Moral distress and euthanasia: what, if anything, can doctors learn from veterinarians?

[摘要] ‘Do 3 more years with a high quality of life justify this therapy, which will be associated with 6 months of serious discomfort for the patient? … Is it better to choose chemotherapy or to allow ‘natural’ death?’(Hypothetical question)These and related questions are no longer exclusively associated with human medicine. Many animals, accordingly classified as companion animals, nowadays have the status of family members, and palliative veterinary medicine has caught up enormously in recent years. On these matters, it is worthwhile for veterinarians to take a look at human medicine and clinical ethics. But, equally, there are issues where GPs and human medicine can benefit from the experience of veterinarians.A ‘GOOD DEATH’ The standard good death ideal of small animal practice (that is, a veterinary practice) involves an animal’s euthanasia at the end of its life.1 Small animal practitioners are not only familiar with euthanasia and grieving family members but also with their own feelings accompanying the act of ending a patient’s life.In the UK and elsewhere, the legalisation of euthanasia or physician-assisted suicide (PAS) is currently debated. Examining the effects of killing on the involved physicians with a view to small animal practice, with its decades-long experience in this field, seems therefore sensible.2 We propose elsewhere to approach questions surrounding end-of-life decisions with an eye on both medical and veterinary ethics.1,3 But it is also essential to first consider which experiences from small animal practitioners may be transferable to GPs to begin with.Many veterinarians experience moral distress as a result of not being able to do the right thing, for instance when there is a conflict between themselves and the animal’s owner.4 With regard to end-of-life decisions, the majority of these conflicts fall into one of two categories: either the vet perceives euthanasia as the right thing to do for this pet in this situation but the owner refuses to have their animal killed, or the vet perceives euthanasia as wrong (at least right now) but the owner wants to have their pet immediately killed.Duncan and Jeffrey, in focusing exclusively on the latter kind of conflict, regard this as a ‘one-way pressure to euthanasia’ in the veterinary profession and argue that this is relevant for physicians ‘who have been reassured that there will be no compulsion to participate in PAS’.

[学科分类] 卫生学