The term moral stress was first used by the philosopher Andrew Jameton in 1984 to describe a situation “when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action.”

Jameton was writing about the field of human nursing, but the term moral stress, a type of stress that arises from ethically challenging situations (ECS) is now used commonly to describe the type of stress experienced by veterinary professionals in daily practice.

It’s probably no surprise to you that the number of ECSs faced by veterinary staff has risen sharply since the start of the pandemic. But the most common types of ECS have changed, too.

That’s among the findings of a new study by researchers from the University of Sydney in Australia. The researchers developed an online, mixed-methods survey to determine the frequency, stressfulness, and types of ECSs experienced by veterinarians, veterinary technicians, and other veterinary staff since the advent of the global COVID-19 pandemic in March 2020.

The researchers analyzed responses from 540 veterinary team members from 22 countries collected between May and July of 2020.

Prepandemic, the most stressful ECS included clients wishing to continue treatment despite an animal's poor quality of life, suspected animal abuse, and euthanasia requests from clients who have funds but are unwilling to pay for treatment.

In the study, pandemic-specific ECSs emerged, including concerns about biosecurity and safe working conditions. The most common ECSs reported by respondents were: 

• Challenging decisions about how to proceed when clients have limited finances (64.4%)
• Conflict between personal wellbeing and professional role (64.3%)
• Conflict between the interests of clients and the interests of their animals (59.6%)

“A key stressor identified in our survey was conflict between one’s personal wellbeing or the wellbeing of one’s family, and one’s professional role and commitment to animal welfare,” corresponding author Anne Quain, MVetStud, DECAWBM, told NEWStat.

Early in the pandemic, the global shortage of personal protective equipment (PPE) led to veterinary staff going without to make sure there was enough for human healthcare workers.

“Veterinary team members literally found themselves having to decide which was more important—their own health and safety, or caring for animals and the people who depend on them,” Quain said.

Disagreements about biosecurity—what measures should be taken, how, and by whom—within veterinary workplaces were also common. Quain thinks that’s partly because, while veterinary teams are used to treating animals as a source of zoonotic infection, “We were less prepared to consider our clients, our colleagues, and ourselves as sources of a highly infectious disease.”

And while client financial limitations have always been a major concern, Quain said that really ramped up during the pandemic due to many clients losing their jobs or having a restricted income. “This manifested as more clients declining recommended diagnostics and treatment,” Quain said. That led to an increase in euthanasia of animals with treatable conditions, “Which was distressing for owners and veterinary teams, alike.”

Determining which, if any, veterinary services counted as “essential” and whether to run noncontact consultations was another big ethical challenge, said Quain: “Respondents shared heartbreaking experiences of their distress around performing noncontact euthanasias, separating an owner and a closely bonded companion animal at the time they needed each other most.”

Quain, a lecturer in veterinary science at the University of Sydney in Australia and a PhD candidate in veterinary ethics, said it’s the first study to describe the impacts of the pandemic on ECSs experienced by veterinary teams globally. It identifies an increase in the frequency of ECSs associated with the COVID-19 pandemic as well as several stressors unique to the pandemic.

“It was very clear from the responses that veterinarians [and veterinary staff] around the world struggled with huge ethical challenges [during the pandemic], in the context of often rapidly changing guidelines, global uncertainty, staff shortages, and significantly increased workloads.”

Quain says the good news is that there are strategies that veterinary teams can employ to help them better navigate ethical challenges like these, not just in a pandemic, but postpandemic as well: “The first step is to recognize that ethical challenges are common, they’re a source of moral stress, and they’re experienced by all veterinary team members.”

The second step is to talk about them.

“When asked what resources respondents used to try to resolve ethically challenging situations, the most common was discussion with colleagues,” Quain said, with 63.1% of respondents saying talking with coworkers helped. “Colleagues get it,” Quain said. “They appreciate the challenges we experience, [and] they can offer practical advice.”

As can management.

Quain said one-third of respondents reported looking to workplace policies for guidance, and that represents an opportunity for the profession: “Veterinary workplaces and professional organizations can help develop policies designed to help veterinary team members successfully navigate common ethical challenges.”

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