End-of-life decisions: A focus group study with German health professionals from human and veterinary medicine.

Introduction: At first glance, human and (companion animal) veterinary medicine share challenging processes in end-of-life (EOL) decision-making. At the same time, treatment options in both professions are substantially different. The potential of an interdisciplinary exchange between both fields has been neglected by empirical research so far. Methods: In this qualitative study, professionals from both fields were brought together in interdisciplinary focus groups to investigate the ethical aspects of convergences and divergences in EOL situations in human and veterinary medicine. The authors present and discuss an innovative mix of materials and methods as stimuli for discussion and for generating hypotheses. Results: The results point toward a general convergence of issues, challenges, and judgements in EOL situations in both fields, such as professional ethos, communication with the family and the role thereof as well as the ideals of death, clearly exceeding the expectations of study participants. At the same time, the study highlights a few prominent differences such as the access to patients' preferences or legal and practical constraints. Discussion: The findings suggest that using social science methods in empirical interdisciplinary biomedical-veterinary ethics could help to shed more light on this new area. Animal as well as human patients can potentially benefit from this mutual, scientifically accompanied exchange and the resulting identification and corrections of misconceptions.

"What If It Was Your Dog?" Resource Shortages and Decision-Making in Veterinary Medicine-A Vignette Study with German Veterinary Students.

The here presented vignette study was part of a survey on ethical judgement skills among advanced veterinary students at the University of Veterinary Medicine Hannover, Foundation. The vignette describes a fictitious dilemma in veterinary practice due to medication supply shortages. First, the students should make an ethically justified decision: who of the two patients in the waiting room gets the last dosage of a medication. Important factors were the animal patients' characteristics (age, state of health, life expectancy), the patient owners' wellbeing, and context-related criteria. Second, the students were asked for decisional changes if one of the patients was their own dog. They reacted in four different ways: (1) for a professional, this should not make a difference; (2) most likely being "egoistic" and preferring their own dog; (3) giving the medication to the other dog; and (4) avoiding a decision. Finally, the students judged a list of possible solutions to the dilemma on a 9-point scale. They preferred patient-related criteria to patient-owner-related criteria in this task. In the overall results, it became obvious that no "gold standard" or guidelines for situations of medication shortages exist, yet, which presents an important subject for future research and veterinary ethics teaching.

Killing Kira, Letting Tom Go?-An Empirical Study on Intuitions Regarding End-of-Life Decisions in Companion Animals and Humans.

Veterinary and human medicine share the challenges of end-of-life decisions. While there are legal and practical differences, there might be parallels and convergences regarding decision-making criteria and reasoning patterns in the two disciplines. In this online survey, six variants of a fictitious thought experiment aimed at pointing out crucial criteria relevant for decision-making within and across both professional fields. The six variants introduced four human and two animal patients with the same disease but differing in age, gender and, in case of the human patients, in terms of their state of consciousness. Participants could choose between four different treatment options: euthanasia, continuous sedation, a potentially curative treatment with severe side effects and no intervention. Study participants were human and veterinary medical professionals and an additional control group of lay people. Decisions and justifications for the six variants differed but the three groups of participants answered rather homogeneously. Besides the patient's "suffering" as a main criterion, "age", "autonomy" and, to a lesser extent, "species" were identified as important criteria for decision-making in all three groups. The unexpected convergences as well as subtle differences in argumentation patterns give rise to more in-depth research in this cross-disciplinary field.

Is Pet Health Insurance Able to Improve Veterinary Care? Why Pet Health Insurance for Dogs and Cats Has Limits: An Ethical Consideration on Pet Health Insurance.

BACKGROUND: Owners often feel the cost of veterinary care is too high, as there remains a limited understanding of the cost of health care in human and veterinary medicine alike. Pet health insurance is often seen as a universal solution. However, especially for patient owners with few financial resources, both the bill at the vet and the monthly premium for pet health insurance can become a challenge. HYPOTHESIS: Pet health insurance can prevent or ease many price discussions at the vet, but it does not offer a solution for patient owners with little financial means. METHODS: In order to verify for which patient owners pet health insurance can be a solution, four theoretical groups were formed depending on the patient owner's willingness to pay and his/her dispensable funds based on a theoretical model. RESULTS: Dispensable funds are a factor that cannot be influenced by the veterinary surgeon. However, low dispensable funds as a result of an insufficient willingness to save (whether due to a lack of financial education or a lack of will) can be solved by pet health insurance. Willingness to pay, on the other hand, can be influenced by empathetic communication from the veterinary surgeon and thus also from pet health insurance. Nevertheless, situations remain where pet health insurance is not a solution either, because owners can neither afford the veterinary costs nor a premium for a pet health insurance.

Culture of care in animal research - Expanding the 3Rs to include people.

Research on animals is essential for science and medical progress. While it is still necessary to conduct this research, it is essential to apply the highest standards in animal welfare, including animal husbandry and care. Furthermore, it is important to recognize the special relationship between research animals and the people who care for them. Caring for research animals can be extremely fulfilling and meaningful, but it also comes with challenges, particularly when caring for animals experiencing pain or distress. These challenges can lead to work-related mental stress. To get more insight into the challenges of working in animal research, we organized a panel discussion at the GV-SOLAS (German Society for Laboratory Animal Science) and IGTP (Interest Group Animal Caretakers) conference 2021 about work wellbeing. This discussion was the first of its kind in Germany. The active panel contributions included the view of an ethical philosopher, a scientist, a lecturer for laboratory animal science, an animal facility manager and an animal caretaker. They gave insights from their perspective into key factors that can affect human wellbeing in animal research. Keys ideas included stigmatization of work, tension between research aims and animal wellbeing, and the importance of supportive culture to overcome work-related strains, as well as lack of education and supportive environments to cope with emotional stress in the workplace. Overall, the discussion has shown that we must also promote human wellbeing when promoting culture of care in animal research, because there is strong relationship between culture of care and individual performance.

Assessing Moral Judgements in Veterinary Students: An Exploratory Mixed-Methods Study from Germany.

Although veterinary ethics is required in veterinary curricula and part of the competencies expected of a trained veterinary surgeon according to the European Association of Establishments for Veterinary Education (EAEVE), knowledge concerning the effects of ethics teaching and tools evaluating moral judgement are scarce. To address this lack of tools with a mixed-methods approach, a questionnaire with three case scenarios presenting typical ethical conflicts of veterinary practice was administered to two groups of veterinary students (one had taken ethics classes, one did not). The questionnaire contained both open-ended and closed questions and was analysed qualitatively and quantitatively. The qualitative part aimed at revealing different argumentation patterns between the two groups, whereas the quantitative part focused on the students' approval of different roles and attitudes possibly relating to veterinarians. The results showed no major differences between both groups. However, answering patterns suggest a clear diversity among the students in their perception of morally relevant factors and the veterinary profession. Awareness of morally challenging elements of their profession was presented by students of both groups. With this exploratory study, the application of an innovative mixed-methods tool for evaluating the moral judgement of veterinary medical students is demonstrated.

Dying like a dog: the convergence of concepts of a good death in human and veterinary medicine.

Standard views of good death in human and veterinary medicine considerably differ from one another. Whereas the good death ideal in palliative medicine emphasizes the positive aspects of non-induced dying, veterinarians typically promote a quick and painless killing with the aim to end suffering. Recent developments suggest a convergence of both professions and professional attitudes, however. Palliative physicians are confronted with patients wishing to be 'put to sleep', while veterinarians have begun to integrate principles and practices from hospice care. We will argue that the discourses on good human and animal deaths are not distinct, but that they interact and influence each other. On the one hand, veterinary medicine adapts techniques like chemotherapy or sedation from palliative end-of-life care. On the other hand, philosophers, veterinarians, pet owners, patients and the general public alike make certain assumptions about the (dis)analogy of human and animal dying or killing. Unfortunately, these interactions have only scarcely been reflected normatively, especially on the part of human medicine. Conflicts and misattributions with potential serious negative consequences for the (animal and human) patients' wellbeing are provoked. For these reasons, palliative physicians and veterinarians are invited to engage in the debate around human and animal end-of-life care.

Philosophy of a "Good Death" in Small Animals and Consequences for Euthanasia in Animal Law and Veterinary Practice.

Moral stress is a major concern in veterinary practice. Often, it is associated with the challenges in end-of-life situations. Euthanasia, however, is also meant to bring relief to animal patients and their owners. The reasons for the moral strain euthanizing animals causes to professional veterinarians need to be further clarified. This article investigates "euthanasia" from a philosophical, legal, and practical perspective. After introducing relevant aspects of euthanasia in small animal practice, the term is analyzed from an ethical point of view. That includes both a broad and a narrow definition of "euthanasia" and underlying assumptions regarding different accounts of animal death and well-being. Then, legal and soft regulations are discussed with regard to the theoretical aspects and practical challenges, also including questions of personal morality. It is argued that the importance of ethical definitions and assumptions concerning euthanasia and their intertwinement with both law and practical challenges should not be neglected. The conclusion is that veterinarians should clarify the reasons for their potential discomfort and that they should be supported by improved decision-making tools, by implementation of theoretical and practical ethics in veterinary education, and by updated animal welfare legislation.

[Mass culling in the context of animal disease outbreaks--veterinarians caught between ethical issues and control policies]. / Massentötungen bei Tierseuchenausbrüchen--Tierärzte im Spannungsfeld zwischen Ethik und Seuchenbekämpfung.

In recent years controversial discussions arose during major animal disease outbreaks in the EU about the ethical soundness of mass culling. In contrast to numerous publications about ethical issues and laboratory animals/animal experiments, literature concerning ethical deliberations in the case of mass culling as a means of outbreak control remain scarce. Veterinarians in charge of decision about and implementation of mass culling actions find themselves in an area of conflict in between the officially required animal disease control policy and a public that is increasingly critical. Those veterinarians are faced with the challenge to defend the relevant decisions against all stakeholders and also themselves. In this context an interdisciplinary workshop was initiated in Switzerland in October 2007 with ethicians and (official) veterinarians from Germany, Switzerland and Austria. With the aim to identify ethical components of animal disease control for official veterinarians, talks and moderated group discussions took place. This article summarizes selected discussion points and conclusions.