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Analysis of a Critical Incident, identifying the Professional, Ethical, and Legal issues

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Published: 4th Dec 2020

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Analysis of a Critical Incident, identifying the Professional, Ethical, and Legal issues

Introduction:

Animal Euthanasia is an act of putting any animal to sleep or allowing it to die, without performing any extreme medical procedures. It is usually referred to as “good death” (Schuurman, 2017). In the clinical veterinary practice, euthanasia is regarded as an ethical and professional procedure, under the informed consent of the guardian. This is because of veterinarian considerations that it is inhumane to keep animals suffering from painful and severe diseases, which cannot be relieved by treatment or medications. Animal Euthanasia is different from animal slaughter or pest control. Owners and veterinary surgeons may choose euthanasia as the fate of an animal because of an incurable disease, lack of resources to support the animal or laboratory procedures. Neverthesless, euthanasia is mostly performed to reduce the pain, distress, and suffering of a sick animal. In the context of euthanasia, the Veterinary Surgeons and Registered Qualified Veterinary Nursing (RVN) have professional responsibilities towards animals, clients, their profession, the entire veterinary team, and the general public (Almond, 2017). The aim of this paper is to identify, examine, and describe the relevant professional, ethical, and legal issues pertaining to animal euthanasia. In this regard, the incident involving uniformed euthanasia will be critically evaluated. The paper will revolve around the views of the veterinary nurse, the owner, and the animal.

Critical Evaluation:

Veterinarians and Nurses may deal with various circumstances where the death of an animal is required. A registered veterinary nurse is now expected to be equipped with the necessary skills, knowledge, and accountability to uphold their profession. In the hypothetical scenario, there are various professional, legal, and ethical issues involved in conducting uninformed euthanasia on a cat. An 18-year-old male neutered cat, suffering from breathing difficulties, weight loss, inappetence, and Extranodal Lympha, is treated with a dose of Pentobarbital. The procedure is conducted by a Registered Qualified Veterinary Nursing (RVN), without the owners’ consent and consultation with the Veteran Surgeon. Both the owners and the surgeons are informed that the cat has died on its own. The concerns revolving around this incident are meticulously discussed in this paper.

Professional Considerations:

The Royal College of Veterinary Surgeons (RCVS) standardizes the veterinary nursing profession through various acts and legislations (Welsh, 2015). These include the Veterinary Surgeons Act 1966, the Royal Charter, and the Veterinary Nurse Conduct and Discipline Rules 2014 to maintain animal health and work in accordance with the public interest (Wild, 2017). According to RCVS, Veterinary surgeons and nurses should be committed to ensuring the health and welfare of animals, as well as fulfilling their professional responsibilities. There are five principles of practice outlined. These include professional competence, honesty and integrity, independence and impartiality, confidentiality of client, and professional accountability (Magalhães-Sant'Ana et al., 2015).

The declaration made by every registered veterinary nurse in the U.K. focuses on the integrity, professionalism, and commitment needed to carry out when treating animals. All the nurses are expected to show professionalism of the highest levels when dealing with the welfare of animals and other people involved. During euthanasia, several professional considerations need to be taken into account. These involve the questions of whether the required consent was taken before proceeding with any medical treatment, was the conducted treatment legal, and how was the aftermath of euthanasia dealt with.

In the aforementioned case, the nurse conducted euthanasia without communicating anything with the veterinary surgeon or the owners of the cat. This goes against the Code of Professional Conduct for Veterinary Surgeons. According to the Code, the veterinary surgeons and the veteran team are supposed to maintain an open and honest relationship with clients (Priestman, 2017). In this case, a client may be the owner of the animal or someone having the authority of the owner. The provision of veterinary services generates a systematic contract between the owner and the veterinary staff. It is then deemed upon the veterinary staff to ensure that they maintain accurate case records and leave the freedom of choice on the client.

Moreover, it is also the responsibility of the veterinary surgeon to ensure that the client is aware of any treatment carried out by the staff, other than the veterinary surgeon. All these professional conducts were not followed in the case. It can also be suggested that there was sheer negligence on the part of the veterinary surgeon for not ensuring that appropriate procedures are taken only. After all, veterinary surgeons are expected to keep correct and comprehensive client and clinical records. Informed consent is paramount for the medical profession. In fact, it is an essential part of any contract between the client and the surgeon (Ngo et al., 2016). Consent is deemed important for clients who have the opportunity to consider various treatment options. In this case, the owners of the cat did not consent to euthanasia, instead left the cat in supportive therapy. The failure of the nurse to comply with the consent of the owner is considered unprofessional, despite the advantages provided by euthanasia.

Legal Issues:

Various legislations and Acts are important to consider when following euthanasia. In England, animals under the license of Animal Welfare (Licensing of Activities Involving Animals) Regulations 2018 are allowed to be euthanized only by a veterinary surgeon or those who are authorized to conduct it by the surgeon. These animals include pets, as well as boarded cats and dogs. In this case, the veterinary surgeon did not authorize the nurse to conduct any medical procedure, except for supportive therapy. This establishes the fact that the incident has resulted in major law breaches.

In veterinary practices, there are three main civil cases based on trespass, negligence, and breach of contract. To start with, trespass is defined as an act of doing something on someone else’s property without any official consent (Wong, 2019). According to the Code of Professional Conduct for Veterinary Surgeons, it is important to write and seal consent forms before proceeding with any form of medical treatment. Consent forms, signed and rectified by the client, record agreements and form part of clinical records. The client is given an opportunity to consider the information and consent form before agreeing with anything. However, in this case, there was no consent form for euthanasia. Consent can be acquired in several ways. These include implied, verbal, and written ways. All are equally valid in the U.K. law. Mostly, signed consent forms are preferred for their evidentiary purposes.

However, it is argued that if anyone destroys or destructs anyone’s animal, whether intentionally or recklessly, without any lawful procedure, it is equal to an offense. In this context, the act of nurse was reckless, which is explained in law as an act of being aware of the consequences involved in doing something but deciding to do it anyway. It is perceived that RVN was not possibly aware of the consequences involved in performing euthanasia. The nurse was convinced that it was best to relieve the pain of the cat. Under this consideration, this act is not considered reckless and therefore, unqualified as an offense.

When negligence is considered, it is important to consider three aspects: Was there a duty of care? Has it been breached? Has it resulted in a predictable destruction? Considering the case outlined in this study, a duty of care exists as the owner is a registered client and the veterinarian staff agreed in treating the cat. Coming on the second question, the duty of care can only be breached if the service or treatment provided falls under the benchmark of practice. In this regard, it can be suggested that the RVN was not as experienced as the veterinarian and not supported by any other staff member in performing euthanasia. In this way, the duty of care is not sufficiently breached. However, one can argue that the RVN has breached the overall contract with the client, which did not state that he can perform euthanasia.

Another legal doctrine to consider is that of Vicarious Liability, concerned with the relationship between an employer and employee (Deakin, 2018). As per the English Tort Law, employers are liable for any kind of tort committed by their employees. This is referred to as imputed negligence. In light of this law, RVNs are protected under vicarious liability. It can be argued that in this case, the veterinary surgeon can be held accountable for not ensuring that the staff makes no autonomous decisions, breaching their contract with the client. However, with the surge in the ability of RVNs to act autonomously and pursue professionalism, there are several complications. Although the RVN can be protected from prosecution under civil law, he can face numerous disciplinary strikes and even lose his certifications.

Moving on, it is also important to consider the procedure of euthanasia followed by the RVN. The cat was treated with a lethal dose of the drug Pentobarbital, eventually putting it to sleep. Any means of euthanasia is chosen according to the size, species, tractability, restraint, distress, and disease of the animal. It is equally significant to physical control animals being killed in order to reduce the fear and pain of the animal, as well as ensuring the safety of the attending staff. For this reason, it is often suggested that at least two veterinary staff conduct euthanasia. In this case, the nurse is perceived to perform euthanasia alone, breaching the professional conduct of medical treatment.

However, an acceptable means of euthanasia is the one that causes rapid unconsciousness and eventually, death. In this regard, an overdose of a chemical drug, like Pentobarbital, is a suitable procedure. As per the Veterinary Medicines Regulations, the RVNs are authorized to administer Euthatal (pentobarbital) POM-V, which is a barbiturate schedule 3 drug (Buchweitz et al., 2018). However, it is only valid under the prescription and direction of a qualified veterinarian. It is usually given through an IV injection, which is also a correct method of performing euthanasia. On the other hand, it can only be purchased using a Drug Enforcement Administration (DEA) registration and order form.

Furthermore, the decision of euthanasia should be carried out by considering various factors. These include weight loss or failure to gain weight, tumor growth, emaciation, alopecia, prolonged diarrhea, labored breathing, abdominal distention, and severe leukemia. Similarly, other factors include signs of uncontrolled hemorrhage, paralysis, tremors, and distressful behaviors. Considering that the cat was suffering from cancer, breathing difficulties, dramatic weight loss, and inappetence, together with being diagnosed with Extranodal Lympha, it is established that euthanasia does not breach any important factors aforementioned. It should also be remembered that the veterinary surgeon had advised the owners to put the cat to sleep, establishing the fact that the RVN acted in accordance with the knowledge of the surgeon.

Ethical Issues:

Animal ethics is considered a complex subject. However, several moral and ethical concerns are still involved with the welfare of the animals. According to the Code of Professional Conduct for Veterinary Surgeons, the surgeons are expected to utilize their clinical knowledge and judgment in authorizing any kind of medical treatment and the person who can perform it. Veterinary surgeons can only advise the client to perform euthanasia, which was seen in this case. If the veterinary surgeon is concerned with the welfare of an animal and believes that it is being compromised because of the refusal of an owner to allow euthanasia, the surgeon can take other steps to resolve the situation. For instance, the client can be referred to another veterinary surgeon, who can provide the same opinion of euthanasia or a better option for treating the animal. In this case, the decision of the nurse has prevented this.

There are potential dilemmas faced by the veterinary staff concerning euthanasia. The major question is whether the client’s wish to euthanize the animal is fulfilled or not. Even if the veterinarian is the one with proper knowledge and understanding of the animal’s condition, the client’s consensus is an inevitable requirement. The failure of RVN to comply with the owner’s refusal to allow euthanasia is an unethical and immoral act. Whatever the health state of an animal may be, as per the ethical grounds, the veterinarians should demonstrate the owner why other treatments cannot elevate the condition of their pet.

Autonomy and Beneficence guides the decision-making process of euthanasia. The treatment of individuals as autonomous agents generates respect for individuals. In medicine and healthcare, a patient is autonomous in choosing the treatment he or she wants to receive (Gray et al., 2018). The patient has the ability to understand the potential risks involved in receiving treatment, as well as its advantages. However, in veterinary medicine, autonomy lies with the owner of the animals, as the patients are unable to communicate. Therefore, the autonomy of the owners should be respected, which was not done in this case. On the other side, beneficence is concerned with the wellbeing and quality of life of an animal. Since euthanasia does not case direct suffering but helps an animal to escape from pain, beneficence supports this act. Although the owners of the animal can be quite stressed with the death of an animal, as per ethics, the emotions of the ones performing euthanasia are also important.

The Parties Involved:

Pets have quite different relationships with humans, as compared to the connection between a scientist and a laboratory animal. They are central to the love and care. Most individuals feel strongly connected to their pets and consider them their long-life companions. In this regard, they are very much responsible for the well-being of their pets. Euthanasia is a quite stressful situation for the owners. They cannot bear to lose their companions and see them suffer from pain. This can explain why the owners in the aforementioned case refused to euthanasia and agreed on supportive therapy. However, seeing how the cat died, the owners must have suffered from a terrible setback. Moving on, by staying unaware of euthanasia being performed, the owners have been breached of their right to know everything about their pets.

For the veterinary surgeon, the situation is legally and professionally challenging. Although many veterinary surgeons have mixed views regarding euthanasia, they can only advise their clients to put their pets to sleep. The failure of the surgeon’s staff to comply with the consent of owners raises numerous questions on his or her integrity and professionalism. The same is for the RVN. However, it should be considered that the RVN acted according to his judgment, seeing how distressed the cat was. It is not easy to perform euthanasia. It is widely accepted that veterinarians are also affected negatively by the procedure. They can become affectionately attached to it and may not have the heart to watch it suffer. The RVN also kept euthanasia hidden from the veterinary surgeon and owners because of the fears of being convicted.

Conclusion:

Professional accountability is a forefront element for any professional, especially for a Registered Qualified Veterinary Nurse. Informed consent is important to deal with emotionally tense situations and the procedures to use in treating a distressed animal. In this regard, the ownership and authority of the consent of an owner should be respected. Euthanasia might be a preferred solution in the aforementioned case but the paper has sufficiently established that alternative measures should have been taken to deal with the situation. It is not a requirement, but a responsibility, of those involved in veteran care to maintain the professionalism of highest levels and comply with all ethical and legal terms, during the medical procedure of any kind.

References:

  • Almond, S., 2017. Ethics: the role of the veterinary nurse in the euthanasia of healthy but aggressive animals. Veterinary Nursing Journal32(1), pp.6-8.
  • Buchweitz, J.P., Johnson, M., Jones, J.L. and Lehner, A.F., 2018. Development of a Quantitative Gas Chromatography–Tandem Mass Spectrometry Method for the Determination of Pentobarbital in Dog Food. Journal of agricultural and food chemistry66(42), pp.11166-11169.
  • Deakin, S., 2018. Organisational Torts: Vicarious Liability versus Non-Delegable Duty. The Cambridge Law Journal77(1), pp.15-18.
  • Gray, C., Fox, M. and Hobson-West, P., 2018. Reconciling Autonomy and Beneficence in Treatment Decision-Making for Companion Animal Patients. Liverpool Law Review39(1-2), pp.47-69.
  • Magalhães-Sant'Ana, M., More, S.J., Morton, D.B., Osborne, M. and Hanlon, A., 2015. What do European veterinary codes of conduct actually say and mean? A case study approach. Veterinary Record, pp.vetrec-2014.
  • Ngo, E., Patel, N., Chandrasekaran, K., Tajik, A.J. and Paterick, T.E., 2016. The importance of the medical record: A critical professional responsibility. The Journal of medical practice management: MPM, 31(5), p.305.
  • Priestman, T.I., 2017. Delegation and the legal, professional and ethical issues for veterinary nurses: a case study. The Veterinary Nurse, 8(4), pp.226-229.
  • Schuurman, N., 2017. Performing good death at the veterinary clinic: experiences of pet euthanasia in Finland. Area49(2), pp.208-214.
  • Welsh, L., 2015. The euthanasia of aggressive dogs. The Veterinary Nurse6(9), pp.517-521.
  • Wild, S., 2017. Legal and ethical veterinary practice: a scenario evaluation. Veterinary Nursing Journal32(2), pp.45-49.
  • Wong, J., 2019. Respecting Other People’s Boundaries: A Quintessentially Anglo Cultural Value. In Further Advances in Pragmatics and Philosophy: Part 2 Theories and Applications (pp. 449-467). Springer, Cham.

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