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The things that stood out for me in this Quality of Life Panel were:

The issues with having a ‘gold standard’ of care in a vet clinic, how policies and procedures are often not followed when the clinic is busy and short-staffed, which can cause compassion fatigue in all of the veterinary staff as they are unable to give the best care to their patients. That it is important to not load that on our shoulders and instead reflect on what could have been done better in different circumstances, and give ourselves a pat on the back for a job well done under less than ideal conditions.

Considering the transparency of the complexity of the relationships in the veterinary profession to society. It makes me think of the dog who mauled the vet in Tauranga, and how the vet has now become a social pariah because of several things beyond her control in regards to the owners being charged by the council following an appeal of the court decision. This situation has most certainly reduced the amount of trust the New Zealand society as a whole has toward the veterinary profession, and I believe transparency in cases like this may allow more people to understand the complexities around the responsibilities veterinarians have to clients, animals, governing bodies, colleagues, and society, and the responsibilities that the owners have towards their animals, veterinarians, and governing bodies like the local councils.

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What stood out for me was relationships, how within the industry binary relationships are placing importance on two things and the professionals involved choice is heavily influenced. The scenarios mentioned highlight daily internal struggles surrounding decision making and who has the final say in regards to the final outcome. The scenario used where the owners could not afford the cesarian and euthanasia was the outcome, this is a great example where the veterinarian has reduced the animals pain and suffering whilst meeting the owners cost constraints however not the best outcome for the patient. Using this scenario and thinking beyond the binary relationship could the outcome have been the procedure was performed, the owners kept their pet, the clinics costs were covered and the patient was able to live? Would this outcome have been possible if the veterinarian used other legislation and resources and felt supported throughout the process?

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I enjoyed the video, it focused on many of topics around quality-of-life decisions that I'm challenged with on a daily basis not only in running an animal rescue but within the veterinary practice.

I understand that client-vet-nurse-pet relationship is very important, in order to be able to help assist owners to make an informed decision about their animal's quality of life but do believe that as in human practice that vets should have more control legally to step in and override decisions of clients when it is known that the animal will suffer with the decision the client makes on behalf of their pet. Yes, a vet can call on the SPCA if they feel there is a welfare issue but by the time this process takes place the animal is left to suffer or in many cases I have seen die inhumanely.

I also agree and a firm believer of the power nurses have to advocate for animals, I am often called upon to have that talk with owners when vets are unsuccessful in "the talk". As nurses we can come at this discussion from another angle, other than just medically, which can be highly effective.

As much as we would all love to do the Gold standard care for best patient outcome this is not always possible. I work in an area where there is significant low socio status and not a lot of money, but owners do care, and it is important in my opinion that we offer all levels of care to meet financial capability of clients, this builds relationships and trust. It shows we understand and want to help. These financial restraints mean that treatment often comes with a timeline in which the vet will say "if we don't see improvement by... then we have to make the right decision for the welfare of the animal" this is often accepted well.

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Wow, this video was fantastic. It really got me thinking about our industry, and how one decision may be ethical, but hold no moral value and vice-versa. It makes it very difficutl in some situatons to come to a decision where both are valued, and applied.

It is very difficult in our industry, that we have a triangular relationship. It is not just patient-professional relationship, as it is with human medicine. They are able to just focus on the wants of the patient, and apply the best medical care to this person, and provide best options, at either no, or reduced costs (I am sure there are some countries and instances where money dictates care that human patients opt for, but far less often than in the veterinary industry).

Whereas, veterinary professionals, must take into account the best treatment options for the patient, then discuss it with the client, who as the owner, has full authority over the pet, and what treatment they get, which relies on their ethical and moral views, which may not align with what is best for the patient. Then putting the veterinary professional into strife, creating moral injury etc.

Not that it would really work without the client though, because the patients cannot be autonomous in regard to what happens to them, as they cannot communicate with us. This then makes it difficult in another sense because it could be seen as a dictatorship by the veterinary professionals deciding what occurs, with no partnership in patient care. Meaning no boundaries are in place. So, the veterinary professional would just go off what satisfies their ethical and moral values.

The varying costs of different treatments also plays a factor. As veterinary care costs are not contributed to by the government, treatment can be rather expensive, as the business still has to turn a profit, and pay for machines and equipment and their use and maintenance. So, it can then make it tough on the clinical team involved in the care, and the owners of the patient as they know there is a better treatment out there, but are economically unable to do so, which can cause moral injury to everyone involved.

Some clinics may have certain situations where they will provide care at no cost, but that decision comes down to the business owner, and there also may be schemes set up that the client pays a certain amount each week etc. However, that is only a very rare occasion, so, there is still the bigger issue to deal with, which poses varying ethical and moral concerns.

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This video raised so many interesting questions that I as someone in the profession had not really thought much into. Something that stood out to me was the issue that was raised of what we deem "acceptable suffering" and sometimes the lack of action we take against this in regards to welfare. I work with pig dogs in my clinic who are generally stitched up or stapled together by owners with no pain relief, local or anaesthetic. We are well aware this is happening and some vets will actually give out suture and needles to assist. We know this is wrong, and that owners with absolutely no training should not be performing medical procedures on their dogs, however many of the vets I work with will counter it with "they're going to do it anyway so they might as well have the right gear".

I also understand the points raised about maintaining the relationship with the public and maintaining trust with owners, which is something that can be incredibly fragile. Definitely highlights the pressures on vets and the profession to do things right by the owners, the pets and to maintain your own personal ethics.

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This video gave me a lot of food for thought. I have also often compared the veterinary industry to pediatrics due to both having patients that do not have the ability to make life choices of their own. However, as discussed in this panel, there are actually very clear differentials between the two, including topics such as the value of animals, cultures and production animals that are cared for and then later killed for meat.
I related to the comment about clients sometimes needing leadership from the veterinarians particularly when making decisions in the best interest of the animal.
I enjoyed the discussion around the factors that lead to decisions around patient care, such as the gold standard/best care for the patient verses the cost of treatments, the clients financial budget, if this allows the vet to apply gold standard care, the stress it can cause the veterinary staff if they are not permitted to provided the best care and how all aspects are connected to achieve a good outcome for all (The Vet, the client and the patient).
I thought the discussion around the Animal welfare Act Verses Owner chattel was thought provoking and could definitely be the cause of some conflict in Quality of Life choices.

~ Sam Filbee

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Oh, my goodness, I loved this video. I am incredibly interested in these deeper structural issues in the veterinary industry with ethical and moral concerns in relation to the multitude of aspects effecting the industry. I have had a lot of personal thinking that is similarly in line with what was spoken. There are so many things I want to touch on and talk about but I've written 3000 words in my notepad, and I feel that's not padlet entry acceptable.

A primary takes away for me was the concept of the veterinary social contract the industry has with the public. Then the inability to answer what the 'agreed ends' of this contract is in comparison to the role the veterinary industry has vaguely put itself into. The trust the public has in us we need to uphold and our inability to know how to uphold it. Where veterinary nurses fit into that, and the professional identity issues associated. Have we earned out social contract privilege, and do we uphold it? Should the public trust us?

I wonder about the disconnect in the profession from culture, beliefs, values, and relationship building. Which support client trust and therefore retention, education, understanding and patient outcomes. I have relatives who refuse to go to human doctors out of distrust from their experienced lack of respect on previous visits. It's applicable to the veterinary industry because while yes animal welfare is #1, you need to get those animals into the clinic for treatment. Then the struggles of a relationship-based approach in comparison to policing of the welfare act. The instant distrust that comes with removing client control. Then clients never coming back to the clinic with future animals if they weren't educated on why their control was removed in an appropriate, considerate, and empathetic manner. or instead, the effects of pawning that legal responsibility off onto the SPCA in NZ (which still includes veterinarians and nurses).

Also interesting to me was the fact that pet ownership veterinary is inherently a private healthcare industry. Therefore, there are the struggles of being compared to or adapting public healthcare structures and mechanisms, which don't translate well. Particularly legally and socioeconomically.

Then the struggles of creating overarching systems, ethics and morals and imposing those on sectors of the industry that weren't taken into consideration or discussed with. Such as behavior, farm, research, wildlife, population control (feral cats), etc. How surgeons talked mainly about their position and not until the end of the discussion mentioning other aspects of the veterinary multidisciplinary team when they spoke up. We need to speak up and speak for ourselves. Then there's also the aspects 'outside' of the industry that we are inherently linked to and have delegated tasks to that aren't apart of the 'veterinary clinic'. Such as rescues, the SPCA, investigators, animal control, lawyers, insurance, etc.

The limitations of the scientific approach in terms of positive language -> self-perception. Reduction of social empathy in the industry through language. So interesting.

I also want to write about behavior veterinary science in comparison to ethical and moral challenges, but I would not be able to do it concisely.

I have so much more I could write,,,,,,,,,,,,,,,,,,

Social contact, recognizing relationships, defining 'agreed ends', assessing changes, assessing role, scope, public awareness/education, transparency, policy, regulation, legislation, ease of access to discussion and information.
Our version of this unique to veterinary nursing as our industry. Our voice.

Also, the effects on students or those wanting advice before joining the industry,,,,,

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Quality of Life discussion/reflection- Caitlin

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Quality of Life discussion/reflection- Caitlin

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I found the panel to be very interesting, it seems like the got a good selection of answers and discussion around the questions that they posed. I was surprised that many of the audience had  a different idea to 'allegiances' to patient vs. client, and were almost disagreeing with the speakers. The discussion on pediatric vs veterinary was insightful and puts the topic in a different perspective. Treating the patients needs with the ultimate goal of having the patient best of interest in mind  does differ from what we have to do sometimes in the veterinary industry, and I don't think I fully thought of it that way until hearing that. I feel the pediatric point should be taken more into consideration when dealing with our patients, although it can be difficult when animals are considered 'property' owned by the client. Can/when should we be stepping in and advocating for the patient if a client doesn't see their animals best interests?

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This was an interesting discussion and brought many questions and ideas to light in how we, as veterinary industry professionals, face dilemmas regarding the quality of life ethical boundaries that are faced daily. I liked how one of the speakers in regard to autonomy related animals in the same boat as paediatrics' and how we may learn from their profession in bettering our care for our animal patients. I have had many ethical issues regarding our patients care where we have felt we are going against our morals, and ethics due to either clients not being able to afford care or due to religious/cultural beliefs. We have a few different cultures who genuinely love their animals, but they do not believe in euthanasia, but the patient obviously needs to be put to sleep. This to me is a huge ethical dilemma. How have we let this patient go home to suffer a prolonged death, but the vets will state they can't force the owner. When does it become out of the client hands, other than an obvious neglect or cruelty case where you can call SPCA? This is a complex area and I love that this is being talked about so we can put welfare as the main priority in our industry! Gemma

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A very interesting discussion on this panel, one that I think the industry would really struggle to come to a universal agreement on due the complexities of our work.

From my emergency and ICU experience I see colleagues tackle ethical decisions on a daily basis. From owners with their terminally ill elderly dog wondering what more can be done to "Have just a bit more time" to absolutely distraught owners bringing in there cat who has been hit by a car where they don't have money for stabilization and surgery, so humane euthanasia is their only option. We've had to call owners in the middle of the night to inform them that their pet has arrested, informing them that we have started CPR and trying our best even though getting ROSC is very slim in a lot of trauma patients and even very sick patients.

A personal memory of mine which has happened on a night shift where a patient who had been just diagnosed with Myasthenia Gravis, vomited and then aspirated, causing them to go into respiratory arrest. We promptly intubated/suctioned and started breathing for them while someone was trying to get a hold of the owner who unfortunately never answered their phone overnight. We ended up euthanizing on welfare grounds as we were unable to adequately ventilate the patient. It was a horrible situation that made it even more difficult with the owner unreachable, a very novel situation but one I will never forget.
It puts an emotional toll on everyone involved and it would be nice to have a line in the sand on where to stop but then who makes that decision? We as veterinary professionals should have discussions about what we can do

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From a nursing point of view this video made me very aware of the lack of knowledge I have around the veterinarians proffessional code and the animal welfare act.  I havent had to consider these legalities in my role to the same standard like they have, and watching this made me appreciate this complexity they face when making a decision around the welfare of a patient at times.  This moral stress a vet will carry because of the impossibility to be able to act ethically due to a cascade of factors that play into their decision making.  I thought it was very interesting hearing at the start of the video the clarity there is in the human medical proffession around patient care, becuase here the patient is the first decision and that gives doctors a clear moral code, as apose to veterinarians who as much as they want to prioritise the patient first, often it is the owner they have to base the decision around which at times will make it impossible for them to act ethicially.  I have a new empathy around this for my veterinary collegues.

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Quality of Life - discussion + reflection

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Quality of Life - discussion + reflection

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That was a lot to digest! (It was great to see a veterinary nurse in there.)
Very complex, so many questions, where to start...
A lot to think about but then many things are related to our daily work. Nothing is black and white when it comes to decisions about the quality of life. As they said it is a balancing act. Who comes first? the patient? we need the owner's consent to treat -as from a professional point of view, we want the best for the patients - gold standard? but as we know that is not always the case we can apply due to multiple factors (resources, finance, beliefs, welfare, etc...)

- I see the idea can relate to more human paediatric models since they can't voice themselves either, but obviously, it is not easy to just borrow and apply the idea.
- note of the importance of social evidence-based research, alongside with applying the evidence-based research to deal with people.

This might be slightly off the topic(?), at my current workplace at the emergency clinic, we do come across many difficult situations - naming a few, dealing with high emotional states of the owner, and the financial restrictions mean while a critical ill patient who needs the most attention... Over the years, I have seen and experienced difficult time dealing with this complex issue. It highlights the importance of looking after and protecting people in this industry. With so many faces and responsibilities a veterinarian holds, these pressures can be detrimental.
Akiko

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I've always been aware of the ethical dilemmas we face as veterinary professionals but I don't think I realised how complex the issue really is!

There was a lot to think about in the video and as a lot of things were being said it was making me remember experiences of my own where the same issues had arisen.

I found one of the points about the paediatrician model of care interesting and it made a lot of sense. I had never thought about it from that perspective before. Balancing the needs of the patient and the wishes of the client can be one of the hardest things we need to do, especially when they are sitting at polar opposites.

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Phew, that was a lot to unpack - I may actually re-watch this in a few days to better understand it. It was good that a nurse was there, as we are a huge part of the care that goes into a patient and client relations, and (probably not often enough) nurses opinions, experiences, and advice play a large role in the big picture, and influence the vet's decisions. It is true that nurses have a more objective view of a situation being "out the back", and I think this can often be a positive thing - my vets often feel sorry for clients and discount our bills, for example, where the nurses often bill things as they are because everything we do is valuable (just as a small example, as I am currently ironing this out at work haha), or sometimes the vet will offer to do diagnostics on a patient in the hopes it is unwell for a fixable reason, but when they bring it out the back, I can tell this cat clearly has probable cancer growing through the mouth, and pts is probably the kindest option for the cat's sake (again, another personal experience..). This is probably really off the point, but it's my current though process... *cringe emoji*

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I really enjoyed this. there is just so much to think about and it really highlights a huge issue within out industry and just how hard it is to overcome.

Who is our priority - patients or clients? This is something that I personally feel myself questing often. Interesting to hear some perspectives about it. I think we often end us doing the “lest worst thing” for patients due to the owners wishes which goes agains the key value of veterinary medicine. there have been countless times when it is obvious that a patients needs intervention but due to owners wishes intent getting anything. This  begs the question can we and when can we step in and demand better for our patients are are we doing this as much as we should be. It’s interesting thinking about the aspects of human medicine that we “borrowed” in regards to other human medical aspects we didn’t incorporate. Also that we used human medicine aspects so easily in an industry that is so clearly different. it all leads to the question are we actually doing the best for our patients or have we got lost in the business aspect of clinic life. I think we need to rethink the way we handle our clinical relationships with clients and patients and this all needs to start with a better understanding of these relationships and the link these have to patient outcomes and client satisfaction. At the end of the day much like human medicine it isn’t going to be black and white but having more clear guidance in place limits the harm to patients and this should always be the main goal and any veterinary professional.

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Wow definitely some food for thought, after watching that discussion I realize just how complex the industry is, we have to consider not only small animal practice, that's used to a more individualized approach but also, rural practice: herd health, human safety (animal behavior and food animals). I Like Karen suggesting a pediatrician approach as a possible way of better prioritizing patient needs. Its definitely a notable point in veterinary medicine history that we borrow allot from human medicine, and seldom question if the model is best suited to animals.

I liked the comment about EBVM including science (as evidence) but also social data to consider how we can improve client relationships and trust as a practice and profession. It was great hearing from a veterinary nurse, yet as she pointed out she may have been the only one there. These ethical and moral debates and discussions nurses have struggled to find a voice within, yet their perspective is both valuable and unique. The idea of more ethical boards including nurses and lay people to add perspectives.

Vanessa discussed moral stress, naive of me yet I had never truly considered this or its implications. Veterinary industry holds allot of responsibility and often faces ethically challenging decisions which do place individuals and teams in conflict with their values and beliefs. I really liked here discussion on relationships being inter-linked and connected when considering QOL and ethics. You can't separate all the factors- client (finances, beliefs), animals (needs, welfare) and business (resources, staffing and support) they all interlink and influence the decision and choices available.

Thank you, a very interesting and thought-provoking lesson, :)

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A big point for me that stood out is the mention of veterinary nurses and how we need to be included in discussions and given the opportunities to share our thoughts in patient care. When they were talking about how veterinary nurses often have a different opinion, thought or idea that may not be said to the client because we are “out the back” and not facing the client is something I found really interesting - obviously we all have our own personal ideas and ethics and often we will voice them to our colleagues but realistically we aren’t the ones having the discussions and doing the decision making, this a usually left to the vets to discuss with the owners.
Another thought provoking point discussed was how (in a practising scenario) we have obligations to both the owner/client and the animal/patient, and how it can parallel to human paediatric medicine but we mustn’t take their framework because it is also so different. There is no blanket statement or guideline that the industry as a whole can follow as there are so many aspects and fields under veterinary professionals. From practising in clinic with small animals, to large animals, production animals, welfare, research, wildlife/conservation there are so many different guidelines and sets of ethics that need to be accounted for and addressed that it is so difficult to have one blanket statement.
Further on that topic, poses the question of what do vets actually do, and from there what do us as veterinary nurses do? I feel a lot of us are in it for the love and welfare of the animals, but there are so many different options and avenues that nurses can do and that are often not discussed or advertised, including research and these are the parts of the field that may be the hardest to get into but also can arguably be one of the more important jobs we could have. In New Zealand the opportunities to join the research field are so limited that it can be difficult to pursue that aspect, thus potentially affecting our job satisfaction and QOL as a veterinary nurse if research is something you are interested in but cannot find the means to participate.

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Wow, so much to think about...

- Not just a black and white scenario where vets simply put patients needs before clients want or vice versa.
- Recognising that a more complex approach should be explored. Acknowledging the client-patient relationship, as well as welfare science (focusing on the patient) are needed to consider in order to provide a good overall outcome.
- Not just applying an evidence-based approach, but a socio-scientific evidence-based  approach. Where in veterinary research, more data is collected relating to trust and empathy.
- In this way, there are not only medical 'gold-standards', but also the ability for professionals to provide a high standard of maintaining client trust/empathy. Both ideas can be seen as an accomplishment.
- Improving public awareness - where vets and vet nurses put patient welfare at the forefront, will cause a greater respect response from the public.
- However, vet nurses are not protected by a title, which makes it difficult to maintain the publics trust.
- I think its also important to note that we as vet nurses don't have an influence in the consult room, where we aren't as initially involved with the client. However, if we are to speak up and be an advocate for patient Q.O.L. (without the influence of a client relationship), it can add valuable influence to the vet to consider going forward with care/treatment.