The role of the veterinarian in animal welfare 獸醫師在動物福利所扮演的角色

1. The role of the veterinarian in animal welfare獸醫師在動物福利所扮演的角色 Module 30 模組30

2. This module will enable you to本模組將使您能夠 • Understand role of vets in animal welfare & ethical issues了解獸醫在動物福利與倫理議題所扮演的角色 • Acquire frameworks for making ethical decisions in practice獲得執業時道德抉擇的範例 • Understand the different attitudes to welfare & ethics among vets了解獸醫師們對福利與倫理的多樣態度 • Understand some welfare/ethical issues found in practice了解執業時發現的福利/倫理議題

3. The role of vets獸醫師的角色 • Individually個人 • Collectively團體 • Licensing body 專業領域的主體 • Professional association 職業公會

4. Licensing body專業領域的主體 • Helps animal welfare / ethics by enforcing the local Veterinary Act推動當地獸醫師法來幫助動物福利/倫理 • If members do not follow certain rules, they may lose the right to practice--be ‘struck off’若成員不遵守該法，可能失去執業資格– “罷職” • Following the rules may not always result in the right action遵守該法並不總是導致正確的行為 • May have guidelines for common professional ethical issues需要執業常遇到之倫理議題的方針

5. Licensing body專業領域的主體 • Influences legislation on animal welfare影響動物福利的立法 • Develops policy 推行政策 • May comment publicly on welfare代表動物福利發言

6. Licensing body專業領域的主體 • Help animal welfare by ensuring that vets meet certain standards e.g. have passed national exam.經由確保獸醫師品質來幫助動物福利，如:國家考試 • Vets may have to take a solemn oath獸醫師宣誓詞 • U.K. “…my constant endeavour will be to ensure the welfare of animals committed to my care.” 英國 “我當持續竭力確保動物福利並恆久關切。” • Does the oath help animal welfare?獸醫師宣誓詞有幫到動物福利?

7. Licensing body專業領域的主體 • Helps animal welfare by approving the curriculum at vet schools將動物福利的觀念引入獸醫學校的課程

8. Licensing body專業領域的主體 • Could help animal welfare by acting as spokesperson擔任動物福利之發言人來幫助動物福利 • Promote animal welfare提升動物福利 • Communicate welfare/ethical policies to the general public將動物福利/ 倫理政與民眾協商 • Comment on topical issues 在主要議題上發表評論

9. Professional association職業公會 • Protects vets’ interests保護獸醫的利益 • Sometimes these are the same as animals’ interests有時這也兼顧了動物的利益

10. Professional association職業公會 • May have explicit animal welfare positions 可能有確切的動物福利地位 • Not legally binding非法定的組織 • Not all vets may be members, so positions do not represent the entire profession並非所有的獸醫師都加入，其立場無法代表全體同仁

11. Role of the individual vet in animal welfare獸醫師在動物福利所扮演的個人角色 • Prevention and treatment of disease 疾病的預防及治療 • Education教育 • Communication skills溝通技巧 • Animal cruelty / abuse 動物殘害/虐待案件 • Client confidentiality 客戶隱瞞 • http://canadianveterinarians.net/animal-abuse.aspx

12. Role of the individual vet in animal welfare獸醫師在動物福利所扮演的個人角色 • Humane education人道教育 • Good communication skills良好的溝通技巧 • Ethical decision-making in practice執業時的倫理抉擇 • Ethical dimension to almost every action獸醫師的每一個行為都有倫理層面 • Need robust, logical and consistent reasoning需要強而邏輯的一致性態度

13. A framework for ethical decision-making倫理決策機制 • Identify all possible courses of action確認可能之做法流程 • Establish interests of affected parties注意相關團體利益 • Identify ethical issues involved確認有關之倫理議題 • Establish legal position of the dilemma建立兩難之合法立場 • Choose a course of action選擇做法(行動)流程 • Minimise the impact of the decision將決策衝擊最小化

14. Identify all possible courses of action1.確認行動之所有可能性做法 • ‘Value- free’ stage不考慮道德價值的階段 • Options can include:可能之選擇 • No treatment不治療 • Palliative treatment症狀緩和性治療 • Active treatment積極治療 • Further diagnostics進一步診斷 • Referral轉診後送 • Euthanasia安樂死

15. 2. Establish the interests of affected parties2. 建立相關組織之利益 • Parties may include: 組織可能包括: • Animal動物 • Owner(s)飼主(們) • Vet獸醫師 • Vet profession?獸醫專業? • Society?社會?

16. 2. Establish the interests of affected parties2. 建立相關組織之利益 • Conflicts between parties often central to dilemma不同組織之意見衝突點通常是兩難問題核心 • Economics are often a significant factor成本常為焦點 • Each of those affected (or their agent)should explain why they hold their view相關的組織(或成員)應當解釋某些觀點 • Are their motives reasonable?這些觀點之動機是否合理?

17. 3. Identify the ethical issues 3. 確認倫理議題 • Must consider the ethical dilemma without distraction from surrounding issues需要思考倫理上的兩難而不被周遭事務分心 • May be more than one ethical issue involved可能有超過一項含有兩難之倫理議題

18. 4. Establish the legal position4. 建立合法之立場 • Assume the vet will abide by the law假設獸醫師要遵行法律 • Does the professional body have a policy?公會是否有政策? • Consider relevant professional guidelines公會之職業指導綱領可以幫助這樣之兩難

19. Ex: RCVS Guidance (2000)範例:皇家獸醫外科學院(Royal College of Veterinary Surgeons) 2000年訂定之指導綱領 • “No veterinary surgeon is obliged to kill a healthy animal…”獸醫師不得殺健康的動物。 • “The veterinary surgeon’s primary obligation is to relieve the suffering of an animal but account must be taken not only of the animal’s condition but also the owner’s wishes and circumstances”獸醫師之主要職志為解除動物痛苦, 但須同時考量動物狀況, 飼主願望, 與其他相關狀況。 • “Where in all conscience (憑良心),, a veterinary surgeon cannot accede(同意) to a client’s request for euthanasia he or she should recognise the extreme sensitivity of the situation and make sympathetic efforts to direct the client to alternative sources of advice”憑良心而言，獸醫師不能同意飼主要求動物安樂死, 應該體認此舉極端敏感, 應以憐憫力爭指導飼主做其他選擇。

20. 5. Choose a logical course of action5. 選擇行動程序 • Use a logical ethical theory e.g.使用邏輯性的倫理流程來分析，如: • Utilitarianism效益主義 • Deontology義務論 • Be aware of the theory’s limitations注意各理論的限制 • Is it still the most appropriate for this decision是否為最適當的決定 • In practice, combination of theories used實際上，理論互相融會運用

21. 6. Minimise the impact of the decision6. 要使決定衝擊最小化 • Often termed ‘refinement’通常稱為 “精緻化” • Aim to reduce the harm produced by the decision目標是減輕決定所造成的傷害 • Easily overlooked容易被忽視 • Use principles of medical ethics to help使用醫學倫理的原則來協助

22. Guiding principles from medical ethics醫學倫理的指導綱領 • When making an ethical decision, consider all these:作倫理抉擇時，考量下列: • Non-maleficence不是惡行(不要行惡) • Beneficence善行(要行善) • Autonomy自治權(道德上的獨立自主) • Justice公義

23. Non-maleficence不是惡行(不行惡) • Principle of doing no harm— “Primum non nocere”不做惡的的原則 • Ensure this first before going on to the next step確定此原則後才開始進行下一步 • May have to weigh up short-term harm against long-term benefit必須衡量短期的傷害與長期的利益

24. Beneficence善行 • Principle of promoting good以推動善為原則 • Follows when non-maleficence is ensured當確認不是惡之後就要繼續做下去 • Try to promote good in both the short- and long-term盡量同時推動短程與長程的善

25. Autonomy自治權(道德獨立) • The ability of people or animals to be self-governing—to make choices about their lives and to act upon their choices動物或人的自我打理能力--按照自己的選擇來生活、行動 • E.g., when to eat or sleep如: 何時吃,何時睡 • The choices of two autonomous agents may conflict衝突可能會發生在二個動物(或人)之間 • E.g., vet and client, predator and prey如:獸醫師與飼主(指人), 掠食者與被掠食者(指動物)

26. Justice公義 • Treating all animals and people in a fair and equal way對所有之動物與人以平等待之 • Divide up resources分配資源 • Equally for each individual 每個個體都要平等 • According to need依照需要分配 • According to greatest benefit依照最大效益分配

27. Attitudes among vet students獸醫系學生的態度 • U.K.英國 • Lower empathy among final-year male students than among first-year males應屆畢業之男同學的同理心低於入學第一年之男學生 • Males showed lower empathy than females男同學的同理心低於女同學 • Importance of role models at vet school好的模範在獸醫學校裡非常重要

28. Attitudes among vet students獸醫系學生的態度 • U.S.美國 • Students from farming backgrounds showed lower levels of concern about questions of animal welfare than did students from urban backgrounds具農村背景之學生對動物福利的關懷程度低於都市背景之學生

29. Attitudes among vets獸醫師的態度 • Peri-operative analgesia手術用止痛劑 • In western countries, many vets do not provide adequate peri-op. analgesia to farm animal, horses, or dogs and cats在西方國家，許多獸醫師對農場動物、馬、狗及貓不使用止痛劑 • Male vets may be less likely than female vets to provide adequate analgesia男性獸醫師在手術中使用的止痛劑比女性獸醫師少

31. Attitudes of vets & vet students獸醫師與獸醫系學生的態度 • Logical ethical reasoning will:邏輯理性化的倫理會: • Reduce the effect of biased attitudes to animal welfare降低對動物福利偏差態度的影響 • Enable the right decisions to be made rather than relying on common practice有能力做對(正確)的決定,而不是按照例行的做法來做決定 • Allow confidence in your professional decisions讓你的專業決定有信心

32. Surgery外科手術 • Will the animal be in an unacceptable amount of pain?動物是否有無法承受的痛? • What is the long-term prospect following the surgery?外科手術之長期預後如何? • Does the vet have sufficient expertise for the procedure?獸醫師是否有充分的技術進行手術? • What are the interests of the parties concerned?相關組織所關心的利益是什麼?

33. Confinement of animals during treatment治療時的保定 • How long will confinement be for?需要多久的時間? • How much distress will it cause?緊迫程度? • What are the alternatives?可有取代方法? • How can the negative aspects of the confinement be minimised?如何讓負面情況最小化?

34. Treatment of animals with low income owners低收入飼主動物之治療 • Does the practice have a policy on this?有相關政策嗎? • Does the professional body have a policy on this?公會有相關問題之處理政策嗎 • What are the alternatives?替代方案是什麼? • What action will promote the greatest good?怎麼做才能產生最大的善?

35. Euthanasia of stray animals流浪動物安樂死 • Animals may be: 動物可能是: • healthy or unhealthy健康或不健康 • a public nuisance/health hazard公害/危及健康 • Does the animal have: 動物是否有: • a right to life?生存的權利 • the right to a humane death?人道死亡的權力 • What course of action will promote the overall good?何種行動方式可以成就整體的善?

36. Management of sick farm animals農場病畜/禽之處理 • Lack of treatment / delayed euthanasia不治療/延後安樂死 • Role of “cheap food” policy “廉價食品”政策 • Society demands low food prices社會需要低價的食品 • Supermarkets have powerful buying cartels that dictate the price paid to farmers超市組成 “卡特爾”組織來操縱市場價格 • Farmers’ profit margins are very very narrow農夫的邊際利益非常非常小

37. Management of sick farm animals農場病畜/禽之處理 • What action promotes the greatest good?如何成就最大的善? • Should the animal’s well-being take priority over the farmer’s wallet?動物的福利比農夫三餐的溫飽優先? • When?何時? • Does food policy need to change so that sometimes animals’ well-being can come first?食品的相關策略需要修改以促進動物福利?

38. Management of sick draught animals役用動物生病之處理 • Some may go untreated or have euthanasia delayed. Why? 有些可能不被治療或安樂 死，為甚麼? • Economics經濟考量 • Attitudes: not seen as sentient態度:動物沒有感知能力 • Ignorance忽視 • Economic benefits of treatment / euthanasia?治療/安樂死的經濟利益? • How can attitudes be changed? 如何改變態度?

39. Treatment of wild animals野生動物之治療 • Wild animals野生動物 • May be more adversely affected by veterinary treatment than domestic animals經過獸醫師治療後反而有其他負面之影響 • May have special legal status某些物種有特殊的法律地位 • May be considered as pests某些野生動物被視為有害動物 • Can the needs of the animal be fulfilled in the short or long-term?治療會給予動物長期還是短期的需要?

40. Summary總結 • Profession’s role in animal welfare獸醫專業在動物福利所扮演的角色 • Licensing body & professional association 專業領域的主體 & 職業公會 • Individual vets’ roles in animal welfare個人獸醫師在動物福利所扮演的角色 • Making ethical decisions in practice執業時作倫理抉擇 • 6-point ethical framework 倫理6步驟 • Animal abuse動物虐待

41. Summary總結 • Attitudes among vets獸醫師的態度 • Role of background & vet school背景及獸醫學校的角色 • Not enough attention paid to pain management對痛的處理仍須多關照 • Welfare/ethical issues found in practice執業時所面臨的福利/倫理議題 • Importance of economics經濟的重要性 • Use ethical framework and professional guidelines使用6步驟以及專業指導綱領

42. Further Reading延伸閱讀 • British Society of Animal Science. What Price Cheap Food? <http://www.bsas.org.uk/meetings_&_workshops/past_meetings/past_meetings>. British Society of Animal Science: Penicuik, Scotland, 2002 • Christie JL, Hewson CJ, Riley CB, McNiven MA, Dohoo IR, Bate LA. A preliminary equine abuse policy with potential application to veterinary practice. Can Vet J 2005; 46: 250-252 • De Aluja AS. The Welfare of Working Equids in Mexico. Appl Anim Behav Sci 1998: 59, 19-29 • De Boo J, Knight A. Educating the Veterinary Professional about Animal Welfare. Alternatives to Animal Experiments 2006, 23, special issue: 71-74 • Dohoo SE, Dohoo IR. Factors influencing the postoperative use of analgesics in dogs and cats by Canadian veterinarians. Can Vet J 1996; 37:552-555. • Hewson CJ, Dohoo IR, Lemke KA. Factors affecting the use of postincisional analgesics in dogs and cats by Canadian veterinarians in 2001. Can Vet J 2006; 47:453-459.

43. Further Reading延伸閱讀 • Hewson CJ. How might veterinarians do more for animal welfare? Can Vet J 2003; 44:1000-1004. • Hewson CJ. Showing leadership in welfare: position statements and some of their consequences. Can Vet J 2004; 45:781-786 • Hewson CJ. Leadership in animal welfare: a comparison of Canada with the United States, the United Kingdom, Australia, and New Zealand. Can Vet J 2004; 45:944-950 • Hewson CJ. Leadership in animal welfare: the role of veterinary colleges. Can Vet J 2005; 46:74-78 • Hewson CJ. Veterinarians who swear: animal welfare and the veterinary oath. Can Vet J. 2006 47: 807-811 • Hewson CJ. Hidden costs of food production: the veterinarian’s role. J Vet Med Educ 2007 33: 561-566 • Lemke KA. Understanding the pathophysiology of peri-operative pain. Can Vet J 2004; 45:405-413.

44. Further Reading延伸閱讀 • Levine ED, Mills DS, Houpt KA. Attitudes of veterinary students at one US college towards factors relating to farm animal welfare. J Vet Med Educ 2005; 32: 481-490 • Main DJ. Offering the best to patients: ethical issues associated with the provision of veterinary services. Vet Rec 2006; 158: 62-66 • Molony V. and Kent, J.E. 1997. Assessment of acute pain in farm animals using behavioral and physiological measurements. Journal of Animal Science, Vol 75, Issue 1 266-272. • Muir WW, Woolf CJ. Mechanisms of pain and their therapeutic implications. J Am Vet Med Assoc 2001;219:1346-1356. • Patronek G. Issues and guidelines for veterinarians in recognizing, reporting, and assessing animal neglect and abuse. In: Olson P (ed) Recognizing and Reporting Animal Abuse: A Veterinarian’s Guide. Englewood, Colorado: American Humane Association 1998: 25-39.

45. Further Reading延伸閱讀 • Paul ES & Podberscek AL. Veterinary education and students' attitudes towards animal welfare. Vet Rec2000;146: 269-272 • Schneider, B. A study in animal ethics in New Brunswick. Can Vet J 2001; 42: 540-547 • Serpell JA. Factors influencing veterinary students’ career choices and attitudes to animals. J Vet Med Educ 2005; 32: 491-497