Ethics is a complicated concept, using the idea of drawing from many viewpoints to decide what is morally right or wrong. The BBC (2014) described ethics to be a set of moral principles guiding identification of what is good for individuals and society as a whole. When thinking about ethics in veterinary practice, the individuals thought of would be the patients and the society would be the clients and the general public. Busch (2008) defined veterinary ethics as that which is concerned with animal rights and welfare and modelled to create a Professional Code of Conduct, guiding professionals in their day to day work.
Ethical frameworks
Although there are no veterinary specific ethical frameworks, there are several frameworks used in human medicine that can be applied to veterinary medicine. Of these frameworks, perhaps the most widely used in veterinary medicine is the ‘four principles of biomedical ethics’ (UK Clinical Ethics Network, 2015a). The four principles include autonomy, beneficence, non-maleficence and justice.
Applying this ethical debate, the euthanasia of aggressive dogs, to the four principles of biomedical ethics it is easy to come to the conclusion that the practice is unethical. Euthanasia does not benefit the patient, it does not prevent them from harm and it does not allow for autonomy and justice. Using the earlier definition of ethics, as discussed by the BBC (2014), it could be argued that the reason for acceptance of the euthanasia of aggressive dogs within the veterinary profession is to enable the profession to meet its need to protect the public.
The NHS Scotland (2015) discussed several recognised ethical theories that are particularly applicable to human health care. These included deontology, virtue ethics and consequentialism (NHS Scotland 2015).
The most well known deontological theory is that of Kantianism, where rules a person should obey and the duties a person should follow are used to justify an act (UK Clinical Ethics Network, 2015b). If this theory is applied to the ethical scenario involving euthanasia of an aggressive dog it can be seen that the veterinary surgeons (VSs) and VNs involved will be acting ethically if they are following their duties and obeying their governing rules. The Code of Professional Conduct for VSs and VNs gives guidance for this and will be discussed in greater detail later in the article.
The consequentialist theory includes several subtheories, the most influential being utilitarianism, where the correct action to take in any morally-challenged situation is the one that produces the greatest happiness for the greatest number of people (UK Clinical Ethics Network, 2015b). With respect to the euthanasia of aggressive dogs this is perhaps not the most useful ethical theory as any action taken is unlikely to promote a feeling of happiness to those involved.
The concept of virtue ethics is often described to demonstrate moral character, where decisions and actions are based on this moral character (Hursthouse, 2012). Mullan (2006) suggested that those who are morally good people will naturally act in a moral way. Mullan (2006) goes on to describe the qualities often possessed by healthcare workers including compassion and fairness. However, it could be argued that despite most people possessing these qualities, not everyone in the profession can be assumed to possess them.
How do ethics affect the veterinary nurse?
Since the first VNs, known as Registered Animal Nursing Auxiliaries, began training in 1961, the VN role has changed significantly, with nurses recently becoming accountable for their actions as set out by the Royal College of Veterinary Surgeons' (RCVS) Code of Professional Conduct (Pullen, 2006). The RCVS (2012a) Code of Professional Conduct provides guidance for VNs, ensuring that they know what is expected of them in their job role and understand what they should be aiming to achieve. This code of conduct, used in conjunction with an ethical framework, can be very helpful when dealing with ethical dilemmas in practice.
Changes to the Dangerous Dogs Act 1991
In addition to being mindful of the ethical dimensions it is also important to consider the legal framework. As discussed by Lacey (2014), amendments to the Dangerous Dogs Act 1991 include new legislation stating that it is now a criminal offence to allow a dog to be out of control in England or Wales, including while on private property. This was called for after it became apparent there was a rising number of dog attacks occurring in the UK each year. Prynne (2013) reported for The Telegraph that there had been 17 deaths in the UK due to dog attacks since 2005. Prynne (2013) also stated that the numbers of dog attacks on people had risen in the last 5 years with 6302 people requiring hospitalisation between 2012 and 2013.
One of the main provisions of the Dangerous Dogs Act 1991 is to allow for a destruction order to be taken out by relevant authorities in order to euthanise a dangerous dog. In this instance the VS will require a formal order from the appropriate statutory authority (RCVS, 2012b).
If euthanasia is requested by the owner, destruction of a dangerous dog is decided on based on the severity of any incidences, the ability of the owner to act responsibly and keep the dog under appropriate control in the future, the dog's temperament, and whether any prevention techniques can be implemented, for example muzzling in public and improving lead control (Lacey, 2014).
Canine aggression as a mental illness
It is becoming increasingly accepted by professionals to refer to canines with aggression problems as suffering a mental health illness. There are many types of canine aggression constituting mental illness, including fear, play, redirected, pain, predatory and maternal aggression (Landsberg, 2014). Greenfield (2013) discussed the need for mental stimulation in canine patients to help prevent a stress response. While Greenfield (2013) referred to the use of mental stimulation to reduce stress in hospitalised patients, the concept could also be applied to a home environment.
Euthanasia and the law — where do VNs stand?
The two types of law VNs need to be concerned with are criminal and civil. Criminal law deals with punishments associated with offences of the state, whereas civil law focuses on individuals and the loss or harm they suffer (Gray and Wilson, 2006). For VNs, breaching a legislative act, such as the Veterinary Surgeons Act 1966, would be punishable under criminal law (Crump, 2013). On the other hand, an act of negligence may result in civil charges if damage to a client's property, the patient, occurs (Crump, 2013).
As discussed by Crump (2013), VNs are unlikely to incur any criminal charges through assisting euthanasia, and even performing it. As described in the RCVS Code of Professional Conduct (2012a) euthanasia is by law not considered an act of veterinary surgery and may be carried out by anyone, as long as it is done in a humane way. However, VNs should be aware of the possible civil consequences when assisting with euthanasia. Pets are considered as an owner's property, therefore euthanasia without consent could result in loss to the owner, for which a VN could be held accountable (Crump, 2013).
VNs are encouraged to take guidance from the RCVS Code of Professional Conduct (2012a) while working within their job role requirements as stated by the Veterinary Surgeons Act 1996. As discussed by Mann (2013), difficulties arise when VNs abide by what is believed to be in the best interest of the patient, fulfilling the duties of their Code of Professional Conduct, but that may not legally be acceptable. Applying this to a different situation, if euthanasia to alleviate suffering was carried out without informed consent from the owner, there may be civil consequences.
VNs should always be working within the law, irrespective of their moral beliefs (Tannenbaum, 1995; Mann, 2013).
Animal euthanasia vs human euthanasia
As described by the NHS (2014), human euthanasia is an act to deliberately end a human life in order to relieve that person of suffering. Under current English law euthanasia and assisted suicide are illegal (NHS, 2014). The euthanasia of animal patients is also carried out to alleviate suffering, although as this article discusses, it is not limited to this sole purpose.
Preventing the need for euthanasia of aggressive dogs?
One role of VNs is client education. The RCVS Code of Professional Conduct (2012a) stated that VNs must seek to make sure that public health and animal health and welfare are protected. The word seek is an active one, describing the pro-active role VNs can have to ensure public and animal health is maintained.
The RCVS Code of Professional Conduct (2012a and b) for both VSs and VNs states that tasks above their level of competency should not be performed, and referred to a specialist instead. Loftus (2014) discussed the need for owners to source appropriately qualified behaviour management professionals. The Animal Behaviour and Training Council (ABTC) acts as a regulatory body for the behaviour and training industry with organisations gaining membership once they satisfy the ABTC's requirements (Loftus, 2014).
Hargrave (2013) discussed how the behavioural welfare needs of a dog start with their first experiences at the veterinary clinic. Hargrave (2013) also discussed the need for only those appropriately qualified staff members to advise rehabilitative and preventative techniques to clients regarding their puppy's behaviour; behavioural warning signs are often picked up first by VSs and VNs in practice and that advice given to clients may be detrimental if inaccurate. The opportunities available for VSs and VNs to undertake continuing professional development (CPD) in understanding behavioural problems and puppy training may provide a good way for veterinary staff to advise clients of qualified external sources that may be able to provide further advice and support for the particular problems they are experiencing with their dog.
While rehoming is an option for aggressive patients it should be considered carefully as patient welfare needs may not be met if this option is taken and another ethical dilemma will be raised if the patient ends up in a kennel environment.
Informed consent
As described in the RCVS Code of Professional Conduct (2012b) for VSs, informed consent can only be achieved if a client is given a range of viable treatment options for which the risks and costs of each have been discussed and understood. It is the responsibility of both the VS and VN to ensure that the client receives this information, particularly to ensure that the patient's health and welfare needs are supported.
The RCVS (2014) discusses the need for VNs to communicate with clients, advising that appropriate language is used and that clients are encouraged to take part in discussions. With regards to euthanasia of aggressive patients, owners should be informed of other treatment options and their costs before euthanasia is agreed.
The role of the VS
As spoken in the declaration on professional registration (see Appendix 1), VSs and VNs promise that above all, ensuring the health and welfare of the animals in their care will be their primary endeavour (RCVS, 2012b). To fulfil this duty they must first think of the patient and what is right for it before considering the needs of the owner.
Landsberg (2014) suggests that a VS should evaluate the patient signalment, home environment, patient history and identify the target of the aggression in order to decide if the behaviour is likely to be able to be managed effectively. The VS should also consider the welfare needs of the patient as these could be affected if, for example, muzzling is required frequently or off-lead exercise prohibited.
There are many forms of aggression and medical illnesses causing pain or neurological changes should be considered. A full health check should be carried out by the VS and this combined with all other information should aid in the decision making.
As described in the RCVS Code of Professional Conduct (2012b) for VSs, referral to a more highly qualified person may be necessary prior to any further action.
Resolution
CPD in behavioural management and training for VSs and VNs in practice should be considered so that basic advice can be given to all clients. For those cases where expert knowledge is required, referral to a behaviour specialist should be considered. Dog owners should be aware of the Dangerous Dogs Act 1991 and understand their role towards responsible ownership. Owners with young children should be advised of behavioural signs to watch out for and to ensure their children respect their dog's space. By working together with owners and implementing early management techniques for behavioural concerns the need for euthanasia of these patients can hopefully be avoided.
Conclusion
The euthanasia of any patient is an emotional event, generally avoided if it is reasonable to seek alternative treatment options. The euthanasia of aggressive dogs is particularly difficult for those involved and while it is within a VSs or VNs job role requirements to perform and assist respectively in this act, it is not one to be taken lightly. Working within the guidelines set by the RCVS Code of Professional Conduct (2012a and 2012a) for VSs and VNs, unless there has been a court order to euthanise a dangerous dog, animal health and welfare must come first, followed by respecting the client's needs and wishes.
There is a very thin line separating the ethical act of euthanasia of aggressive dogs from that which is deemed unethical, and for many people this line will vary. Each case should be treated individually to determine the best course of action to take for both the patient and the client. It is unlikely that a definitively correct ethical answer will ever be achieved, but the use of ethical theories can be used to help guide decision making.