We appreciate the opportunity to provide a different perspective regarding Dr. Barry Kipperman's June 27 commentary, Veterinarian: New AVMA ethics policy has a fundamental flaw. Because Dr. Kipperman's primary interest in the recently revised Principles of Veterinary Medical Ethics (PVME) is its mention of the AVMA's humane endings guidance and, specifically, the Guidelines for the Depopulation of Animals, our response also focuses on those documents. 

End-of-life care includes considerations related to the patient, client, veterinarian and practice that are unique to each case. Neither the humane endings guidance nor the PVME obligate the veterinarian to kill animals. Both offer support for veterinarians seeking to bring about animals' deaths in ways that result in the best achievable outcomes for the animals under their care while recognizing that other considerations impact ethical and scientific decision-making in many situations (e.g., disease control, public health, food security, human safety and well-being). In this regard, the PVME cautions: “Ethical decision-making involves balancing competing interests in a specific situation. The PVME should be used in this context and interpreted in its entirety, rather than selectively applying a single section.” 

Unfortunately, Dr. Kipperman misrepresents the AVMA's humane endings guidance when he states those documents are "based on scientific criteria, not ethics." In fact, the AVMA's respective panels on euthanasia, humane slaughter, and depopulation develop and maintain guidance that assists veterinarians in delivering end-of-life care using techniques that are rooted in science, but with decision-making informed by ethics. The panels include PhD-credentialed ethicists who are actively engaged in ongoing review of the guidance, and who are the primary authors of each of the documents' introductory chapters that directly address ethical concerns.

With respect to depopulation, the AVMA guidelines note that "Ethical decision-making is at the core of determining our obligations to animals during disaster or crisis situations and is essential for judicious preparation, policies, response, and recovery." Depopulation methods (including handling of animals) and choice of agents should be evidence-based and designed to minimize anxiety, pain, and distress, and bring about complete loss of brain function in animals. With all of this in mind, and to further support veterinarians in their approach to ethical decision-making during these very challenging and complex situations, the depopulation panel worked with its ethicists to draft an ethical decision-making tree that accompanies that guidance. 

The humane endings documents also encourage veterinarians to be sensitive to a range of views regarding what is appropriate regarding the use and care of animals ― including their own biases ― when assessing the ethics of their and others' actions. The euthanasia guidelines indicate, “In thinking seriously about veterinary medical ethics, veterinarians should familiarize themselves with the plurality of public moral views surrounding animal issues and also be cognizant of personal views and complicating factors that may impact their own ethical decision-making. While the Veterinarian's Oath, Principles of Veterinary Medical Ethics of the AVMA, state veterinary practice acts, and other guidance emanating from veterinary professional associations and regulatory bodies provide direction for how veterinarians should interact with clients and their animals, different veterinarians may have different personal ethical values and this may impact their recommendations.” 

We do agree with Dr. Kipperman's concerns regarding the mental toll that end-of-life care and killing animals can impart on veterinarians and veterinary care teams. Recognizing this, the AVMA's Steering Committee on Human-Animal Interactions' Working Group on the Psychological Impact of Humane Endings continues to develop resources to support veterinarians' and veterinary teams' mental health, including a webinar available on AVMA Axon and an in-depth article published in Journal of the American Veterinary Medical Association. 

The AVMA also encourages and works to ensure the input of its members and key stakeholders is considered when developing and revising its policies, including the AVMA PVME. The PVME was revised via a multi-year process of deliberation that was led by the AVMA Council on Veterinary Service and included representatives from across the profession and its stakeholders. A penultimate draft was the subject of a 60-day comment period, as well as opportunities for feedback from the AVMA's Board of Directors, House Advisory Committee, and House of Delegates. The many thoughtful comments received were reflected in the final draft, which was slightly amended and approved by the AVMA House of Delegates on June 21.

Dr. Sandra Faeh is president of the American Veterinary Medical Association.