Veterinary Medical Ethics Déontologie vétérinaire Ethical question of the month — May 2016 A veterinarian treats a middle-aged dog with a mild cough symptomatically and fails to identify a heart murmur. Another veterinarian treats a vomiting dog symptomatically and fails to test for an intestinal blockage. A third veterinarian treats a calf that is not eating with antibiotics and fails to consider rabies in the differential diagnosis. In each of these cases a second opinion is sought after the initial treatment fails to resolve the clinical signs. In each case the second opinion veterinarian, with the benefit of knowing the failed treatment histories, performs further diagnostics and arrives at the correct diagnosis. In these and similar situations the initial veterinarians are at risk of being cited for a substandard level of care. Are veterinarians allowed to make mistakes? Does every case require that all possible diagnoses be explored at the time of the first examination?
Question de déontologie du mois — Mai 2016 Un vétérinaire traite un chien d’âge mûr souffrant d’une légère toux symptomatique et il n’identifie pas un souffle cardiaque. Un autre vétérinaire traite les symptômes d’un chien qui vomit et n’effectue pas de tests pour détecter un blocage intestinal. Un troisième vétérinaire traite un veau qui ne mange pas à l’aide d’antibiotiques et n’envisage pas la rage dans le diagnostic différentiel. Dans chacun des cas, une deuxième opinion est sollicitée après l’échec du traitement initial. Dans chacun des cas, le vétérinaire de la deuxième opinion, qui a l’avantage de connaître l’anamnèse des traitements infructueux, effectue d’autres tests diagnostiques et obtient le bon diagnostic. Dans ces situations et dans d’autres exemples semblables, les premiers vétérinaires s’exposent au risque d’être accusés d’avoir fourni des soins inférieurs aux normes. Doit-on, dans tous les cas, explorer tous les diagnostics possibles au moment du premier examen? Comments/Commentaires :
Name/Nom : Address/Adresse :
Responses to the case presented are welcome. Please limit your reply to approximately 50 words and forward along with your name and address to: Ethical Choices, c/o Dr. Tim Blackwell, 6486 E. Garafraxa, Townline, Belwood, Ontario N0B 1J0; telephone: (519) 846-3413; fax: (519) 846-8178; e-mail: [email protected] Suggested ethical questions of the month are also welcome! All ethical questions or scenarios in the ethics column are based on actual events, which are changed, including names, locations, species, etc., to protect the confidentiality of the parties involved.
Les réponses au cas présenté sont les bienvenues. Veuillez limiter votre réponse à environ 50 mots et nous la faire parvenir par la poste avec vos nom et adresse à l’adresse suivante : Choix déontologiques, a/s du D r Tim Blackwell, 6486, E. Garafraxa, Townline, Belwood (Ontario) N0B 1J0; téléphone : (519) 846-3413; télécopieur : (519) 846-8178; courriel : [email protected] Les propositions de questions déontologiques sont toujours bienvenues! Toutes les questions et situations présentées dans cette chronique s’inspirent d’événements réels dont nous modifions certains éléments, comme les noms, les endroits ou les espèces, pour protéger l›anonymat des personnes en cause.
Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs. CVJ / VOL 57 / MAY 2016
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Ethical question of the month — February 2016 A model for a rare but fatal disease of children has been created in laboratory mice. Should the number of mice that suffer and die in studies utilizing these mice be a consideration in any way when research intended to cure or control this disease is proposed? Would the answer change if this rare and fatal disease affected only dogs?
Question de déontologie du mois — Février 2016 Le modèle d’une maladie infantile rare mais mortelle a été créé dans des souris de laboratoire. Le nombre de souris qui souffrent et meurent dans les études y ayant recours devrait-il être considéré lorsque l’on propose de la recherche pour guérir ou contrôler cette maladie? La réponse changerait-elle si cette maladie rare et mortelle affectait uniquement les chiens?
Mice as models for children’s disease — Comments In Canada the number of mice utilized must be a consideration when research is proposed to the local Animal Care Committee (ACC). The Canadian Council on Animal Care (CCAC), the national peer-review organization responsible for setting, maintaining, and overseeing the implementation of high standards for animal ethics and care in science, requires the ACC to carefully evaluate the number of animals proposed by a researcher. CCAC-certified institutions are to follow CCAC standards. In many provinces this is a legal requirement. Employing strategies that will result in fewer animals being used and which are consistent with sound experimental design (1) is Reduction, a crucial component of the 3Rs (i.e., Replacement, Reduction, Refinement), all three of which must be considered by the researcher in that interaction with the ACC.
There is no difference in approach applied to research benefiting only animals (dogs in this instance) from the situation posed involving research directly benefiting humans.
Reference 1. Canadian Council on Animal Care. [homepage on the Internet] Available from: http://www.ccac.ca/en_/standards/threer Last accessed March 30, 2016.
Douglas W. Morck, DVM, PhD, University Veterinarian, University of Calgary, Professor, Science and Veterinary Medicine, University of Calgary
An ethicist’s commentary on mice as models for children’s disease This case in essence once again raises the perennial question of moral legitimacy of research on animals for human or other animal benefit. In the many papers I have devoted to animal research I have concluded that there is no clear moral justification for hurting others for our benefit, but that we will certainly continue to do so. Given the social tendency to raise the moral status of animals, it is not clear whether this question will arise to a major moral issue confronting society. But it is heartening that concern for minimizing pain, suffering, and death of research animals has spread globally. In Europe for example, there has been a significant rejection of the use of animals in testing the safety of cosmetics encoded in law. This in turn reflects consumer rejection of hurting animals in science and toxicology testing for what is ever-increasingly being seen as trivial reasons. Even the National Institutes of Health have abandoned the use of chimpanzees in research, as have most other countries. It is also encouraging that analgesia for laboratory animals is being taken seriously. In the early 1980s, when I was part of a group drafting US legislation assuring the welfare of laboratory animals, I did a literature search under the rubric of “analgesia for laboratory animals,” which depressingly revealed no papers. When I broadened the search term to “analgesia for animals,” only 2 papers turned up, 1 of which affirmed that there ought to be papers. Largely as a result of the efficacy of US federal law, when I repeated the search a few years ago on analgesia for laboratory animals, it turned up almost 13 000 papers. 462
It is thus unquestionable that care of laboratory animals has significantly improved in the past few decades. And surveys have not surprisingly shown that public support for animal research is significantly higher when the research does not involve pain and suffering than when it does. Yet the major justification for invasive research on animals continues to be the benefit that results. The study described in this case, researching a fatal disease of children, is a paradigmatic example of what society would consider a justifiable use of animals even when pain and suffering is involved. Nonetheless, US law demands a careful statistical justification of the number of animals used, as well as the limiting and controlling of pain as much as possible. This involves not only use of anesthesia and analgesia, but also creating early “endpoints” for the animals used, i.e., euthanizing them before suffering becomes pronounced, if at all possible, and researchers conducting a search for alternatives to animal use. All of this notwithstanding, there are significant numbers of scientists who continue to believe the issue of controlling animal suffering to be an intrusive and illegitimate imposition on scientific freedom. I believe that the number of scientists in that camp will shrink as young scientists are taught, contrary to what I call “scientific ideology,” that science is not “value-free in general and ethics-free in particular.” Cognizance of ethical issues in science by scientists, like the question of research animal suffering, is an essential part of public support for science. Changing the situation, as the case does, from children to dogs, does not appreciably alter the discussion we have CVJ / VOL 57 / MAY 2016
D É O N TO LO G I E V É T É R I N A I R E
rovided. As we have indicated in previous columns, dogs are p ever-increasingly being viewed as “members of the family.” This is of course evidenced by the proliferation of canine oncological research and the willingness of clients to spend money on cancer treatment. Whether or not it makes sense from an ethical theory
464
point of view or not, certain animals are favored over others. I seriously doubt that society would accept a version of this case where research was being done on dogs to cure diseases of mice! Bernard E. Rollin, PhD
CVJ / VOL 57 / MAY 2016
Question de déontologie du mois — Mai 2016 Un vétérinaire traite un chien d’âge mûr souffrant d’une légère toux symptomatique et il n’identifie pas un souffle cardiaque. Un autre vétérinaire traite les symptômes d’un chien qui vomit et n’effectue pas de tests pour détecter un blocage intestinal. Un troisième vétérinaire traite un veau qui ne mange pas à l’aide d’antibiotiques et n’envisage pas la rage dans le diagnostic différentiel. Dans chacun des cas, une deuxième opinion est sollicitée après l’échec du traitement initial. Dans chacun des cas, le vétérinaire de la deuxième opinion, qui a l’avantage de connaître l’anamnèse des traitements infructueux, effectue d’autres tests diagnostiques et obtient le bon diagnostic. Dans ces situations et dans d’autres exemples semblables, les premiers vétérinaires s’exposent au risque d’être accusés d’avoir fourni des soins inférieurs aux normes. Doit-on, dans tous les cas, explorer tous les diagnostics possibles au moment du premier examen? Comments/Commentaires :
Name/Nom : Address/Adresse :
Responses to the case presented are welcome. Please limit your reply to approximately 50 words and forward along with your name and address to: Ethical Choices, c/o Dr. Tim Blackwell, 6486 E. Garafraxa, Townline, Belwood, Ontario N0B 1J0; telephone: (519) 846-3413; fax: (519) 846-8178; e-mail: [email protected] Suggested ethical questions of the month are also welcome! All ethical questions or scenarios in the ethics column are based on actual events, which are changed, including names, locations, species, etc., to protect the confidentiality of the parties involved.
Les réponses au cas présenté sont les bienvenues. Veuillez limiter votre réponse à environ 50 mots et nous la faire parvenir par la poste avec vos nom et adresse à l’adresse suivante : Choix déontologiques, a/s du D r Tim Blackwell, 6486, E. Garafraxa, Townline, Belwood (Ontario) N0B 1J0; téléphone : (519) 846-3413; télécopieur : (519) 846-8178; courriel : [email protected] Les propositions de questions déontologiques sont toujours bienvenues! Toutes les questions et situations présentées dans cette chronique s’inspirent d’événements réels dont nous modifions certains éléments, comme les noms, les endroits ou les espèces, pour protéger l›anonymat des personnes en cause.
Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. L’usage du présent article se limite à un seul exemplaire pour étude personnelle. Les personnes intéressées à se procurer des réimpressions devraient communiquer avec le bureau de l’ACMV ([email protected]) pour obtenir des exemplaires additionnels ou la permission d’utiliser cet article ailleurs. CVJ / VOL 57 / MAY 2016
461
D É O N TO LO G I E V É T É R I N A I R E
Ethical question of the month — February 2016 A model for a rare but fatal disease of children has been created in laboratory mice. Should the number of mice that suffer and die in studies utilizing these mice be a consideration in any way when research intended to cure or control this disease is proposed? Would the answer change if this rare and fatal disease affected only dogs?
Question de déontologie du mois — Février 2016 Le modèle d’une maladie infantile rare mais mortelle a été créé dans des souris de laboratoire. Le nombre de souris qui souffrent et meurent dans les études y ayant recours devrait-il être considéré lorsque l’on propose de la recherche pour guérir ou contrôler cette maladie? La réponse changerait-elle si cette maladie rare et mortelle affectait uniquement les chiens?
Mice as models for children’s disease — Comments In Canada the number of mice utilized must be a consideration when research is proposed to the local Animal Care Committee (ACC). The Canadian Council on Animal Care (CCAC), the national peer-review organization responsible for setting, maintaining, and overseeing the implementation of high standards for animal ethics and care in science, requires the ACC to carefully evaluate the number of animals proposed by a researcher. CCAC-certified institutions are to follow CCAC standards. In many provinces this is a legal requirement. Employing strategies that will result in fewer animals being used and which are consistent with sound experimental design (1) is Reduction, a crucial component of the 3Rs (i.e., Replacement, Reduction, Refinement), all three of which must be considered by the researcher in that interaction with the ACC.
There is no difference in approach applied to research benefiting only animals (dogs in this instance) from the situation posed involving research directly benefiting humans.
Reference 1. Canadian Council on Animal Care. [homepage on the Internet] Available from: http://www.ccac.ca/en_/standards/threer Last accessed March 30, 2016.
Douglas W. Morck, DVM, PhD, University Veterinarian, University of Calgary, Professor, Science and Veterinary Medicine, University of Calgary
An ethicist’s commentary on mice as models for children’s disease This case in essence once again raises the perennial question of moral legitimacy of research on animals for human or other animal benefit. In the many papers I have devoted to animal research I have concluded that there is no clear moral justification for hurting others for our benefit, but that we will certainly continue to do so. Given the social tendency to raise the moral status of animals, it is not clear whether this question will arise to a major moral issue confronting society. But it is heartening that concern for minimizing pain, suffering, and death of research animals has spread globally. In Europe for example, there has been a significant rejection of the use of animals in testing the safety of cosmetics encoded in law. This in turn reflects consumer rejection of hurting animals in science and toxicology testing for what is ever-increasingly being seen as trivial reasons. Even the National Institutes of Health have abandoned the use of chimpanzees in research, as have most other countries. It is also encouraging that analgesia for laboratory animals is being taken seriously. In the early 1980s, when I was part of a group drafting US legislation assuring the welfare of laboratory animals, I did a literature search under the rubric of “analgesia for laboratory animals,” which depressingly revealed no papers. When I broadened the search term to “analgesia for animals,” only 2 papers turned up, 1 of which affirmed that there ought to be papers. Largely as a result of the efficacy of US federal law, when I repeated the search a few years ago on analgesia for laboratory animals, it turned up almost 13 000 papers. 462
It is thus unquestionable that care of laboratory animals has significantly improved in the past few decades. And surveys have not surprisingly shown that public support for animal research is significantly higher when the research does not involve pain and suffering than when it does. Yet the major justification for invasive research on animals continues to be the benefit that results. The study described in this case, researching a fatal disease of children, is a paradigmatic example of what society would consider a justifiable use of animals even when pain and suffering is involved. Nonetheless, US law demands a careful statistical justification of the number of animals used, as well as the limiting and controlling of pain as much as possible. This involves not only use of anesthesia and analgesia, but also creating early “endpoints” for the animals used, i.e., euthanizing them before suffering becomes pronounced, if at all possible, and researchers conducting a search for alternatives to animal use. All of this notwithstanding, there are significant numbers of scientists who continue to believe the issue of controlling animal suffering to be an intrusive and illegitimate imposition on scientific freedom. I believe that the number of scientists in that camp will shrink as young scientists are taught, contrary to what I call “scientific ideology,” that science is not “value-free in general and ethics-free in particular.” Cognizance of ethical issues in science by scientists, like the question of research animal suffering, is an essential part of public support for science. Changing the situation, as the case does, from children to dogs, does not appreciably alter the discussion we have CVJ / VOL 57 / MAY 2016
D É O N TO LO G I E V É T É R I N A I R E
rovided. As we have indicated in previous columns, dogs are p ever-increasingly being viewed as “members of the family.” This is of course evidenced by the proliferation of canine oncological research and the willingness of clients to spend money on cancer treatment. Whether or not it makes sense from an ethical theory
464
point of view or not, certain animals are favored over others. I seriously doubt that society would accept a version of this case where research was being done on dogs to cure diseases of mice! Bernard E. Rollin, PhD
CVJ / VOL 57 / MAY 2016
