Veterinary surgeons, like most other people, have their attitudes (including their prejudices) moulded by society long before they embark upon their professional training. Within the existing curriculum, veterinary medicine is dominated by the 'biomedical' model of care.
Therefore, psycho-social issues tend to be ignored. With little or no formal training, veterinary surgeons are expected to understand how their own personal beliefs, anxieties and fears can affect their attitude toward clients, and behaviour with them.
Veterinary surgeons must also devise their own coping strategies for situations which often require highly developed interpersonal skills (Engel 1977; Buckman 1984; Tubridy and Wellard 1991).
The following case history demonstrates the destructive power of professional and client roles; illustrates the restrictions that role expectations can place on communication; highlights some misplaced stereotypic attitudes about guide dogs; and provides bona fide evidence to support the conviction that veterinary surgeons should receive training in the behavioural sciences.
A personal account
"Before making the decision to terminate life, all reasonable alternatives should be considered and carefully evaluated" (Stewart 1989).
Such advice is also relevant when a veterinary surgeon is making a decision to terminate an established relationship while the animal is still alive, as illustrated in this case history of forced rehoming.
Forced re-homing refers to a situation in which a person who is emotionally bonded to an animal can no longer keep it. This is usually due to a change in circumstances: for example, long term hospitalisation or moving into sheltered housing, with a 'no animals' ruling.
The forced re-homing of a much loved pet has a power for devastation potentially greater than that of euthanasia, because the animal is still alive yet out of its owner's reach.
My guide dog Sherry was a yellow Labrador and an inseparable part of my life. Sherry was two-and a-half years old when I got her in April 1977, from Leamington Spa Guide Dog Centre. As a working companion animal she had attended university with me, accompanying me to all my lectures and seminars; she was also present at my graduation ceremony. On one occasion she was even allowed into Buckingham Palace and was stroked by Prince Philip.
In her tenth year, my veterinary surgeon, who offered no valid explanation that I could understand, decided that I was no longer a suitable owner for Sherry. The person nominated by him to be Sherry's new owner was a friend of mine. In order to convince me that Sherry should live with this friend, he embarked upon a series of lectures. To ensure that I had no way of escaping from them, each lecture was eloquently delivered when I took Sherry for her annual vaccinations!
I was confused. Suddenly, without fully understanding why, I was being ordered to put the past behind me, sever the bond that existed between me and my dog and, just as if she was a sack of old rubbish, I was expected to give her away and immediately adjust to a life without her; just as if she had never existed! For the final three years of Sherry's life I felt as if she was owned by a cooperative.
Sherry died on 14th June 1988. She had spondylitis. Her condition had deteriorated rapidly during what were to be the final three weeks of her life. On that fateful day my veterinary surgeon remarked that "I think we've reached the end of the road"; my reaction was that of shock and disbelief. In fact, I was devastated. He became aware of my bewilderment and sense of helplessness and spent the next three hours or so patiently discussing all available options, covering the same ground several times over. Without feeling pressurised, I eventually came to the conclusion that euthanasia was the only viable option given the circumstances.
On that occasion, my veterinary surgeon demonstrated great sensitivity and has demonstrated sensitivity on many other occasions. This makes feeling hurt about what happened over two years ago in relation to re-homing Sherry all the more difficult to reconcile.
Reaching an understanding
I wrote the above account one afternoon in 1990, because two years after my dog had died, the reasons for my lack of suitability as a responsible owner of my own guide dog still evaded me. I still felt very angry with my veterinary surgeon and angry with myself for feeling angry. I also thought that when I had it on paper the cause of the problem would become clear to me. But, in effect, only one thing became clear: that something was still hurting.
I found myself in tears several times when originally writing the above text. I showed what I had written to a friend who was a social worker.
After reading the text through, she came up with three key words to explain my feelings: Invalidation, Choice and Functional. I felt physically relieved. Through the use of these three simple terms she had given me a clear indication that what I had written had been understood.
I took her advice and sent a copy of the above account to my veterinary surgeon and made an appointment to discuss it with him. I am very glad that I did.
We discovered that, in the main, the whole episode had been a classic case of communication breakdown.
Discussion and analysis
There had been fault on both sides and a lot of fear on both sides. I had thought that the suggestion to re-home Sherry, ostensibly on the grounds of her being ten years old, had been irrational. I discovered that my veterinary surgeon had been motivated by a fear of litigation, in relation to 'a breach of the duty of care'. He believed that had I been 'run over by a bus', he might have been held responsible and sued. I would like to pose the question, at this point, by whom he would have been sued and on what legal basis?
As a response to this seemingly irrational behaviour I had developed a fear of taking my dog to the surgery. I was afraid she would be taken away from me; he appeared to be unaware of my fear and doubtless thought that my attitudes and behaviour were irrational. A situation had arisen in which my veterinary surgeon became defensive whenever I questioned his judgement. I became defensive whenever he suggested that I should re-home my dog. We no longer talked to each other, instead we talked at each other and hardly communicated at all.
I believe that it would be useful to explain the source and consequences of our communication breakdown, as I perceive them. The three 'key' words, used by my friend, proved to be the key to what had gone wrong.
Invalidation: This is a situation in which little or no acknowledgement is given to a person's thoughts, feelings or behaviour and a person feels as if she or he is worth very little.
My veterinary surgeon had not consulted me about whether or not I should give away my dog. Consequently, I felt as if I was being totally ignored, (i.e., invalidated). I had also been guided by very mixed and powerful emotions. I was jealous of my dog's potential new owner. I felt guilty about feeling jealous, paranoid about what people were saying behind my back. I was also very angry with the veterinary surgeon. It seemed to me that my feelings had not been acknowledged by him.
Choice: I had a feeling that I had no choice as to whether or not Sherry remained with me. My veterinary surgeon had not explained to me his reasons for wanting to evict Sherry from her home. I thought that it must be because he believed that I was incapable of looking after her. On the other hand, I had not asked him for his reasons. I felt trapped and powerless. As a client I had fallen into the trap of allowing him to 'set the agenda'. This meant that if he did not offer to discuss an issue then it remained unresolved. I acted out the role of the 'model' client and (like all good and compliant clients) I had let the veterinary surgeon decide what was important. In addition, he had role-played the 'model' veterinary surgeon in that he did not express his own fears and anxieties.
Neither of us had done anything wrong. We had just played our roles so well that our 'role expectations' got in the way and we could not communicate with each other.
Functional: It seemed to me that as far as the veterinary surgeon was concerned a guide dog had a purely functional role as a mobility aid. Once this role was redundant the dog had no further use.
In fact, he did explain later that a guide dog should be re-homed when it is no longer working. "This is because if another guide dog comes into the home the presence of a retired guide dog would make things difficult". Evidence refuting this assumption has recently been published. In a study of the relationships that exist between guide dog owners and their dogs, Jill Nicholson (1992) notes that problems rarely arise when the old dog has its role taken over by the new dog. When problems do arise, they are relatively short lived.
The termination of a relationship between an emotionally bonded owner and animal can precipitate intense feelings of loss both when an animal has died and when it is still living. In this respect this case history highlights an interesting paradox. My veterinary surgeon had handled Sherry's euthanasia with great sensitivity.
He demonstrated an awareness and understanding of the strength of attachment I had to her. When considering the option of euthanasia he had taken into account both the desires of the owner and the needs of the animal. Yet, with regard to the rehoming of Sherry, the desires of the pet owner were excluded. It was the needs of the animal and the desires of the veterinary surgeon that formed the criteria for decision-making.
Both situations involved a 'break' in the emotional bond; both could precipitate a grief reaction; both situations involved the same owner and the same dog. Nevertheless, both situations received very different approaches from the same veterinary surgeon. I do not know the reasons why this should have happened. But possibly it was related to the development of persona[ attitudes and beliefs. These are known to be heavily influenced by the society in which we grow up.
It is my belief that, to some extent, my veterinary surgeon had fallen victim to a popular misconception (which I have frequently encountered: that the blind are helpless but for their marvellous guide dogs 'and certainly can't be trusted to cross roads safely without them'. My veterinary surgeon would appear to have, unintentionally, 'projected' his own fears and anxieties about the consequences of blindness (i.e., his perception of my vulnerability) on to me. His problem then became my problem and was treated as such.
It seems that Sherry had fallen victim to another misguided belief that 'guide dogs are public property'. As a consequence, she was perceived as 'public responsibility. In turn, I was no longer considered to be eligible for the rights that other veterinary clients take for granted; in particular, the right to keep my dog. One thing is clear to me: any dog I have in the future will be my companion and the property of nobody. This is an experience which I never wish to repeat.
Perhaps I should point out one underlying feature that has not been overtly stated. At no stage of this affair did I consider taking my custom to another veterinary surgeon. Retrospectively, if I had possessed the knowledge that I have now, I may have sought a second opinion but I did not consider at any stage terminating the professional relationship.
It is said that trust is the foundation stone for all good relationships; I wonder if the foundation stone had already been laid here, as this relationship had weathered quite a severe storm - a storm which, perhaps, could have been avoided. I have written here only one side of the story. I have not told of the sarcasm, cynicism and poisoned arrows that the veterinary surgeon had to endure because of my pent-up anger.
BUCKMAN, R. (1984)
Breaking bad news: why is it still so difficult?
British Medical Journal 288, 1957-1960.
ENGEL, W.L. (1977)
The need for a new medical model: a challenge for biomedicine.
Science 196 (4286), 129-136.
NICHOLSON, J. (1992)
The end of a partnership: a study of the reactions of guide dog owners to the end of a working partnership with their guide dog.
Technical Review (4). Reading: Guide Dogs Association.
STEWART, M.F. (1989)
The dilemma: when to kill or not to kill companion animals.
In: Proceedings of British Small Animal Veterinary association animalWelfare Foundation pp 1-15.
TUBRIDY, ]. and WELLARD, A. (1991)
A survey of small animal veterinary surgeons in Dublin city and county to investigate the need for a bereavement service for owners of pets.
Irish Veterinary Journal 44, pp7579.