Ethically challenging situations (ECS) are not new to veterinary medicine, but the COVID-19 pandemic has made them much more common. The tremendous toll that ECS impose on all members of the veterinary team cannot be overstated. A 2018 survey study of almost 900 North American veterinarians revealed that more than 70% experienced or witnessed moderate to severe distress among team members when obstacles prevented the provision of appropriate veterinary care. The survey also revealed that the majority of veterinarians feel inadequately prepared to deal with ECS. 

A recent study analyzed the responses of 540 surveys collected from veterinarians (78%) and other veterinary team members (22%), mostly working in companion animal practice (68%). The average year of graduation of the respondents was 2004 and the average age was 42 years old. In addition to demographic questions, the survey was composed of questions assessing the frequency, type, and level of distress caused by ECS, and resources for handling the ECS, as well as open text responses to share examples. 

The survey results revealed that the pandemic has increased ECS dramatically, with veterinary team members experiencing ECS a median of several times per week, compared to several times per month prior to the pandemic. 

The study was also able to determine what ECS occurred most frequently and which ECS were considered the most stressful. The five ECS veterinary team members considered “very or maximally challenging” were as follows, starting with the most challenging:

1. Conflicts between the interests of clients and the interests of their animals. While many pet owners feel empowered by information that is available online, through breeders, or from other pet owners, sometimes what they believe is the appropriate treatment or procedure for their pet does not align with what the veterinary team feels is best. These situations can be difficult to handle given that most pet owners feel emphatically that they know what is best for their pet and because they are inevitably the person who must consent to and pay for care.  
2. Conflicts between the interests of the employer and the employee’s own interests. Due to the power differential that exists between employees and employers, concerns about job security or punitive measures likely exacerbate the stress felt in these ECS. The pandemic has undoubtedly resulted in conflicts arising around mask-wearing, curbside appointments, vaccination regulations, and other biosafety decisions made by the employer that impact the employee. 
3. Challenging decisions about how to proceed when clients have limited finances. These ECS are common in veterinary practice and result in offering a lower standard of care treatment or euthanasia for economical reasons. Unfortunately, the pandemic has no doubt increased the frequency of these ECS given that many pet owners have experienced job loss, reduced working hours, or other economic hardships as a result of COVID-19. Additionally, many people became first-time pet owners during the pandemic and were perhaps not prepared for the financial responsibility of owning and caring for a pet.  
4. Conflict between personal wellbeing and professional role. The pandemic has led to a relatively new ECS among veterinary team members in the form of “sickness presenteeism”. Many team members feel torn between the need to show up for work and / or support colleagues while demonstrating possible symptoms of COVID-19 or being a “close contact” of someone with COVID-19. Alternatively, concerns regarding weighing “acceptable exposure” to COVID-19 and the personal vulnerability of individual team members also creates ECS for which there are no easy or clear-cut solutions. 
5. Conflict between wellbeing of family / household members and professional role. Similar to the situations outlined above, veterinary team members have had to weigh their professional role as “essential workers” with their personal role as caregiver to other possibly immunocompromised or unvaccinated individuals. Not knowing whether to prioritize protecting loved ones thereby imposing more stress on colleagues and co-workers results in ECS that feel insurmountable. 

While none of these situations have easy solutions or obvious resolutions, there are strategies and policies that employees and employers can use, in order to ease the stress and uncertainty experienced during ECS. 

For employees, identifying and discussing ECS helps to diminish some of the distress surrounding them. More than 60% of veterinary team members use discussion with colleagues as a means to help resolve ECS. Debriefing these situations and acknowledging personal and professional boundaries are important when making decisions about how to handle ECS. Other strategies include referring back to the veterinary oath or code of conduct, taking steps to reduce trait perfectionism, enrolling in continuing education related to ethics training, and leaning on trusted friends or family for advice and perspective. 

For employers, it is important that workplace policies are in place regarding handling ECS involving clients requesting futile care or with limited financial capabilities. These should include having options for financial support, promotion of pet insurance, and strict policies regarding estimates, deposits, and informed consent. Additionally, practice owners and managers must put in place systems for handling team member illness. This includes plans for modifying the schedule, cross-training of team members, and back-up plans that involve contract or locum workers or case diversion. Workplace policies must also explicitly state whether and how much time off will be paid to those who are away from work while isolating or awaiting COVID tests. 

The additional strain that the pandemic has placed on veterinary teams is undeniable and the increase in ECS is just one small component of that strain. Identifying and managing ECS is imperative for helping to mitigate the distress that occurs as a result and preserving the wellbeing of veterinary professionals.