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What causes moral stress in the veterinary practice?

If you work in the veterinary profession, you’re likely familiar with the term compassion fatigue. Compassion fatigue is defined as “the physical and mental exhaustion and emotional withdrawal experienced by those who care for sick or traumatized people over an extended period of time.”

When people discuss compassion fatigue, they’re usually thinking of the impacts of patient suffering. We certainly deal with plenty of that in veterinary medicine, and it can be distressing to witness sick or suffering patients. However, in our role we are also often subjected to a different kind of stress – known as moral stress.

According to recent studies, moral stress is likely the greatest contributor to compassion fatigue in veterinary medicine.

What is moral stress?

Moral stress (also known as moral distress) has been defined as “psychological state born of an individual’s uncertainty about his or her ability to fulfill relevant moral obligations.” It has also been described as “an emotional state that arises where a person feels that their ethical principles are different from the external factors which they must undertake (such as company policies or procedures).”

Regardless of the precise definition which you use, moral stress is caused by ethical conflicts. It often occurs when we are unable to act in accordance with our own personal ethics.

What are potential causes of moral stress in the veterinary hospital?

Perhaps the most obvious cause of moral stress in the veterinary hospital is euthanasia. Many pets are euthanized at the end of a long and happy life, as a caring and compassionate step on a pet’s journey. Performing this sort of euthanasia, while sad, doesn’t usually cause moral stress. In these scenarios, the client, veterinarian, and veterinary team members are all typically in agreement that euthanasia is the morally correct choice for the pet.

Unfortunately, not all euthanasias are so straightforward. When a pet’s medical needs exceed a client’s financial resources, for example, euthanasia may be a justifiable but morally sticky choice. Even though we can’t force a client to pay, can’t treat patients for free, and can’t rehome every pet, euthanizing a pet with a treatable condition is morally complicated. Behavioral euthanasias can also cause moral distress, as there are often multiple ways to view the patient’s behavior and expected outcomes.

Euthanasia certainly isn’t the only situation that can cause moral stress. Some clients insist on pursuing painful and aggressive treatments in a pet with a poor prognosis, while others decline pain-relieving or medically indicated treatments for their pets. While some clients are happy to pursue their veterinarian’s recommendations, other clients make requests that are more difficult to justify.

There are countless scenarios in veterinary medicine in which the interests of the patient, the client, the veterinary community as a whole, and society in general are in conflict. In any given day, a veterinarian or veterinary team member may find themselves dealing with multiple potential sources of moral stress.

How can you reduce moral stress in your practice?

Begin with awareness

Simply learning about the concept of moral stress can be helpful for many individuals. Once you recognize that you’re in a difficult ethical situation, it may be easier to understand and process your feelings and move forward in a productive way. Look for opportunities to discuss moral stress with your team, during spontaneous conversations and in team meetings. Simply understanding this issue can start a path toward healing.

Bring clients and staff into alignment

Moral stress can also be alleviated by bringing clients and the veterinary team into better alignment with each other. Clear communication helps clients and the veterinary team work towards a common, shared goal instead of creating an adversarial “us vs. them” mentality. Using objective measures, such as Quality of Life scales, to facilitate conversations can allow all parties to communicate more clearly and with greater understanding for each other.

Give staff more control

Empower your staff to act in ways that prevent moral stress. Veterinary team members often acquiesce to requests cause them discomfort, simply because they feel like they have no choice. Empower them to demonstrate a greater sense of agency in their work, by giving them permission to decline client requests that cause moral distress.

Enact a policy

In order to reduce the moral stress associated with euthanasia, consider developing a euthanasia policy for your practice. Clearly stating the scenarios in which euthanasia can and should be provided can help alleviate moral distress for veterinarians and veterinary team members, by empowering veterinarians to decline euthanasia requests that are not medically justified.

Summary

Moral stress is a prevalent issue in veterinary medicine, and a significant contributor to compassion fatigue in veterinarians and veterinary support staff. Help your team recognize signs of moral stress, and work together to identify scenarios that contribute moral distress. Collaborate with your team members to alleviate moral stress, improving their mental health and maximizing their chances of long-term success in the veterinary field.

 

Author

Cathy Barnette, DVM

Cathy Barnette, DVM is a veterinarian and freelance writer based in Florida. After 14 years as a small animal general practitioner, Dr. Barnette now focuses on creating educational content for veterinary teams and their clients. She shares her home with her husband, daughter, one dog, two cats, and a rescued white dove.

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