care can exact a toll on veterinarians.
The upshot from both studies is that medical futility is a significant contributor to moral distress and burnout. Given how frequently veterinarians encounter futility in their practices–along with the other everyday aspects of veterinary practice, which can also cause distress –it is not surprising that over 30% of veterinarians report feeling depressed and that veterinarians have higher than average rates of suicide.
Several things need to change to support veterinarians. First, veterinary education should explicitly address the ethical dilemmas faced in practice and acknowledge that mental health can suffer as a result. Second, veterinarians should recognize signs of burnout and depression in themselves and their staff members. Creating practice cultures where ethical conflict and its impact are openly identified, and staff have strategies to manage them, is sorely needed in the veterinary world.
And, finally, pet owners ought to be aware that their veterinarians may share their anguish when a beloved companion is suffering, and that veterinary medical decision-making can be emotionally complex for vets, too. A healthy dose of compassion from all sides, can go a long way to lessening the ethical conflicts and how badly they make everyone feel.
Lisa Moses, VMD (@drlisamoses), is a veterinarian and animal focused bioethicist who is a faculty member of Harvard Medical School’s Center for Bioethics and a senior advisor to The Hastings Center. Nathan W. Peterson, VMD, is a veterinarian and an associate clinical professor at Cornell University College of Veterinary Medicine and is a master’s degree candidate at Harvard Medical School’s Center for Bioethics. J. Wesley Boyd, MD, PhD (@JWesleyBoydMD), is a professor of medical ethics and psychiatry at Baylor College of Medicine.
The authors thank Hastings Center President Mildred Solomon for her mentorship and inspiration for the first study of moral distress among veterinarians.