A veterinary career immersed in ethics
Applying for a place at a veterinary school was very competitive 15 years ago, as it still is today. My desire to study A level philosophy and ethics had to give way to A levels focused on the sciences. But this changed once I started my veterinary undergraduate degree. The Royal Veterinary College (RVC) offers the opportunity to undertake an intercalated degree so one other RVC student and I became the first vet students to read a BSc degree in philosophy at King's College London (KCL); a course designed for medical and dental students. My eyes were opened to the world of philosophy of medicine, medical ethics and the philosophy of science. I knew I wanted to return to this subject later in my career and develop this discipline in veterinary medicine, but first I needed a grounding in clinical practice or else the discipline would be purely abstract and academic.
Following qualification I did an intensely busy small animal internship at Dick White Referrals, Newmarket. It was a steep learning curve observing and assisting in remarkable surgical and medical interventions. I was also fortunate to spend time in the USA at North Carolina university, Cornell and the University of Pennsylvania. While at Penn I observed feline renal transplantation and the treatment of the racehorse Barbaro; two highly memorable events that again triggered my interest in veterinary ethics. I then moved to a small animal general practice back in the UK before working for two of the large groups of veterinary practices, CVS and a locum position at Medivet. These were strongly formative in my understanding of the veterinary profession.
The trigger to return to academia came in 2010 when I watched the BBC's Panorama programme ‘It Shouldn't Happen at a Vets’. The programme was not congruent with my idealistic view of the profession. I was awarded a scholarship to read a Masters in medical ethics and law back at KCL. The interplay between medical ethics, medical law and the physicians was fascinating to me. It is a very well established discipline, taught and researched at many of the top medical schools across the world; it also has its own institute and journal. Understanding how the boundaries of practice are pushed forwards by science and evidence-based medicine, and developed in other ways as clinicians adapt their skills to impoverished societies, means that medical ethics and law can never sit still and must always rediscover and justify socially accepted norms. I was determined to investigate this further for the veterinary profession.
Interested in animal welfare across the world, I joined a British Council-sponsored expedition to Sri Lanka to assist the government vets there in disease control for brucellosis and bovine TB. I was struck by the resilience and effectiveness of their practice in such financially restricted situations – a world apart from the relative affluence in the UK.
My current position at the RVC came at a time of radical change to its curriculum and pedagogical approach. The LIVE centre awarded me £10,000 to develop a novel curriculum in veterinary ethics and law to teach to the veterinary students, and they granted approximately 55 hours teaching time. The focus of this new teaching was on professional conduct and veterinary ethics, in addition to what is taught in animal welfare. Veterinary ethics is a system of moral principles that apply values and judgements to the practise of veterinary medicine; it encompasses practical application in clinical settings as well as work on its history, philosophy, theology, and sociology. It can be interpreted as a critical reflection on the provision of veterinary services in support of the profession's responsibilities to animal kind and mankind.
The aim of the teaching is not to produce veterinary philosophers, but rather to produce ethical vets, so we focus on practical scenarios. The key element is the social contract empowerment of the veterinary profession and our legal immunity to practise. The curriculum was designed as an active and participatory multiple format cumulative learning structure. We cover topics like informed consent, conflicts in welfare, euthanasia, clinical trials and insurance fraud, and delve into complex areas like ‘when to refer’ and ‘who is a specialist?’
Business ethics is a new topic to this discussion and students review business models from small practices as well as larger corporate practice to try to understand how these fit with that social contract empowerment of the profession. Much of the ‘teaching’ is facilitated small group discussions or large-scale class debate, which can be challenging when there are in excess of 200 students! We also cover much of it on Twitter to get the public engaged (@mwhiting81).
Day-to-day academic life
The day-to-day life of an academic in this field is hugely varied. In addition to teaching (which is perhaps the highlight of the job), I undertake research on ethics, law and professional regulation. I spend a great deal of time writing grant proposals and applying for funding and hopefully will soon have PhD students to supervise.
I also sit on the research ethics committees at the RVC and at the Zoological Society of London, ensuring appropriate ethical and lawful standards of research are conducted. Approving clinical trials on client-owned animals under the Veterinary Surgeons Act and research animals under the Animals (Scientific Procedures) Act is not a box ticking exercise. Finding ways to improve the welfare of the research subjects and ensure the clients are protected are the committees' first concern. Working closely with the Home Office and the RCVS in resolving these requests, and navigating the difficult grey area between these Acts, is an interesting intellectual challenge. My interests in this are now moving towards the legal side, in trying to level the regulatory discrepancies between them. I participate in discussions with Defra or in parliament, and have been an active member of the veterinary nurses' legislation working party at the RCVS.
It is with some regret that I do not work clinically anymore, but I regularly assist those in our small animal hospital with problems they encounter with ethical or legal dilemmas. The ever-progressive specialists in the Queen Mother Hospital for Animals are developing new techniques, such as dialysis and heart by-pass, which give cause for rigorous ethical and legal discussion. Such developments help to keep the work I do focused on the clinical vet rather than in abstract academia.
As the profession enters the rigorous world of evidence-based veterinary medicine (EBVM), there are many ethical considerations; systems like VetCompass and VeNom can facilitate the large-scale big-data analysis that is needed for EBVM, clinical auditing and governance. Researching ethics and law in this area is my next major challenge and will run concurrently with another project looking at the history and development of professionalism using the RVC archives. There are not many veterinarians who are interested or work in this field and collaborations are always welcome. Thankfully, the student body has a great deal of enthusiasm and several students choose to undertake research in ethics and law during their degree, especially with regards to clinical audit and governance. It is exciting to have been invited by the Nuffield Council to assist in answering questions relating to veterinary ethics.
There is a saying that finding a job you love means you will never work a day in your life; while I am very fortunate to have found such a job, it is important to never forget to prioritise the downtime. I never let a year pass without finding time for skiing, but hill walking, photography, films, theatre and watching rugby are my main pastimes. I would be remiss if I did not include cooking in my hobbies, but in reality, it is the eating that I enjoy most.
In 2014, I submitted my PhD on veterinary justice. I was fortunate to be able to spend time discovering more about the concept of justice and it is not as straightforward as one might think. How a veterinarian balances that perplexing triad of competing interests between the client, the animal and the profession is remarkably complex. The years of work on this topic have led me to investigate informed consent, clinical trials and the relationship between society and animals in great detail, and this will keep me occupied in further investigation for many more years. I am very grateful for my formative early clinical years of practice to keep the thesis as a practical application of justice.
Alongside this has been my appointment to the RCVS Disciplinary Committee (DC). It is not a pleasant task, but I am passionate about the excellence of our profession and seek to serve it in a fair way. The PhD allowed me to study the work of the DC, dating back to its foundation, and, while there have been great advances clinically in the profession, the matters coming before the DC rarely change. We as veterinarians are uniquely empowered to treat animals, and we have a monopoly power to do that. The public trust we will use that power for the advantage of animal welfare; it has sadly been the deviations from that path that have been the essence of over 100 years of disciplinary cases.