Os tênues limites entre o direito de viver e o direito de morrer: a perspectiva acadêmica, jurídica e bioética dos cuidados paliativos em animais de estimação / Els tènues límits entre el dret a viure i el dret a morir: la perspectiva acadèmica, legal i bioètica de les cures pal·liatives per a animal de compañía / Los tenues límites entre el derecho a vivir y el derecho a morir: la perspectiva académica, legal y bioética de los cuidados paliativos para animal de compañía / The tenuous limits between the right to live and the right to die: an academic, legal, and bioethics perspective of palliative care in pets

Os cuidados paliativos (CP) de animais de estimação constituem um tema emergente na Medicina Veterinária se caracterizando como uma alternativa terapêutica para a eutanásia precoce. Objetivou-se mapear a perspectiva, critérios, procedimentos e referenciais éticos e científicos dos CP e da eutanásia em animais de estimação, testando a hipótese de diferenças nas perspectivas da eutanásia e dos CP, bem como entre os cenários nacional e internacional. Para tal, realizou-se uma revisão bibliográfica integrativa da produção científica e um recorte de análise jurisprudencial a respeito dos reflexos jurídicos na atividade médico-veterinária. A revisão integrativa resultou em 535 artigos, dos quais 43 atenderam aos critérios de inclusão, acrescida de 800 ementas, as quais 30% foram relativas a ações indenizatórias contra serviços e médicos veterinários. Os dados obtidos, sob o recorte proposto na pesquisa, permitiram caracterizar a abordagem científica dos CP e da eutanásia, bem como lançar trilhas interpretativas de como os aspectos funcionais e perspectivas de aplicação podem subsidiar as decisões da equipe médica veterinária e dos responsáveis pelos animais. Contudo, para superação das limitações e a consolidação das potencialidades dos CP se faz necessário um esforço multidimensional, incluindo a esfera normativa, técnica, social e ética.Vislumbra-se o acolhimento da questão nas pautas da Bioética sugerindo que seja performada no espaço multidisciplinar do Comitê de Bioética Hospitalar Veterinário, com intuito de auxiliar na deliberação de decisões conflituosas, considerando o direito de proporcionar uma vida digna ao animal e, consequentemente, mitigando vulnerabilidades comprometedoras do direito de viver e de morrer.(AU)

Los cuidados paliativos (CP) de las mascotas es un tema emergente en medicina veterinaria que constituye una alternativa terapéutica para la eutanasia temprana. Nuestro objetivo fue avaluar la perspectiva, los criterios, los procedimientos y las referencias éticas y científicas de los CP y la eutanasia en las mascotas, probando la hipótesis de las diferencias en las perspectivas de la eutanasia y los CP, así como entre los escenarios nacionales e internacionales. Con este fin, se realizó una revisión bibliográfica integradora de la producción científica y un recorte del análisis jurisprudencial de los reflejos legales en la actividad médica veterinaria. La revisión integradora dio como resultado 535 artículos, delos cuales 43 cumplieron con los criterios de inclusión, más 800 resúmenes de procesos, que el 30% estaban relacionados con acciones de indemnización contra servicios veterinarios y médicos. Los datos obtenidos, bajo el recorte propuesto en la investigación, se permiten caracterizar el enfoque científico de CP y eutanasia, así como lanzar senderos interpretativos de cómo los aspectos funcionales y las perspectivas de aplicación pueden subsidiar las decisiones del equipo médico veterinario y aquellos responsables de animales. Sin embargo, para superar las limitaciones y la consolidación de las potencialidades de CP, se requiere un esfuerzo multidimensional que incluya la esfera normativa, técnica, social y ética. Se vislumbra la recepción del problema en la agenda de la bioética, lo que sugiere que se realiza en el espacio multidisciplinario del Comité de Bioética del Hospital Veterinario para ayudar en la deliberación de las decisiones de conflicto considerando el derecho a proporcionar una vida digna al animal y, en consecuencia, mitigando las vulnerabilidades comprometedoras del derecho a vivir y morir.(AU)

Palliative care (PC) of pets is an emerging theme in veterinary medicine constituting a therapeutic alternative for early euthanasia. Our objective was to map of the perspective, criteria, procedures and ethical and scientific references of PC and euthanasia in pets, testing the hypothesis of differences in the perspectives of euthanasia and PC, as well as between the national and international scenarios. Thus, an integrative bibliographic review of scientific production and a cut of jurisprudential analysis of legal reflexes in veterinary medical activity was performed. The integrative review resulted in 535 articles, of which 43 complied with the inclusion criteria, agree with 800 actions, which 30% were related to indemnity actions against veterinary services. The data obtained,under the profile proposed in the research, allowed to characterize the scientific approach of PC and euthanasia, as well as launch interpretative trails of how functional aspects and prospects of application can subsidize the decisions of the veterinary medical team and those responsible for animals. However, to overcome the limitations and the consolidation of PC potentialities, a multidimensional effort is required including the normative, technical, social and ethical sphere. We discern the reception of the issue in the agenda of bioethics suggesting that it is performed in the multidisciplinary space of the veterinary hospital bioethics committee to assist in the deliberation of conflict decisions considering the right to provide a dignified life to the animal, and consequently, mitigating compromising vulnerabilities of the right to live and die.(AU)

Managing conflicting ethical concerns in modern small animal practice-A comparative study of veterinarian's decision ethics in Austria, Denmark and the UK.

Small animal veterinarians frequently have to manage conflicting interests. Beside the key consideration of the patient's interests, small animal veterinarians are often challenged to consider not only client's emotional needs, but also their own personal aspirations to provide quality patient care and to make a good living as a professional. Further, veterinarians have an interest in continuous professional development and the use of the newest treatments, which may influence their decision-making process. Based on published work, we hypothesize the existence of four decision ethics orientations that veterinarians can use to manage potentially conflicting concerns. These are: the patient-focused, the client-empathetic, the client-devolved and the development-oriented decision ethics orientations. We surveyed small animal veterinarians in Austria, Denmark, and the UK using a questionnaire (N = 648), and successfully identified the four decision ethics orientations in all three countries. The patient-focused and client-empathetic decision ethics orientations are salient in all countries, whereas Danish and UK veterinarians are slightly more client-empathetic and client-devolved compared to their Austrian colleagues. Across countries our findings show that experienced and older veterinarians tend to be more client-empathetic. Younger and less experienced professionals are more development-oriented compared to their older and more experienced colleagues. In contrast to other studies investigating ethical issues in small animal practice, we found no evidence that gender plays a decisive role in the tendency towards any decision ethics orientation. We also show that veterinarians with a higher client-empathetic orientation and development-orientation more often discuss the possibility of health insurance with clients who do not have it. The present study provides a first empirical insight into how veterinarians manage challenging expectations and ethical concerns as part of decision making in modern small animal practice.

Telling their own stories: Encouraging veterinary students to ethically reflect.

BACKGROUND: Veterinary practice raises complex and unique professional ethical dilemmas. There is increasing discussion of how best to deliver ethics education to veterinary students, so that they are fully prepared to address ethical conflicts in professional practice. This paper proposes the use of innovative methods to allow students to share and reflect on their own experiences of ethical dilemmas. METHODS: Two innovations are described. The first is formal and compulsory, and involves a small-group facilitated session for final year students, wholly designed around student dilemmas. The second is informal and voluntary, and constitutes a short-story writing competition. RESULTS: The methods described are conducive to student engagement in ethics and ethical reflection. CONCLUSION: Veterinary schools should consider adopting student-led techniques, deliberately designed to allow students to tell their own stories. Similar methods could also be adapted for use in clinical practice, thereby creating opportunities for professional dialogue on ethical dilemmas.

Historical Perspective of Euthanasia in Veterinary Medicine.

The history of companion animal euthanasia includes a blend of good and bad methodology, the shifting landscape of the human-animal bond, and maturation of the veterinary euthanasia experience. Time has shown us that critical exploration of what once was acceptable will lead the way to modern best practices. Animal welfare remains at the heart of the procedure, with equally matched attention now given to client and veterinary team well-being. Although euthanasia will continue to evolve, it is clear through the twenty-first century advancements, a tipping point of necessary change is upon us.

Ethical dilemmas in clinical practice: a perspective on the results of an electronic survey of veterinary anaesthetists.

Medical progress has greatly advanced our ability to manage animals with critical and terminal diseases. We now have the ability to sustain life even in the most dire of circumstances. However, the preservation of life may not be synonymous with providing 'quality of life', and worse, could cause unnecessary suffering. Using the results of an electronic survey, we aim to outline and give examples of ethical dilemmas faced by veterinary anaesthetists dealing with critically ill animals, how the impact of these dilemmas could be mitigated, and what thought processes underlie decision-making in such situations.

Blame and shame in the veterinary profession: barriers and facilitators to reporting significant events.

Significant event reporting is an important concept for patient safety in human medicine, but substantial barriers to the discussion and reporting of adverse events have been identified. This study explored the factors that influence the discussion and reporting of significant events among veterinary surgeons and nurses. Purposive sampling was used to generate participants for six focus groups consisting of a range of veterinary professionals of different ages and roles (mean N per group=9). Thematic analysis of the discussions identified three main themes: the effect of culture, the influence of organisational systems and the emotional effect of error. Fear, lack of time or understanding and organisational concerns were identified as barriers, while the effect of feedback, opportunity for learning and structure of a reporting system facilitated error reporting. Professional attitudes and culture emerged as both a positive and negative influence on the discussion of error. The results were triangulated against the findings in the medical literature and highlight common themes in clinician's concerns regarding the discussion of professional error. The results of this study have been used to inform the development of the 'VetSafe' tool, a web-based central error reporting system.

Care as an Alternative to Euthanasia? Reconceptualizing Veterinary Palliative and End-of-life Care.

Palliative care is routinely offered to humans in the United Kingdom, while euthanasia remains illegal. The converse is true for nonhuman animals (henceforth animals). Indeed, euthanasia is widely accepted as the appropriate course of action for "suffering" animals, and for those whose behaviors or suspected ill health are thought to pose a threat to others. This article details examples of nonhuman death at a multi-faith ashram whose members vehemently oppose all forms of killing on religious grounds. Through exploring their efforts in palliative care for animals, and their emphasis on natural death as a means of respecting the sanctity of life, the practical, emotional, and theoretical viability of caring for, instead of killing, other animals at the ends of their lives is considered. In the process, normative distinctions between different categories of animals, (including humans), and different approaches to end of life care (palliative care, euthanasia, natural death) are called into question. Indeed, paying mindful attention to the diverse ways in which individual animals are cared for as they die reveals the potential violence inherent in both palliative care leading to natural death, and euthanasia, blurring perceptions of good and bad death in both veterinary and human medicine.

VETERINARY STUDENTS' OPINIONS ON THEIR REQUIRED COMPETENCE IN DEALING WITH WELFARE AND ETHICS ISSUES PERTAINING TO WILDLIFE.

The aim of this research was to determine what veterinary students in Australia and New Zealand consider important for animal welfare and ethics (AWE) competence when dealing with wildlife, and to determine how these priorities correlate with gender and stage of study. These students were asked to state their gender and stage of veterinary education and to rank the importance of six AWE topics: (1) "disaster preparedness," (2) "veterinarians' duties to wild animals," (3) "methods and justification for wild animal use" (e.g., harvesting/ hunting, wildlife parks), (4) "tensions between animal-welfare concerns and environmental concerns," (5) "the nature and status of semiowned animals," and (6) "euthanasia," pertaining to wildlife for competence on the first day after their graduation. Data were then analyzed. Of 3,320 students invited to participate, 556 responded to questions about animals in the wild. The AWE topic ranked as the most important was "veterinarians' duties to wild animals," followed by "euthanasia." Senior students ranked "euthanasia" as the most important topic. The rankings of "methods and justification for wild animal use" and "tension between animal welfare and environmental concerns" were significantly less important for students in the later years of study than for those in early years. Male respondents ranked "euthanasia" as more important than female respondents did, especially in later years of study. Senior veterinary students ranked "euthanasia" as the most important AWE topic for day one competency.