Veterinary Emergency Response

What is the veterinarian’s ethical responsibility when responding to an emergency?

How many times have you had an emergency call for a horse that you simply couldn’t help, either because you were too far away, didn’t have the necessary equipment, or were busy working on another horse? How much did it bother you?  If you are a veterinarian who is on-call for emergencies, chances are you wrestle with this issue on a regular basis. If you find yourself facing this scenario frequently, it is likely to be causing you distress. 

Equine veterinarians have an ethical responsibility to care for the horse. In fact, the Principles of Veterinary Medical Ethics of the AVMA clearly states that “a veterinarian should first consider the needs of the patient to prevent and relieve disease, suffering, or disability.”  Yet what happens when the veterinarian faced with an emergency can’t respond because they lack the necessary resources, whether that means equipment, facility, skills, or simply their own time or emotional energy?

Equine veterinarians have finite resources, including time and emotional energy. Balancing the need to provide emergency services with our duty to ourselves is an increasingly urgent quandary within the profession, as evidenced by the startling statistics related to veterinarians leaving practice. We know 50% of new equine veterinarians leave equine practice within five years. This isn’t sustainable. We also know emergency availability is a major issue leading to veterinarians electing work without equine on-call responsibilities.

There are numerous discussions of how to set boundaries by pooling resources and working together to create emergency cooperatives that help relieve the burden of providing emergency care. Just as important is helping veterinarians develop the tools they need to justify refusal of care as an ethical choice when circumstances require it. Any veterinarian who offers emergency on-call must also occasionally say “no” in order to preserve their ability to get up and fight another day.

There’s no question that the decision to refuse care for a horse in need can create a significant source of moral distress for a veterinarian. Moral distress, or the realization that one is constrained from taking an action that one knows is ethically appropriate, is a leading cause of burn-out. Statistics tell us that equine veterinarians who experience this type of burn-out are likely to leave the profession altogether. Without equine veterinarians, the landscape of equine emergency care shifts dramatically, to the detriment of the care of the horse.

The ethical framework of utilitarianism tells us that finding the answer to an ethical dilemma depends on making the decision that has the most benefit to the greatest number. If we apply this framework to the question of whether we have an ethical responsibility to provide care for “every emergency, every time,” we can easily answer no. More damage will be done to horses everywhere if equine veterinarians continue to leave the profession at such a rate that none remain to provide emergency care at all.  But what about our duty to the individual horse?

Any equine veterinarian who has experienced on-call understands the powerful duty to serve patients and clients, and a majority of equine veterinarians will continue to feel helpless when confronted with an emergency to which they cannot respond, or cannot adequately manage with available resources. We need to understand that our duties as veterinarians expand beyond our patients and their owners.  We also owe a duty to ourselves and to our colleagues. 

As veterinarians, it’s time we recognize our duty to ourselves and begin to understand that it is ethically permissible to create boundaries, even if that means we won’t be available for “every emergency, every time.”  Our mental health depends on it. We also owe a duty to our regular patients and clients to ensure they have access to emergency care.  Finally, there is a balance: we must recognize our duty to our colleagues who are likely to experience extraordinary pressure if increasing numbers of equine veterinarians refuse to provide emergency services at all.  

The answer to the ethical dilemma surrounding provision of emergency care requires that we work together to find solutions that ensure individual veterinarians feel comfortable declining to respond to an emergency by knowing that their patients and clients can find help at the hands of colleagues. Whether this means exploring options for emergency cooperatives or encouraging the establishment on emergency-only practices, one thing is certain; no veterinarian should feel ethically responsible to respond to “every emergency, every time.”