Moral Distress in Equine Veterinary Practice
In equine practice, veterinarians must adapt to situations outside their control due to conflicting opinions with colleagues, horse owners’ time constraints, and financial limitations. This can lead to moral distress, or excessive stress that comes from not being able to do what you think is morally right, causing mental health concerns. Liz Arbittier, VMD, CVA, associate professor of clinical equine field service at the University of Pennsylvania School of Veterinary Medicine’s (Penn Vet) New Bolton Center, in Kennett Square, and Page Buck, PhD, LCSW, an embedded social worker at Penn Vet New Bolton Center and professor at the nearby West Chester University, spoke on the topic at the 2023 American Association of Equine Practitioners Convention, held Nov. 20-Dec. 3 in San Diego, California. “Burnout and mental health concerns are some of the most common byproducts of moral distress,” said Arbittier in her introduction.
Who is Most Likely to Experience Moral Distress?
Arbittier and Buck shared that many veterinarians have reported feeling psychological distress from a patient care scenario. Participants in this table topic at AAEP reported that they experience distress most often from cases of:
- Convenience or financial euthanasia.
- Distress about the well-being of a human client.
- Overtreatment of a performance horse (a high-value horse with pressure to continue competing).
- Horses prevented from engaging in natural horse behaviors.
- Rider safety concerns (i.e., riders continuing to ride horses with neurologic diagnoses).
- Lack of time and resources (on the part of the veterinarian staff member).
Although nearly all veterinarians experience moral distress at some time in their careers, students, technicians, and administrative staff often face the highest risk due to lack of agency—a feeling of control over one’s action and their consequences. “Sometimes the people tasked with providing patient care do not understand or agree with the owner’s decision-making,” said Arbittier. “This may set them up to experience moral distress.”
How Veterinarians Can Cope With Moral Distress
“It is important to understand that occupational stress is not moral distress,” said Buck. Moral distress happens when you are unable to do what you feel is morally right. Some of the most common symptoms are anger, depression, and anxiety. In order for veterinarians to overcome these, they should develop effective (and healthy) coping strategies, she and Arbittier added.
Coping strategies are unique to each individual. Some practitioners might be able to “leave their work at work,” while others use physical exercise to cope. Others still might spend time with family and friends to relax after handling a difficult case. It is important to find a healthy coping strategy that works for you and to avoid counterproductive strategies such as excessive eating or drinking, sitting in silence, or scrolling mindlessly on social media.
Moral distress is not uncommon in the equine veterinary profession; studies have shown most individuals say they have experienced moral distress at least once in their career. This stress stems from a veterinarian or support staff member being unable to do what they feel is morally right and can lead to mental health concerns and burnout. It is important to find healthy coping strategies for moral distress, they add, and to work with other practice members to create a support network for those experiencing moral distress.
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