Surviving Moral Stress

February 2022 |

Keep your balance in the face of ongoing ethical dilemmas.

Ethical dilemmas are all too common in veterinary medicine, from requests for “convenience euthanasia” to disagreements about quality of life.

In a recent study of small-animal veterinarians, 53% said they encounter ethical dilemmas at least weekly, 13% said multiple times daily, and 84% said ethical dilemmas contribute to their moral stress.

Carrie Jurney, DVM, an advisory board member of MightyVet and president of Not One More Vet, offers these ideas to build resilience.

Foster Optimism
Consciously cultivate optimism and gratitude in your life, suggests Jurney. This can be a challenge, since studies have shown that veterinarians in general are not naturally optimistic. “My brain is fantastic at thinking about every possible way things will fall apart, which is part of what makes me a good doctor,” she says. “But we need to foster optimistic neurons too.”

Try practicing “Three Good Things,” Jurney recommends. “Now my brain automatically looks for the silver lining when faced with a negative situation, which helps me calm down and work on the problem rather than wallow in it,” she says. “Fostering optimism helps you see solutions.”

Practice Problem-based Coping
Next, check for solutions using problem-based coping. This strategy directly addresses the cause of the stress with the aim to reduce or remove that cause. “It’s learning to evaluate the things that cause us stress and tackle them from a practical standpoint,” says Jurney. Use three steps:

1. Causal analysis: Step back and think critically and unemotionally about your problem. Ask yourself:

  • What happened? “Be objective and think about facts,” says Jurney. “If you start using victim words like ‘always’ and ‘never’ or start making villains and calling people names, try again.”
  • Why did it happen? “Some recommend asking ‘why’ three to five times to get to the root issue,” she says.
  • What can be done to decrease the likelihood of it happening again? Rank the solutions in order of easiest to most difficult to implement, as well as by their chance of success.

2. Instrumental social support: Reach out to people who can give you another perspective on the problem. Select people with material knowledge of similar situations. “This is different from just providing social support or letting you vent,” says Jurney. “It’s asking people who actually may be able to offer concrete steps to help you work on solutions.”

3. Systems implementation. Think carefully about your goal. “Really sit with it and own how you will have to be different and how achieving it will change you,” says Jurney. Then move to action. Focus on short-term habits to achieve medium- and long-term goals, Jurney suggests, using the “SMART” system to structure goals that are specific, measurable, attainable, relevant and timebound.

“Veterinary medicine can be incredibly fulfilling and rewarding,” says Jurney, “but only if we have the skill set to deal with some of the real challenges we face in our profession.”

For More Info
Free CE on ethical-related topics:

Policy Power

Try creating clear hospital policies around common moral dilemmas. For example: When will your team perform euthanasia? Do you allow surrenders? Do you have a rescue fund? How and when can you use it? What are your payment plan options?

“You come from a much stronger place as a veterinarian if you can refer to clear hospital policies,” says Jurney. “Work together and figure out what you’re willing to do.”