Symposium on the Human-Companion Animal Bond
Ethics and Human-Companion Animal Interaction A Plea for a Veterinary Ethics of the Human-Companion Animal Bond ] errold Tannenbaum, M.A., ]. D., Esq.*
As the articles in this symposium demonstrate, we may be at the beginning of a new era of scientific work on the human-companion animal bond and its relevance to the practice of veterinary medicine. Although the health of scientific research on the human-companion animal bond is promising, the present state of ethical studies about humancompanion animal interaction is dismal. Indeed, to all intents and purposes, a veterinary ethics of the human-companion animal bond, a useful body of work applicable by practitioners to practice situations, does not yet exist. This article is a plea for a serious veterinary ethics of the humancompanion animal bond. I shall argue that· not only morality, but selfinterested expediency-perhaps even the survival of veterinary practice as we now know it-require that the profession nurture and develop a serious veterinary ethics of human-companion animal interaction. I shall urge veterinarians to assume a more prominent role in ethical discussions. I shall consider several important ethical issues and shall suggest how we might begin to go about resolving some of them. What I shall offer-and what anyone, in my view, must offer at this point in the development of veterinary ethics-are fewer conclusive principles and answers than suggestions and questions.
AN ILLUSTRATIVE CASE Suppose that a client appears in your office for the second time in 4 weeks with her 2-year-old dog. At the first visit, you diagnosed a moderate *Clinical Assistant Professor of Environmental Studies, Tufts University School of Veterinary Medicine, Boston, Massachusetts; Member of the Massachusetts and New York Bars; formerly Assistant District Attorney for New York County, and Assistant Professor of Philosophy, University of California at Santa Barbara Editors' Note: The views expressed in this article are those of the author and do not necessarily reflect the opinions of the Guest Editors. Veterinary Clinics of North America: Small Animal Practice-Val. 15, No. 2, March 1985
case of flea allergy dermatitis, dispensed an appropriate medication and powder for the dog, and advised the client to vacuum and powder her premises thoroughly for a number of weeks to prevent recurrence of the problem. As the client and dog enter your examination room, it is apparent that its condition has deteriorated. You believe that the medication has not been applied as directed, and you doubt that the client has attempted to remove the fleas and their eggs from her home. The client tells you for the first time that the animal has been impossible to housebreak. She asks you to put it to sleep. What should you do? THE INESCAPABILITY OF ETHICS: THE NEED TO MAKE MORAL CHOICES
It would be wrong to think that, because veterinary medicine is a science, you need not make any moral or value judgments in response to the example. Whatever you would decide to do in this example, and in many of your professional decisions, moral choices are inescapable. If you would simply euthanatize the dog because the client has requested it, you would be asserting your adherence to a number of ethical views, such as (1) a companion animal has no inherent right to live; (2) a companion animal's owner may have the animal killed because keeping the animal has become an inconvenience; (3) the owner of a companion animal with a curable malady or behavioral problem need not take extraordinary steps to remedy these problems but can simply opt for euthanasia; (4) it is proper for a veterinarian to euthanatize a companion animal simply because its owner requests that this be done. Likewise, if you would decide to persuade the client to at least try to cure the dog's medical and behavioral problems, you would be asserting your belief in a number of ethical views, one of them probably being that an animal like the one in our example ought not simply to be euthanatized, but deserves, at the very least, a "second chance." . It is obvious that even a routine practice decision can involve making a large number of ethical choices if one considers just some of the choices you might make in our example. You might 1. Euthanatize the animal on the client's request. 2. Ask the client whether she has followed your directions and about the housebreaking problem, hoping that this will lead her to conclude on her own that the animal need not be put to sleep. 3. Ask the client whether she has followed your directions and about the housebreaking problem and actively challenge her decision to euthanatize the dog, but agree to the euthanasia if she still wants it. 4. Aggressively challenge the client on her failure to treat the dermatitis and insist that she make some serious attempts to do so before you will agree to euthanatize the animal. 5. Ask the client whether she will board the animal at your facility temporarily and have you treat the skin condition and assess the housebreaking problem. 6. Decline to euthanatize the animal, and ask the client for permission to place
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it with an animal shelter for adoption or euthanasia, if the shelter cannot find a suitable owner. 7. Decline to euthanatize the animal, and ask the client to permit you to place it out for adoption. 8. Nicely tell the client that, although you can accept her desire to euthanatize the animal, it is against your personal principles to euthanatize pets with curable conditions and refer her to another individual or agency who will put her dog to sleep. 9. Tell the client that you think euthanatizing a curable animal is morally wrong and criticize her for her indifference to the life of her animal.
Some of these alternatives may well be unacceptable. That is not the point. The point is that, whatever your response to the client's request, you will be choosing only one or some of the possible alternatives. In so doing, you will be reflecting your views about what is proper for you to do, whether or not you entertain consciously all the alternatives you would not choose.
THE DIFFICULTY OF ETHICS If the morally correct decisions in veterinary practice were always obvious, the fact that there are usually many possible alternatives would not be troubling and would certainly not argue for a serious discipline of veterinary ethics of the human-companion animal bond. In almost anything we do, there are a number of alternatives we could choose, but many of the alternatives may be so obviously unacceptable that we need not consider them seriously. If an acquaintance approaches me on the street and says hello, a proper response is to return the greeting. That I might throw my briefcase in his face or cry out to a police officer "Thiefl Stop him!" or do any of a thousand other awful things does not mean that serious ethical deliberation regarding a proper response is justified. What makes veterinary ethics of the human-companion animal bond important is that it is often far from obvious how the practitioner should act. Several of the possible choices I have listed for our illustrative case have some force behind them. For example, it appears to be the client's fault that the dog's dermatitis has not improved, and the housebreaking situation may be attributable to her as well. If this is so, and if the dog's "problems" can be readily cured, one can argue with some plausibility that it would be unfair to the animal to deprive it of the opportunity to give and receive love and devotion from a more suitable owner. This argument appears stronger the longer the dog has been in our client's possession, for there is at least some plausibility in suggesting that a companion animal that has been taken care of and been a functioning member of a humananimal bond for some time deserves some extra consideration before it is killed at the whimsy of a now dissatisfied owner. But just saying even these things raises further questions. Should the client be responsible for treating the dog if doing so would be a significant financial expense? If so, how great an expense can she be expected to bear
under these circumstances? Is it unfair not to try to persuade the client, who might, with some education, make a good pet owner, to keep the animal? Should the practitioner, who has a business to run, take the time and money to attempt to place curable animals? Even if the dog should not yet be euthanatized, why should the veterinarian concern himself with attempting to save it? The client can take the animal elsewhere; by making a nuisance of himself, the practitioner may only risk losing other clients as well.
THE INESCAPABILITY OF ETHICS: PROTECTING THE PROFESSION Veterinarians should consider ethical issues because doing so may guide the way to morally correct choices. It is also generally in the profession's self-interest to take veterinary ethics seriously. Between 1981 and 1983, the number of lawsuits against veterinarians reported to the AVMA Professional Liability Insurance Trust increased by 20 per cent. 4° Courts and juries now award clients-including owners of companion animals-large sums of money. When a practitioner's behavior has been especially bad, in almost all jurisdictions, he may be forced to pay punitive damages (that is, money not to compensate the client but to punish the practitioner and make of him an example). Punitive damages frequently dwarf compensatory awards. 10 Under certain circumstances, some courts will now award owners of companion animals compensation for pain and suffering caused by a veterinarian's malpractice on their animals. 3 • 10 Such mental anguish can be considerable, and a sympathetic jury might assess an enormous award for it. Recently, the Supreme Court of one state recognized a new cause of action against veterinarians, holding that the practice of threatening to euthanatize an animal in the practitioner's possession unless the owner pays the bill can justifY a suit against the veterinarian for causing the owner emotional distress. 11 Around the country, there are lawyers seeking to expand the grounds on which veterinarians can be sued so that aggrieved clients, and their attorneys, will find suing veterinarians more rewarding. If the trend toward increasing legal liability of veterinarians continues, you will face significantly higher malpractice insurance premiums. There will be more emphasis upon defensive practice: more tests, more consent forms, more witnesses to important conversations with clients, and more attorneys to be consulted more frequently. The costs of such measures must be passed on to clients. An increasing number of companion animal owners will be unable to pay for veterinary services or may be forced to choose euthanasia as the only affordable alternative. In many court cases in which veterinarians have been found liable to owners of companion animals, and in most of the decisions that have expanded dramatically the legal exposure of practitioners, the aggrieved have charged the practitioner not just with failing to meet expected standards of technical competence, but with behaving unethically-with
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disregard or disrespect for the value of the human-companion animal bond to the client, the animal, or both. Attorneys who have sued veterinarians tell me that their clients often have felt aggrieved less by what they believe has been the veterinarian's incompetence than by what are perceived as excessive fees, by a practitioner's failure to take enough time with and to show a serious interest in the patient, by a practitioner's failure to understand the importance of the patient to the client, or by a practitioner's failure to treat the client like an adult who can understand what is wrong with his animal and who is capable of making an important decision by himself. Apparently, such complaints against veterinarians are not isolated. 2 Physicians know well the dangers of an insensitivity to ethics. Their malpractice crisis of recent years was not brought on by a sudden increase in incompetence, but by a distinct change in attitudes by many in the public who began to believe that too many doctors were treating them arrogantly, uncaringly, and unfairly. Today, ethics has been brought into the medical school curriculum, the hospital setting, and medical policy discussions-not just as a matter of morality, but as a matter of selfprotection. Veterinarians, in my view, face a far more ominous situation than have physicians. There are relatively few veterinarians (there are as many graduating from law schools each year as there are veterinarians practicing in the United States). The profession cannot muster even a small fraction of the funds and political clout available to organized medicine to defend itself in the courts, legislatures, and regulatmy bodies. Yet, veterinarians are threatened not only with a potential malpractice crisis of their own but also with sometimes politically effective critics who accuse the profession of immoral abuse of animals on farms, in industry, and in research laboratories. 20 • 37 Nor can the public's regard for the profession be helped by dissent from within that is so acrimonous that it might appear to the public more like warfare, as, for example, when the journal of the American Veterinary Medical Association bristles with letters from veterinarians accusing large segments of the profession of bad faith, 5· 9 or when local veterinarians sue a humane society to close down its competing veterinary facility. 38
THE PROFESSION'S RESPONSE: BENIGN NEGLECT The AVMA Principles of Veterinary Medical Ethics claims to "light the path to ... ennoblement" and to set forth "fundamental concepts and guidelines" for the profession. 17 The Principles do say a great deal, especially about the ethics of competition among practitioners. But the document fails to provide any guidance regarding almost all the fundamental moral issues involving the human-companion animal bond. Few issues are more basic than those concerning euthanasia of companion animals. Not only do the Principles fail to address these issues, the word "euthanasia" does not occur in the document even once! The Principles proclaim that it is not ethical rules but really "attitude that counts" and
that veterinary ethics is "based on the Golden Rule." 17 However, we are not told from what kind of "attitude" an answer regarding even our illustrative case would follow. Also, the notion that the Golden Rule can provide the foundation for veterinary ethics is unsatisfactory. That Rule directs one to "do unto others as you would have them to do unto you." Yet, the essence of a professional relationship, such as that between client and veterinarian, is that the parties to the relationship are not equal and cannot treat each other equally. This does not mean that the practitioner must or should treat the client as an inferior. It does mean that, in seeking professional (that is, expert), advice, the client recognizes that the practitioner exists to do for the client something he cannot do for himself. The Principles suggest that "the teaching of ethics and professional morals be intensified in the schools. " 18 To my knowledge, however, only two AVMA-accredited schools (my own has doubled the number) require all students to take separate formal instruction in veterinary ethics. The prevailing view is that ethics can be squeezed into available crevices in present courses. This reflects an attitude that ethics is not really a serious matter-that it can be taught entirely by clinicians with no training in ethical theory, and it need not be approached systematically, as a separate discipline with its own distinctive problems and methods. The suggestion that a veterinary school follow the lead of many medical schools and actually use its own money to support one full-time ethicist instead of another of many clinicians would be rejected as wasteful, even though ethics-related lawsuits and regulation threaten to cost even a graduate who is never found liable for malpractice tens of thousands of dollars over the course of his career. Nor will it do to allow someone else-a charitable foundation, a humane society, or a government agency-to pay for veterinary ethics. Such outside sources have their own axes to grind. They cannot be counted on to understand or represent the perspective and interests of practitioners in ethical discussion.
THE NEW ANIMAL RIGHTS PHILOSOPHERS: AN UNACCEPTABLE ALTERNATIVE Some veterinarians may be wary of supporting studies in veterinary ethics because they may identifY the discipline with the approach of academic philosophers like Bernard E. Rollin and Tom Regan. These thinkers, who argue for moral and legal "rights" for animals, want you to identify veterinary ethics with their views. They portray the field of moral philosophy as specialized as chemistry21 or surgery. 31 They remind you that they, and not you, are experts in this field. They urge you to let them train your students. 21 · 23 They ply you with unfamiliar kinds of arguments that,
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they assure you, show what you, as veterinarians, must do to make your profession truly worthy.* It is beyond the scope of this article to refute the major contentions of Rollin and Regan. What must be said here is that, in the opinion of others, many of their views are wrong and short-sighted. These things must be said in any realistic plea for professional support of veterinary ethics. For many veterinarians will, in fact, continue to see ethical studies as subversive to their interests and livelihoods unless they can be assured that a commitment to ethics need not involve a commitment to the views of a Rollin or Regan. (Even Rollin appreciates the fears of some veterinarians that his views would destroy the economic base of the profession when he argues, 34 erroneously, as I maintain here, that his proposals will bring more business and more respect to practitioners.) Rollin, for example, declares that his approach is based on the absence of morally relevant differences between people and animals and on the presence of morally relevant similarities-the presence of interests in animals, their ability to feel pleasure and pain, the fact that they, like people, have a biologically determined telos or nature. Ideally, then, we must conclude that animals have a basic moral right to life if people do, and furthermore, a basic moral right to live their lives in accordance with their natures, which we should infringe on only for the gravest of reasons and which should enjoy legal protection. 33
Rollin is not always completely clear about· what constitutes sufficiently grave reasons for infringing on the supposed natures of animals. When challenged, he often says things many would find acceptable (for example, that dogs should not be euthanatized because they do not fit in with the owner's new decorating scheme or cannot keep up any longer with the family jogger). 25 He then calls his more radical proposals an "ideal" or a "vector" that, although not realizable today, can play a role in improving the treatment of animals. 32• 33 However, if Rollin's claim that there are no morally relevant differences between humans and animals means anything, it must mean that an animal owner cannot, for example, choose a relatively inexpensive euthanasia for a pet over a very expensive cure unless choosing treatment would literally bankrupt the owner or threaten his ability to feed and clothe his children. (And, then, if there are no morally relevant differences between humans and animals, it is not clear why the owner should choose his child over his pet.) It must mean that the millions of *As a former professional philosopher, I think I can say with confidence that such claims about philosophical "expertise" are rarely made by philosophers to other philosophers, probably because there is far more disagreement among philosophers about ethics than there is among chemists about chemistry or surgeons about surgery. It should also be noted that a number of very prominent professional philosophers reject the kinds of arguments Rollin and Regan raise for widespread animal rights. 4• 13· 15· 16 Indeed, even Peter Singer, another professional philosopher, whose book Animal Liberation36 inspired much of recent animal activism, differs in major respects from Rollin and Regan. Singer, a utilitarian, does not believe in moral rights, either for animals or persons. Thus, the appeal of Rollin and Regan to their professional standing to convince veterinarians of the weight of their approach is misleading, whether or not their positions are better than those of their professional colleagues who disagree with them.
abandoned pets now, sadly, euthanatized must be maintained at untold expense unless doing so would have the "gravest" of consequences. Rollin's eagerness to enact his own moral views into law exposes most strikingly the danger of his approach to veterinarians and to the clients and animals they serve. Rollin dismisses warnings about the possible effects of permitting clients to recover in court for their mental suffering as "dire predictions" of the sort that were made for "universal suffrage and women's liberation. " 35 He insists that awards for clients' mental distress would raise the status of animals and, therefore, of veterinarians. 34 Whether such awards should be allowed is surely not an easy question. A relevant and important consideration is the likelihood that the unavoidable increase in veterinary fees resulting from increased malpractice premiums and awards will discourage many pet owners from obtaining adequate treatment, will force many others to choose euthanasia, and may well result in a decreasing role for veterinarians. Rollin also argues for legal "standing" for animals-that is, appointment of a legal guardian or representative to bring suits on behalf of an animal to recover money or other kinds of relief for it. 22 • 27 He concedes, as an afterthought and almost in passing, that such a development would be "inexpedient," "bothersome," and have "enormous" utilitarian costs. 28 But we cannot be so nonchalant about costs. Rollin does not care to discuss the impact his scheme would have on the ability of our already overburdened and failing court system. (In many states, a civil case takes more than 5 years to reach trial, which is longer than the lifespans of many of Rollin's intended beneficiaries.) Nor does he address the problems courts would have in attempting to assess the monetary value of an animal's pain and suffering, or injury to that animal. These things aside, however, suppose a legal guardian were appointed to represent a pet that its owner wants to euthanatize because he feels he cannot afford more extensive therapy. The owner, who is already short of funds, will have to engage legal counsel at significant expense. The veterinarian, who is caught between the demands of the owner and the legal representative, will also require an attorney to protect his interests. One can also imagine animal owners being sued because someone (Rollin suggests veterinarians as a possibility22) thinks they are not exercising, feeding, grooming, or loving their animals enough.* *An important example of what can happen when a well-meaning legally appointed representative steps in to assert the interests of a being against the wishes of those normally entrusted with its care is provided by the recent "baby Jane Doe" case on Long Island, New York. There, an attorney had himself appointed by a state court to represent an infant born with spina bifida and brought a legal action against her parents to compel a surgical procedure that the parents had refused to authorize. Subsequently, the United States Department of Justice sued the hospital at which the baby had been treated for her medical records, claiming that the child's civil rights might have been violated. The child's parents insisted that they loved her and were acting in her interests. Their decision ultimately proved correct medically. The state and federal courts have also found in the parents' favor. But the parents have been precluded from recovering any of the tens of thousands of dollars of legal fees spent in defending against the attorney as a condition of his ceasing his protracted litigation. The federal government, which expressed its concern over the civil rights of the baby, refuses to reimburse the parents for their legal expenses in the federal case on the grounds that the government sued the hospital and not the parents. One wonders how long the owners of a companion animal could persist against a zealous, legally-appointed guardian of their animal's rights who is intent on using every available legal forum.
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All of this will increase the costs and burdens of having a pet and of veterinary care and may ultimately discourage pet ownership and lead to the needless abandonment and euthanasia of animals. All of this in the name of elevating the legal status of animals! Rollin would have government determine how many animals someone may own and under what conditions; he would have government dictate "minimum standards of pet care"; and he would have government give examinations to and license all who want to have a pet, requiring that a potential owner demonstrate "fitness to have an animal, just as one must show fitness to adopt a child, and fitness to drive a car. " 26 Aside from its totalitarian aspects, this scheme would ultimately harm countless animals. Faced with the costs in money, aggravation, and inefficiency that would inevitably accompany such a massive licensing system, many who would make wonderful pet owners will simply decide not to have animals.
FOUR CENTRAL CONCERNS OF A VETERINARY ETHICS OF HUMAN-COMPANION ANIMAL INTERACTION The Moral Value of the Animal Among the tasks of a veterinary ethics of human-companion animal interaction will be to give the arguments of Rollin and Regan the consideration they do deserve. For now, I want to .highlight some of the central general concerns of veterinary ethics of human-companion animal interaction and to begin discussing several particular issues. The most fundamental concern of veterinary ethics is determining the moral value or weight of the veterinary patient, the animal. Rollin is surely correct that too many companion animals are not treated with the respect and value they deserve. However, it is not the case that there are no morally relevant differences between pets and humans, or, to use Regan's terminology, that humans and most mammals over 1 year of age have "equal inherent value." 19 No acceptable moral theory could prove this. In morality, as in science, certain basic principles or data are so fundamental that, if a process of argument denies them, we must conclude that there is something wrong with the argument. Among these basic givens is the fact that pet interests (and animal interests generally) must sometimes-indeed, often-give way to human interests. Based on these considerations, it would be wrong for a poor pet owner to let her child starve so that her dog can eat or to spend her life savings so that her elderly pet may live a few more months. It would be wrong for a pet owner who needs to live near work to forego a new apartment just because the smaller quarters will make vigorous exercise for her dog somewhat less frequent. It would be wrong for an animal lover to take in yet another stray animal if doing so will jeopardize his successful marriage. It would be wrong for society to somehow keep alive the millions of unclaimed and unwanted strays at the expense of programs to help human unfortunates. However, as philosopher Robert Nozick has noted, there has been
little persuasive thinking, even by academic philosophers, about where in the spectrum of moral value animals lie. Given that they are not our equals, and given that we cannot simply do with them as we like, how much do we owe them, and why? 14 These are difficult questions, and veterinary ethics must tackle them, because how an animal should be treated by client and veterinarian will turn, at least in part, upon the moral worth and value of the animal. In this respect, human medical ethics, for all its controversies, is much easier than veterinary ethics. Medical ethics can at least begin with the assumption that all human life is equally valuable. Simply proclaiming that animals have "rights" is not, I submit, the monumental step even some veterinarians apparently take it to be. Some philosophers are skeptical about any tendency to translate all moral discourse into the language of rights, in part because there is still great controversy about the proper analysis and substantive content of moral rights. 1• 12 More importantly, declaring that animals have rights of itself does nothing to clarifY what these rights might be and how strongly they might weigh against the rights of client, practitioner, and society. 1 There is, I believe, an added danger in an uncritical eagerness to proclaim the cause of animal "rights." Some of the activists have not only taken up the term "rights" as their slogan, but believe that this term is their exclusive property, not to be used by those who merely want to "regulate" how animals are treated. 7 As "rights" becomes identified with a particular (and, in my view, unacceptable) general approach, some may move uncritically from the rather modest-and probably correct-view that animals have some rights to a more radical approach than they would, on reflection, choose. Another reason we should oppose the attempt of activism to appropriate the term "rights" for its exclusive use is that some who cannot accept activism will wrongly assume that they should not speak about or explore the nature of animal "rights." An interesting article by Drs. Phillip C. Tillman and Dale L. Brooks provides an example of veterinarians who have yielded the notion of "rights" to their activist opponents. They accept their opponents' distinction between an animal "welfare" approach (which is "concerned about the conditions under which animals are kept and used and would like to improve the lot of animals") and an animal "rights" approach (which they see as "generally advocat[ing] the complete cessation of all human 'exploitation' of animals. ") 37 For those of us who reject activism, "rights" is simply too useful a concept to give up entirely. A concern for animal welfare does not preclude arguing that animals have some rights. The Moral Significance of Human-Animal Companionship
Most recent discussion concerning the moral value of animals has centered around the issue of their mental capacities. For Rollin and Regan, most mammals have certain moral rights because, in their view, these animals are as sophisticated mentally-with feelings, beliefs, desires, and interests-as a good many human beings (such as infants and the retarded), who are universally said to have moral and legal rights. Conversely, those who question the animal rights philosophers tend to dispute whether some
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or all animals do have the beliefs or interests6 or self awareness4 the animal rights philosophers claim for them. Perhaps because some activists have deliberately sought to challenge the preference of many in our society for our dogs and cats over other kinds of animals, there has been little discussion of the moral relevance of human-animal companionship. (For example, even when Rollin discusses the distinctive ways in which we interact with pets, he seems to base our moral obligations to these animals not so much on their individual interactions with humans as on what he believes has been the fashioning of the companion animal's biological nature into beings that are dependent on, and interact with, humans. 24• 29) Most of us believe that there is something special about an individual companion animal's interaction with humans, over and above its biological nature, which can give such an animal special and distinctive moral value. Even if pigs and poodles have comparable mental abilities, or even if pigs are smarter, we believe that we owe a good deal more to the family poodle, whose care and dependence we have willingly undertaken and which, unlike a pig, keeps us company, warns us of intruders, and plays with our children. We also believe that different companion animals of the same kind or breed (that might have the same "nature") may be owed different treatment depending upon their individual interactions with people. These things are obvious. What is not so clear is the extent to which such factors, and other factors, obligate us to treat our pets in certain ways. For example, I would be inclined to say that the client in our illustrative example has a stronger obligation to try to cure the dog's skin and behavioral problems the longer she has had the animal, and I am inclined to say that the more affectionate and devoted the animal, the stronger the obligation. However, I am not clear about why these things are so or about how far they do push our client's moral obligations. I would like to say that, over time, the dog has become "used" to being cared for and that the owner has herself fostered a "dependence," but I am not sure these notions can be attributed to even the most intelligent dog. I would also like to say that loyal and affectionate pet often deserves better treatment than a nasty one. However, I am not sure that a pet consciously decides to be nice, and I am left with the unsettling possibility of according stronger moral claims to an animal whose natural temperament might make it nice than to another animal, not at "fault," that is just naturally nasty. The Practitioner's Response to a Conflict of Interests Ideally, a practice decision will benefit the patient, the client, and the practitioner. However, this cannot always be the case. The animal and the client can have conflicting interests-as, for example, when an expensive procedure can cure the animal but will cause great financial burden to the client, or when the animal would be best served by a quick and painless euthanasia but the client desperately wants to keep the animal alive as long as possible. Also, it is not a secret that the veterinarian has legitimate interests that can conflict with the interests of the animal or client-as when the financial demands of the practice argue against offering a service at a reduced price for a particular client.
A third central general concern of veterinary ethics of human-companion animal interaction must be exploring how the practitioner should respond to the sometimes conflicting legitimate interests of the animal, the client, and himself. Under what circumstances, if any, should the practitioner be an advocate for the animal and resist the wishes or inclinations of the client? Under what circumstances should the practitioner bend economic or other practice considerations to accommodate the needs of client or patient? (A more general question, which has yet to surface in the AVMA Principles but has long concerned the legal profession, is whether practitioners have an obligation, or should at least be encouraged, to provide low or no-cost services to the disadvantaged.) It would be hard enough to settle such conflicts if all one had to do was to determine and then resolve the legitimate interests of patient, client, and veterinarian. However, these potential conflicts-indeed, many problems in veterinary ethics-are complicated by a number of other kinds of considerations that can limit the range of ethical choice. Among these considerations are promises made by you to your client. If, for example, you assure your client that you will euthanatize his animal, you have committed yourself to accommodate the client's perceived interests; this decision carries strong moral weight, even if a good argument could be made that you never should have agreed to euthanatize this particular animal. The most important complicating factor in veterinary ethics is the law. For example, some of my students ask whether the practitioner "works for the client or for the animal." In most circumstances, the law says that you work for the client (an exception would be the unlikely instance in which the client requests a procedure that would violate the anti-cruelty to animals or some other applicable animal welfare statute). This means that if you agree, for example, to euthanatize an animal at the client's request but then give the animal to a friend because you think this is really in the animal's best interests, you can get yourself in very serious legal trouble. Of course, particular legal requirements can be morally bad; veterinary ethics can legitimately ask whether certain laws should be changed or even disobeyed. (I have heard practitioners admit that they feel justified in not always euthanatizing animals they have agreed to put down, and several have told me that they believe they have a moral right to treat wild animals such as raccoons even where it is illegal for their clients to possess, and for veterinarians to treat, these animals.) Because the consequences of disobeying the law can be severe, however, it is a foolhardy veterinarian who, in asking what he ought morally to do in a particular situation, does not first ask whether the law attempts to restrict his alternatives. The Practitioner's Role in the Client's Decisions I want to conclude by considering a fourth central concern of a veterinary ethics of human-companion animal interaction: the proper role of the practitioner in the client's decisions. Some practitioners 8 have expressed the opinion that the best course of action should be determined by the veterinarian, who will then guide the client toward making this choice by presenting the facts to the client in
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such a way to make this decision virtually inevitable. One technique sometimes recommended to assure that the "right" decision is made (and that the client believes he has made this decision) is to paint an especially bleak (but not inaccurate) picture of the effects of the wrong alternatives and then to offer the client the positive effects of the decision the practitioner prefers. I do not mean to question the motives of those who urge this approach, for they clearly want to do what is best for client and animal alike. It seems to me, however, that this approach mistakenly identifies a professional's being concerned about ethics with his being entitled to make the decisions. As we have seen, even if veterinarians received training in ethics, the field needs more more work before anyone-practitioner, client, or ethicist-can feel very confident about how to decide many of the hard issues. Moreover, veterinarians are not trained in human psychology. Nor would the few minutes you usually spend with a client qualify even a psychologist to know very much about the client or his family and the precise nature of their relationship with their animal. Your knowledge of the animal's condition may well enable you to direct the client's attention to matters that the client would not think of on his own. But you simply cannot presume to know enough to order the alternatives, much less to make the client's decision for him. Indeed, it is largely the attitude that the practitioner knows more about the client's needs than does the client himself that has turned so many people against physicians and has made much of the practice of medicine a legal nightmare. This is an attitude that veterinarians would do well not to emulate. However, even if veterinarians could ever know better than clients what is in their and their animal's best interests, I would urge you not to orchestrate your clients' decisions. In the majority of cases, and therefore, as a general rule, the client is entitled to make the decision, even if he would make the wrong decision. The client has undertaken the care of the animal, he has made the personal and financial sacrifices, he has arranged his life and that of his family around, and with, that of his animal. Having made these commitments and decisions, he is entitled to decide, without subtle psychological manipulation from a stranger who will not have to live with the decision, how his life and that of his family will proceed in the future. But there is more here than the legitimate rights and expectations of the client. We do need to think more clearly about how the humancompanion animal bond should be characterized (and psychological and ethologic work on the bond should be of immense assistance to ethical studies). However, we know that both parties to the bond express something that is, at the very least, analogous to trust, reliance, and confidence. For example, I know that my Yorkie Phillip trusts me to throw him into the air in play but will not trust strangers to do so, and I know that when he barks to me and not to others for his dinner or for his walk, he understands we have a relationship he does not share with others. Perhaps it would be inappropriate to say that he has "entrusted" me with his care (although I am not at all sure we cannot say this) and that this gives me, and not the
veterinarian, a special claim to make decisions regarding his welfare. It is surely appropriate to say that my dog and I have established a pattern of exclusive interaction that not only makes it likely that I will want to do what is in his interests but that entitles me to judge, for both of us, how matters of health or illness should affect the relationship.* These principles should not be obscured by complaints about how many people treat their pets too poorly to be entrusted with their welfare. 25 • 26 • 29 That animals are abandoned or mistreated speaks ill for those who would do this, not for the vast majority of your clients, for whom the human-companion animal bond is an essential part of their daily lives. Moreover, the way to educatt those who would abuse their animals is not, surely, to make their decisions for them. This approach can only encourage a lack of seriousness and concern. What you should attempt to do is to present to the client, noncoercively whenever humanly possible, the medically feasible alternatives and their likely effects. This does not mean that you should never express your opinion about what would be best for the animal or client. You should not hesitate to correct the client if he underestimates or fails to understand what is likely to happen given certain choices; nor should you be precluded from expressing ethical disagreement about the client's choice, or, on occasion, from declining to do what the client requests. As I have indicated, however, determining when you should do these things is one of the more difficult unanswered questions of veterinary ethics. Where possible, however, you should strive to allow the clients to make their own informed decisions, assisting them· primarily with your medical knowledge. t To apply subtle pressure or guidance is sometimes tempting, especially when you are genuinely concerned for the client and his animal and do not want the client to make a mistake. It is difficult not to stress the bad effects of a wrong decision when you have little time to spend with the client. It *Note, again, how staking out a position in veterinary ethics invariably raises a host of questions. There are certain companion animals, such as birds and probably cats, with whom humans communicate less, or at least in a different way, than they communicate with dogs. Does this mean that the client's right to decide-as well as other ethical matters-must be justified on different grounds for different kinds of companion animals? tThe paternalistic view that practitioners should guide clients' decisions would probably be in accord with legal requirements for obtaining an informed consent if the approach were adopted by the profession generally. There is as yet little explicit law on the requirements for an informed consent in veterinary practice. Although some courts have held that a human medical patient is entitled to be told what a reasonable patient would find material to making a decision, most states, by statute or court decision, adhere to the rule that a physician need disclose what an ordinarily competent, reasonable, and prudent physician would disclose under the circumstances. It could be argued that the legal status of companion animals as property would either require veterinarians to disclose less than physicians (because the patient is not a person but property) or more (because the owner of property generally has full dominion and control over it). At least until the courts focus more directly on informed consent in veterinary practice, they are likely to apply to veterinarians the informed consent standards applicable in their jurisdictions to physicians. However, any informed consent standards constitute a minimum of required disclosure. Thus, even if veterinarians who followed the paternalistic approach would ever meet the minimum legal requirements for obtaining informed consent, practitioners would be legally free to tell their clients more and to follow the approach recommended here.
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is difficult to resist a client's request that you tell him what to do. It is sometimes difficult to explain the facts to a relatively unsophisticated client or to one who cannot bear to accept your prognosis. Also, there are legitimate fears that you will be blamed, perhaps even sued, when the client makes a decision you know will be disastrous. As is so often the case in ethics, saying these things raises still more questions. There are many issues regarding how a practitioner can be concerned and noncoercive that veterinary ethics must address. How, for example, should one approach a client who refuses to understand how ill his animal is or who appears to be too distraught to think clearly? Are there certain circumstances in which the practitioner is justified in guiding the decision (for example, a situation in which the client might be so unsophisticated or infirm and there is no family member or friend to assist in the decision making)?
CONCLUSION I have discussed, in a preliminary fashion, only some of the most important issues that must be faced by a veterinary ethics of the humancompanion animal bond. Much work needs to be done, not-as some would have it-because your profession has been unworthy, or because you have not really been good to animals, or because most of the moral choices you make are bad ones. There is a growing realization by science, by the public, and by the law, of the importance of the human-companion animal bond. This realization has led some to question current moral assumptions. As the profession concerned with the care and welfare of companion animals, veterinary medicine is becoming the target of many of these questions. Will you respond? Will you engage in serious ethical thinking that clarifies, informs, and proclaims the values of your profession? Or will you turn aside and let those who cannot speak as you can for your profession and for the clients and animals you serve prevail by default? These questions are provocative. They are also unavoidable. ACKNOWLEDGMENTS I wish to thank Drs. Donald Abt and Victoria L. Voith for their helpful criticism and suggestions.
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delivered to a pet cemetery for a funeral, but on arrival at the cemetery discovered a dead cat in the casket. Feinberg, J.; Human duties and animal rights. In Feinberg, J.; Rights, Justice, and the Bounds of Liberty. Princeton, New Jersey, Princeton University Press, 1980, p. 197, conceding that animals can sensibly be said to have some rights, but maintaining that, although animals "do qualifY for a certain moral respect ... the higher kind of dignity that precludes even humane use as mere instruments requires a level of rational awareness that animals cannot achieve." Fox, M.: Letter, J. Am. Vet. Med. Assoc., 182:1314-1315, 1983, charging the veterinary profession with "compromising its ethics" and "demean[ing] ourselves by devaluing our animal charges-in allowing them to endure undoubtedly harmful procedures on the grounds of utility, and so to do to them, in the name of education, what the medical profession would never do to their human charges." Frey, R. G.; Interests and Rights: The Case Against Animals. Oxford, England, Clarendon Press, 1980. Holzer, H. M.; Editor's comment. Animal Rights Law Reporter, April1983, pp. 14-15. Hopkins, A. F.; Ethical implications in issues and decisions in companion animal medicine. In McCullough, L. B., and Morris, J. P. (eds.); Implications of History and Ethics to Medicine--Veterinary and Human. College Station, Texas A & M University Press, 1978, pp. 107-114. Kesel, M. L.; Letter, J. Am. Vet. Med. Assoc., 183:35, 1983, accusing "food animal veterinarians" and the AVMA Animal Welfare Committee of "pure pandering and propagandizing for agribusiness" and "making apologies for questionable practices." Knowles Animal Hospital, Inc. v. Wills, 360 So. 2d 37 (Fla. 3d DCA 1978), in which the hospital corporation, but not the practitioner-owner, was found liable for $1000 compensatory and $12000 punitive damages when, following an operation, plaintiffs dog was (in the words of the court) "placed on a heating pad in a cage and permitted to remain thereon in the hospital for a day and the better part of a second day with an absence of care or attention." Lawrence v. Stanford, 665 S. W. 2d 927, 930 (Tenn. 1983), remanding to the trial court for a trial on the merits of the plaintiffs complaint; holding that threatening to "do away with" the client's dog "as the doctor sees fit" with the. intention of inducing mental distress in the client to encourage him to raise the money to pay the bill "is outrageous and extreme and is not tolerable in a civilized society." Midgley, M.; Animals and Why They Matter. Athens, University of Georgia Press, 1983, pp. 61-64. Narveson, J.; Animal rights revisited. In Miller, H. B., and Williams, W. H. (eds.): Ethics and Animals. Clifton, New Jersey, Humana Press, 1983. Nozick, R.: About Mammals and People, Review of Regan, T., The Case for Animal Rights. New York Times Book Review, November 27, 1983, pp. 11, 29. Nozick, R.: About Mammals and People, Review of Regan, T., The Case for Animal Rights. New York Times Book Review, November 27, 1983, p. 29, stating that although animals "do have some inherent value and hence may not be treated any way anyone might please ... their inherent value is not equal to that of people." Passmore, J.; The treatment of animals. Journal of the History of Ideas, 36:212, 1975, asserting that although we do not have unlimited rights to do what we like to animals, "animals cannot have rights." Principles of Veterinary Medical Ethics. Schaumburg, Illinois, American Veterinary Medical Association, 1983, p. 2. Principles of Veterinary Medical Ethics. Schaumburg, Illinois, American Veterinary Medical Association, 1983, p. 4. Regan, T.; The Case for Animal Rights. Berkeley, University of California Press, 1983, 235ff. Regan, T.: The Case for Animal Rights. Berkeley, University of California Press, 1983, p. 390. Regan, T.; Veterinary medical ethics: Between a rock and a hard place. J. Vet. Med. Ed., 9:115, 1983. Rollin, B. E.: Animal Rights and Human Morality. Buffalo, Prometheus Books, 1981, pp. 81-82.
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23. Rollin, B. E.: Animal Rights and Human Morality. Buffalo, Prometheus Books, 1981, p. 117. 24. Rollin, B. E.: Animal Rights and Human Morality. Buffalo, Prometheus Books, 1981, pp. 155--157. 25. Rollin, B. E.: Animal Rights and Human Morality. Buffalo, Prometheus Books, 1981, p. 158. 26. Rollin, B. E.: Animal Rights and Human Morality. Buffalo, Prometheus Books, 1981, p. 168. 27. Rollin, B. E.: The legal and moral bases of animal rights. In Miller, H. B., and Williams, W. H. (eds.): Ethics and Animals. Clifton, New Jersey, Humana Press, 1983, p. 115. 28. Rollin, B. E.: The legal and moral basis of animal rights. In Miller, H. B., and Williams, W. H. (eds.): Ethics and Animals. Clifton, New Jersey, Humana Press, 1983, p. 118. 29. Rollin, B. E.: Morality and the human-animal bond. In Katcher, A. H., and Beck, A. M. (eds.): New Perspectives on Our Lives with Companion Animals. Philadelphia, University of Pennsylvania Press, 1983, pp. 505--508. 30. Rollin, B. E.: Morality and the human-animal bond. In Katcher, A. H., and Beck, A. M. (eds.): New Perspectives on Our Lives with Companion Animals. Philadelphia, University of Pennsylvania Press, 1983, p. 507 31. Rollin, B. E.: The Teaching of Responsibility. London, England, UFAW, 1983, pp. 9-10. 32. Rollin, B. E.: The Teaching of Responsibility. London, England, UFAW, 1983, p. 23. 33. Rollin, B. E.: Veterinary ethics and animal rights. Calif. Vet., 37(1): 12, 1983. 34. Rollin, B. E.: Veterinary ethics and animal rights. Calif. Vet., 37(1):13, 98, 1983. 35. Rollin, B. E.: Veterinary ethics and animal rights. Calif. Vet., 37(1):98, 1983. 36. Singer, P.: Animal Liberation. New York, Avon Books, 1977. 37. Singer, P.: Animal Liberation. New York, Avon Books, 1977, pp. 70-71. 38. Southampton Roads Veterinary Association, et al. v. Virginia Beach S.P.C.A., Inc., et al., Virginia Court of Chancery, C81-181, 1981. 39. Tillman, P. C., and Brooks, D. L.: Animal welfare, animal rights, and human responsibilities. Calif. Vet., 37(1):33, 1983. 40. Williams, L.: Malpractice suits escalating. D.V.M., 14(10):1, 1983. Department of Environmental Studies Tufts University School of Veterinary Medicine 203 Harrison Avenue Boston, Massachusetts 02111