A veterinary surgeon (VS) and registered veterinary nurse (RVN) have been looking after a cat with chronic kidney failure. Over the last 6 months the cat has been deteriorating despite receiving maximum medical treatment. The VS advises euthanasia but the owners are refusing because of strong moral beliefs that euthanasia is always unacceptable. Both VS and RVN are concerned that the cat is suffering and decide to investigate the legislation surrounding euthanasia without owner consent.
Introduction
While working in veterinary practice, VSs and RVNs see patients and clients who bring legal and ethical challenges. In this fictional scenario, the euthanasia of a cat with chronic kidney disease may appear the morally just decision, however the owner will not give consent because of their own personal beliefs. This report will critically reflect on the legal responsibilities of the VS and RVN as well as review how confidentiality commitments affect reporting the owner to the local authorities for animal welfare abuse.
The legal system
In England and Wales the legal system is built around criminal and civil law. Criminal law is the body of law that relates to acts of parliament intended to protect the public from harm (Wild, 2017). When offences occur, criminal proceedings take place and can involve prosecution and a penalty fee decided by a judge (Wager, 2011). Civil law addresses individuals who have suffered harm or loss (Wild, 2017). The injured party sues and, if successful, is offered financial compensation or injunctions at the discretion of a judge (Wild, 2017).
Civil law
Legally, domestic animals are considered as personal possessions or ‘chattels’, therefore, euthanasia without the owner's consent could result in disciplinary action or civil law proceedings because of the owner's loss of property (Lee et al, 2013). The Criminal Damage Act 1971 s.1, states that anyone who destroys or damages another person's property is guilty of an offence. The word ‘destroy’ is also used in the Animal Welfare Act 2006 when discussing euthanasia of animals, perhaps to cement the idea of animals being considered as property. Labelling animals as chattels seems an old fashioned view and belittles animals' worth as sentient beings. If the VS had euthanased the cat in this scenario, the owner could be entitled to financial compensation for the monetary value of the cat with no consideration to distress this may have caused. One way to recognise the potential that loss of a pet can cause the owner, would be to legally consider protected animals as human companions. With this change, measures could be taken to ensure support is given to owners if their pet is harmed or euthanased unlawfully.
Criminal law
The Animal Welfare Act 2006 s.9, requires animals to be protected from pain, suffering, injury and disease, with an offense being caused if the person(s) responsible for the animal fails to meet this need (Table 1). Simply not inflicting pain or suffering is no longer acceptable as (s.4) an offence is caused where the failure to act causes animal suffering. ‘A person who owns an animal shall always be responsible for it’ (s.3) however, responsibility can be permanent or temporary. This means veterinary staff with animals under their care, share responsibility with an owner. In the scenario, all other treatment options for the cat have been exhausted, leaving euthanasia as the most suitable choice. By refusing euthanasia the owner is in breach of the Animal Welfare Act 2006 by allowing animal suffering through failing to act. If the VS were to accept the owner's refusal they could also be in breach of the Act by not taking further legal action. This creates a complicated legal scenario, where an offence could be caused by either owner or VS in the name of protecting animal welfare.
Table 1. Five Animal Welfare Needs (Animal Welfare Act, 2006)
| a | Its need for a suitable environment |
| b | Its need for a suitable diet |
| c | Its need to be able to exhibit normal behaviour patterns |
| d | Any need it has to be housed with, or apart from, other animals |
| e | Its need to be protected from pain, suffering, injury and disease |
To create a piece of legislation that allows the prosecution of veterinary staff may seem arbitrary, since the VS and RVN can work only within the owners' wishes. The Animal Welfare Act 2006 (s.18), names the VS as a responsible person for the animal. This means that the VS would have a legal obligation to report the owner to the authorities, who would then be able to grant euthanasia of the animal without the need for consent. This is contradictory as previously in the Criminal Damage Act 1971, there is a legal responsibility towards protecting an owner's property, yet the Animal Welfare Act 2006 gives the VS an overriding power if animal welfare is at risk.
Professional responsibilities
Legal guidance
According to the Royal College of Veterinary Surgeons (RCVS) Code of Professional Conduct for Veterinary Nurses (CoPC), RVNs have professional responsibilities to animals which include prioritising their health and welfare (RCVS, 2017). This differs from the legal duty of care which is to the owner (Abbitt, 2010). The role of the RVN is to educate owners in all aspects of animal ownership and ensure that owners are aware of any legal implications of their actions (Crump, 2013). To achieve this in the most sensitive manner, RVNs should discuss the five needs reported in the Animal Welfare Act 2006 in their daily nursing consultations. Many RVNs may already find themselves asking questions such as ‘What does Tilly eat on a normal day?’, and at this point could add in ‘that sounds like a good diet. Did you know that owners have a legal requirement to provide a suitable diet for their pets?’. This is likely to spark a conversation into the other four needs set out in the legislation. Conversations like this in low pressure situations could help to reinforce this aspect of legislation, so that it becomes second nature to owners. When difficult decisions, such as euthanasia, need to be discussed, it would be insensitive of the VS or RVN to suddenly bring up that the owner could be committing a crime by refusing euthanasia. RVNs are taught to put animal welfare above all, however owners who have not received this training, may not understand that sometimes the best way to relieve animal suffering is through euthanasia.
Guidance from the RCVS Code of Professional Conduct for Veterinary Nurses
If an owner refuses to have their animal euthanised a VS and RVN should look to the CoPC for guidance, although, the professional responsibilities towards animals and clients can often contradict. Animal health and welfare should be prioritised, however, section 2.1 of the CoPC states ‘Veterinary nurses must be open and honest with clients and respect their needs and requirements’ (RCVS, 2017). Section 8.5 in chapter eight of the supporting guidance states that the purpose of euthanasia is to relieve suffering (RCVS, 2017), which complements the work of the Animal Welfare Act 2006. Section 8.7 of the supporting guidance advises that a VS's primary obligation is to relieve animal suffering, but must also consider the owner's wishes (RCVS, 2017).
Where an owner refuses euthanasia a VS should look to seek the opinion of a second VS (8.9) (RCVS, 2017). The purpose of this could be to invoke feelings of paternalism in the owner. Paternalism is an ethical theory commonly used in human medicine with the idea that doctors and nurses know best (Crump, 2013). This could be applied to veterinary medicine, where if two VSs expressed concern about an animal's welfare and the need for euthanasia, the owner may be more likely to agree.
Client confidentiality
Schedule 11 of the Data Protection Act 2018 advises that data protection rules do not apply for the prevention and detection of crime. This allows VSs and RVNs to report owners in breach of the Animal Welfare Act 2006 to the local police without fear of being prosecuted themselves. Legislation is less clear on whether it is acceptable to disclose client information to an organisation such as the RSPCA. Section 14.1 of the CoPC supporting guidance advises under normal circumstances VSs or RVNs should not disclose any personal information or anything revealed by a clinical examination to a third party without consent (RCVS, 2017). Further explanation (14.2) justifies breaching confidentiality if animal welfare is at risk. The RCVS (2017) advises that general data protection regulation (GDPR) should not be a barrier when reporting concerns about animal welfare. While the legislation allows a breach in confidentiality to report an issue to the local authorities (Animal Welfare Act 2006), the CoPC goes further by naming the RSPCA as a relevant authority in section 14.15 (RCVS, 2017). This is useful for VSs and RVNs as they might consider the term ‘local authorities’ to mean the police only.
Clinical governance
Section 6.1 of the CoPC supporting guidance describes clinical governance as a professional obligation for veterinary staff focusing on reflection, analysis and improvement (RCVS, 2017). Reflection is the process of learning from past experience and incorporating new knowledge to provide better patient care (Husebo et al, 2015). Gibbs' (1988) Reflective Cycle (Figure 1) is one of multiple reflective models available and is often favoured as it allows the inexperienced reflective practitioner to fully understand the stages of learning (Husebo et al, 2015). Section 6.3.a.i of the CoPC supporting guidance advises that no-blame meetings should be held after a critical event (unexpected medical or surgical complication, serious complaint or an anaesthetic death) (RCVS, 2017). Euthanasia is often an emotive topic, therefore, discussing what went well and areas for improvement could be beneficial. This analysis should be shared with all team members and an action plan for future situations can be implemented.
Future practice
Schwartz rounds have been trialled in veterinary hospitals to help staff discuss emotional topics. Originating from human medicine, the purpose of Schwartz rounds is to support all hospital staff members and help them to reflect on their roles (Flanagan et al, 2020). For RVNs, the experience is extremely valuable as there is an opportunity to discuss emotions relating to specific patients which are not always discussed in clinical rounds. The discussion of feelings is a critical step in Gibb's Reflective Cycle (Figure 1), therefore, Schwartz rounds are starting to make an appearance in clinical governance discussions. Non-clinical staff also benefit from Schwartz rounds as these members of the team may not feel comfortable attending clinical debriefings.
Conclusion
For RVNs, knowledge of relevant legislation and the CoPC is crucial. Euthanasia is often thought of as the VS's role, however RVNs have a responsibility to support owners through difficult times. In a society where consumerism dominates, animal welfare should be remembered and respected. The CoPC advises that owner confidentiality or wishes should come second to animal welfare. This is important for VSs and RVNs to know so that they can prioritise animal welfare without fear of disciplinary action.
KEY POINTS
- The Animal Welfare Act 2006, grants veterinary surgeons temporary responsibility of animals in their care.
- The role of the registered veterinary nurse is to educate owners in all aspects of animal ownership.
- The Code of Professional Conduct supporting guidance gives advice on professional responsibilities towards animals and clients.
- Data protection rules do not apply for the prevention and detection of crime.
- Clinical governance provides an opportunity for veterinary staff to reflect on past experiences which will positively impact future clinical decisions.