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Autonomy and paternalism in quality of life determinations in veterinary practice

Published online by Cambridge University Press:  11 January 2023

CA Morgan
CA Morgan*
Affiliation:
The University of British Columbia, Room 230, 6356 Agricultural Road, Vancouver, British Columbia, Canada V6T 1Z2
*
Correspondence: camorgan@interchange.ubc.ca
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Abstract

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Assessments and predictions of patient quality of life (QoL) permeate many veterinary decisions, including (1) whether to perform a procedure due to concurrent QoL issues, (2) whether a procedure will negatively affect QoL in the near or distant future, and (3) whether QoL is poor enough to warrant euthanasia. In order to understand how veterinarians manage decisions relating to patient well-being, interviews with 41 veterinarians and over 100 hours of observations of 10 veterinarians were conducted. Participants held diverse views regarding the type of parameters that should be included when defining QoL. Interestingly, they also held differing views about who should be assessing patient QoL, with some participants believing that animals' owners were better able to assess patient QoL than veterinarians. For these veterinarians, respecting the client's autonomy in deciding what was best for the patient weighed heavily in their decisions. Other veterinarians felt that they, rather than the client, were the best assessors of QoL and felt justified in persuading clients to follow a certain course of action (often considered a paternalistic approach). These findings raise some interesting questions for the profession. What role should veterinarians play when assessing patient QoL? When is paternalism acceptable or even mandatory in veterinary medicine? Does respecting client autonomy also require an evaluation of the client's abilities to make appropriate decisions for the patient? The lack of uniformity in defining and assessing patient QoL highlights the need for increased dialogue with respect to veterinarians' responsibilities to both animals and clients.

Keywords

animal welfaredecision-makingquality of lifeveterinarian–client–patient relationshipveterinary medicine
Type
Research Article
Information
Animal Welfare , Volume 16 , Issue S1: Quality of Life: the heart of the matter: Proceedings of the UFAW/BVA Ethics Committee International Symposium, The Royal Society, London, 13-14 September 2006. , May 2007 , pp. 143 - 147
Copyright
© 2007 Universities Federation for Animal Welfare

References

Addington-Hall, J and Kalra, L 2001 Who should measure quality of life? British Medical Journal 322: 1417–1420CrossRefGoogle ScholarPubMed
Beauchamp, TL and Childress, JF 1989 Principles of Biomedical Ethics. Oxford University Press: New York, USAGoogle Scholar
Brock, DW 1994 Good decision making for incompetent patients. Hastings Center Report 24 (Suppl): S8-S11CrossRefGoogle ScholarPubMed
Buchanan, AE and Brock, DW 1989 Deciding for Others: The Ethics of Surrogate Decision Making. Cambridge University Press: New York, USAGoogle Scholar
Charles, C, Gafni, A and Whelan, T 1999 Decision-making in the physician–patient encounter: revisiting the shared treatment decision-making model. Social Science & Medicine 49: 651–661CrossRefGoogle ScholarPubMed
Charmaz, K 2006 Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. Sage Publications: Thousand Oaks, CA, USAGoogle Scholar
Emanuel, EJ and Emanuel, LL 1992 Four models of the physician–patient relationship. Journal of the American Medical Association 267: 2221–2226CrossRefGoogle ScholarPubMed
Flemming, DD and Scott, JF 2004 The informed consent doctrine: what veterinarians should tell their clients. Journal of the American Veterinary Medical Association 224: 1436–1439CrossRefGoogle ScholarPubMed
Hartman, K and Kuffer, M 1998 Karnofsky's score modified for cats. European Journal of Medical Research 3: 95–98Google Scholar
Kluge, E-HW 1999 After “Eve”: whither proxy decision making? In: Kluge E-HW (ed) Readings in Biomedical Ethics, A Canadian Focus pp 187-195. Prentice-Hall: Scarborough, CanadaGoogle Scholar
McMillan, FD 2003 Maximizing quality of life in ill animals. Journal of the American Animal Hospital Association 39: 227–235CrossRefGoogle ScholarPubMed
Morgan, CA 2006 Stepping up to the plate: animal welfare, ethics, and veterinarians. PhD thesis, University of British Columbia, Vancouver, CanadaGoogle Scholar
Rollin, B 2002 The use and abuse of Aesculapian authority in veterinary medicine. Journal of the American Veterinary Medical Association 220: 1144–1149CrossRefGoogle ScholarPubMed
Stevenson, FA, Barry, CA, Britten, N, Barber, N and Bradley, CP 2000 Doctor–patient communication about drugs: the evidence for shared decision making. Social Science & Medicine 50: 829–840CrossRefGoogle ScholarPubMed
Tonelli, MR 1997 Substituted judgments in medical practice: evidentiary standards on a sliding scale. Journal of Law, Medicine & Ethics 25: 22–29CrossRefGoogle ScholarPubMed
Wiseman-Orr, M, Nolan, AM and Reid, J 1997 Development of a questionnaire to measure the effects of chronic pain on health-related quality of life in dogs. American Journal of Veterinary Research 65: 1077–1084CrossRefGoogle Scholar
Wojciechowska, J, Hewson, CJ, Stryhn, H, Guy, NC, Patronek, GJ and Timmons, V 2005a Development of a discriminative questionnaire to assess nonphysical aspects of quality of life of dogs. American Journal of Veterinary Research 66: 1453–1460CrossRefGoogle ScholarPubMed
Wojciechowska, J, Hewson, CJ, Stryhn, H, Guy, NC, Patronek, GJ and Timmons, V 2005b Evaluation of a questionnaire regarding nonphysical aspects of quality of life in sick and healthy dogs. American Journal of Veterinary Research 66: 1461–1467CrossRefGoogle ScholarPubMed