Study: You could be dealing with high moral distress as a result of unresolved ethical conflicts and not even know it
Whether you call it compassion fatigue or burnout or plain old depression, the growing number of veterinarians who report suffering from some form of it is of critical concern to the profession. According to a 2015 study, close to 7% of male veterinarians and nearly 11% of female veterinarians suffer some kind of serious psychological distress.
But according to the authors of a new study, the root causes of these problems haven’t been rigorously identified. They believe that ethical conflicts with clients over patient care and the resultant moral distress may be at the root—but veterinarians wrestling with those issues may be unaware that the issues even exist.
The study, “Ethical conflict and moral distress in veterinary practice: A survey of North American veterinarians,” published last month in Journal of Veterinary Internal Medicine, found that a majority of veterinarians experience moral distress when clients made inappropriate requests for euthanasia, as well as in cases where veterinarians faced circumstances that prevented them from providing appropriate medical care because to do so would go against a client’s wishes.
That may seem pretty obvious, but here’s the kicker: The authors believe that “veterinarians may not consider commonly felt distress as being triggered by a conflict between their actions and their personal morals. Instead, they may perceive the situation as ‘sad’ or ‘upsetting’ without acknowledging why.”
In other words, veterinarians may be suffering from depression because they feel that they routinely have to make decisions and deal with client requests that run counter to their own moral and ethical beliefs, but without realizing that that’s what’s going on.
The authors designed their study to document the existence of unlabeled ethical conflict in veterinary medicine and to see whether it was a problem for veterinarians and/or their staff.
The study surveyed 889 veterinarians in North America about how they cope with ethical conflicts and moral dilemmas arising from disagreements with clients over appropriate patient care. The veterinarians were asked to fill out an anonymous 49-item online questionnaire.
More than 70% of respondents said that the obstacles they faced that prevented them from providing appropriate care caused them or their staff moderate to severe distress, and 79% reported being asked to provide care that they considered futile.
When asked, “How often have you been asked to do something in the course of your clinical practice that feels like the wrong thing to do?” 45.3% said “sometimes” and 5.6% said “often.” When asked how often they complied with these requests, approximately 25% said “never,” 45% said “rarely,” 23% said “sometimes,” 7% said “often,” and fewer than 1% said “always.”
Significantly, despite the varying rates of compliance, 62% said that they sometimes or often felt that clients put them in a no-win situation where they couldn’t “do the right thing.”
NEWStat reached out to the study’s lead author, Lisa Moses, VMD, DACVIM, CVMA, for comment.
Moses, a research fellow at the Harvard Medical School Center for Bioethics and chair of the Animal Ethics Study Group at the Yale Interdisciplinary Center for Bioethics (and a practicing veterinarian at AAHA-accredited Massachusetts Society for the Prevention of Cruelty to Animals–Angell Animal Medical Center in Boston, Massachusetts), said, “The reason I did this research was because we haven’t done much exploring the root causes of compassion fatigue and poor wellness in vets, even though [the profession as a whole is] talking a lot about the effects of those problems.” The findings have strengthened her suspicion that ethical conflict and resulting moral distress are big contributors. “This study [documents] the problem of moral distress in veterinarians, which hasn’t been done before.”
Moses added, “In all the talking I do to veterinarians about ethical conflict, I’m pretty struck by how many of us just accept that this is inevitable and not something we can change.”
Moses disagrees with that stance.
“I think we can [change],” she says, but adds that it’s going to take a concerted, profession-wide effort. “I urge my colleagues to talk to each other and [to] other veterinary professionals to share this burden and explore ways that [we] can help each other.”
But as the study shows, the first step is getting veterinarians to understand and acknowledge that some feelings they may be dismissing as “sad” or “upsetting” could run much deeper than that.
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