Advances in veterinary technology provide pet owners with an ever-increasing array of treatment options for their pets. However, more options can lead to complex situations and difficult questions about care goals and quality of life that must be navigated by veterinary caregivers and pet owners. Clinicians and researchers from North Carolina State University and Duke University have developed a first-of-its-kind veterinary medical ethics committee to aid care providers in navigating these situations.
Jeannine Moga, a veterinary social worker at NC State, has seen some of these issues firsthand. "Even though everyone involved in an animal's case is trying to act in the animal's best interest, determining the best course moving forward can lead to conflicts and that can be distressing for the people involved," Moga says. "I wanted to find an ethics-based way to help our hospital staff address differences and form consensus in these cases."
Moga contacted Dr. Philip Rosoff for guidance and advice on how to proceed. Rosoff, pediatric oncologist and director of the clinical ethics program at Duke University Hospital, is corresponding author of a new paper describing the committee's formation. "The establishment and growth of veterinary specialty hospitals for very sick animals is a relatively recent phenomenon," Rosoff says. "It's not surprising that veterinary hospitals also now see the need for ethics committees to mediate and adjudicate disputes about care."
Together, Rosoff, Moga and Bruce Keene, Jane Lewis Seaks Distinguished Professor of Companion Animal Medicine at NC State, set out to adapt human ethics committee guidelines currently in use to address issues in a veterinary hospital, creating NC State's first Clinical Ethics Committee (CEC).
"The pediatric model works very well for our situation in veterinary medicine," Keene says. "In both cases, you're dealing with a patient who cannot advocate for him or herself, and a decision-maker who is very involved in the process. However, we do deal with some thorny issues - such as euthanasia - that human hospitals do not."
The CEC consists of seven people: three doctors, three veterinary technicians and a social worker. When cases arise, as many as four or as few as two members of the committee meet with the veterinary patient's care team to serve as a resource or a sounding board. The entire process operates independently from the academic and business aspects of the NC State veterinary hospital to avoid conflicts of interest. The CEC formed in late 2016 and as of December 2017 had worked on seven cases. While the CEC currently serves veterinary clinicians, staff and students, Moga hopes to expand its availability to hospital clients in the near future.
"Our job is not to make treatment recommendations," Moga says. "We are there to make sure that any ethical issues raised are dealt with openly and fairly. Sometimes it's as simple as just getting everyone in the same room to hash things out.
"Figuring out which medical options are feasible and ethical in a way that also respects client autonomy can be difficult, but dealing with ethical issues pre-emptively rather than reactively is in everyone's best interest."
The research appears in the American Journal of Bioethics. Corresponding author Rosoff is also a resident scholar of the Trent Center for Bioethics, Humanities and History of Medicine and a professor of pediatrics and medicine at Duke University School of Medicine. Moga and Keene are co-authors along with Chris Adin, associate professor of surgery, Callie Fogle, clinical associate professor of equine surgery, veterinary technicians Heather Hopkinson and Charity Weyhrauch, and NC School of Science and Math student Rachel Ruderman.
Note to editors: An abstract of the paper follows.
"Resolving Ethical Dilemmas in a Tertiary Care Veterinary Specialty Hospital: Adaptation of the Human Clinical Consultation Committee Model"
Authors: Philip Rosoff, Duke University Medical Center; Jeannine Moga, Bruce Keene, Christopher Adin, Callie Fogle, Heather Hopkinson, Charity Weyhrauch, North Carolina State University College of Veterinary Medicine; Rachel Ruderman, North Carolina School of Science and Mathematics
Published: American Journal of Bioethics
Technological advances in veterinary medicine have produced considerable progress in the diagnosis and treatment of numerous diseases in animals. At the same time, veterinarians, veterinary technicians and owners of animals face increasingly complex situations that raise questions about goals of care and correct or reasonable courses of action. These dilemmas are frequently controversial and can generate conflicts between clients and healthcare providers. In many ways they resemble the ethical challenges confronted by human medicine and that spawned the creation of clinical ethics committees as a mechanism to analyze, discuss and resolve disagreements. The staff of the North Carolina State University Veterinary Hospital, a specialty academic teaching institution, wanted to investigate whether similar success could be achieved in the tertiary care veterinary setting. We discuss the background and rationale for this method as well as the approach that was taken to create a Clinical Ethics Committee.