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Issue: 56 - Aug 15, 2013
Behind Door #3: Ethics Exhaustion
By: Katherine Dobbs, RVT, CVPM, PHR
interFace Veterinary HR System

As the veterinary profession struggles with how to define and cope with the emotional aspects of the work we do, we have recently identified two concepts, burnout and compassion fatigue. Behind Door #1 is BurnOut, simply defined as the stresses caused by our interaction with the work environment. Among the list of causes is the feeling of having no control over the quality of care provided, and a conflict between individual values and organizational goals and demands. Behind Door #2 is Compassion Fatigue, defined as the stresses caused by our relationship with our patients and clients. In healthcare, the majority of this stress comes from the fact that we are expected to be technically proficient, emotionally available, straightforward, clear, and compassionate…all at the same time!

So what happens when we see corners being cut, perhaps resulting in the provision of services below our own personal opinion of “standard medical care”, and we feel powerless to change the system? What happens when we find out we’ve accepted a job at a practice that provides “convenience euthanasia” and we are forced to participate in the humane death of animals we feel morally obligated to protect? What happens when we have to be straightforward, yet hide sub-standard quality of services? What happens when we have to demonstrate compassion and be emotionally available when we feel we are asked to act in an immoral way? This is the dangerous zone of Ethics Exhaustion, behind Door #3.

At the 2013 Veterinary Social Work Summit, Sonnya Dennis, DVM, DABVP, presented a session on Ethics Exhaustion. She defined “ethics” in this regard as a code of moral conduct or rules, following duty and not convenience, and doing the thing that “I should do”. The problem is, there is not universal acceptance of what is “wrong” and “right”; ethics is clearly a personal concept and will vary from person to person. Yet if we accept a position in a practice that provides a service we personally feel is immoral or unethical, we are allowing our ethics to be compromised. Dr. Dennis explains that ethics exhaustion is fatigue, emotional distress, and lack of will to continue to act in a way that is consistent with what you believe is the ethical thing to do.  It is having failed to square behavior with belief so often that you no longer care to try. At times, ethics exhaustion can be having trouble defining what that right thing is, or can be a mismatch between your ethical belief and your actual behavior. “Ethics exhaustion is not a loss of compassion, but being prevented from acting on what you believe is the compassionate, caring thing to do,” Dr. Dennis explained.

In order to explore your personal ethics versus the practice’s ethics, consider the range of possibilities when a client decides upon euthanasia. How do you feel, and what does your practice do, about the 17 year-old poodle with end-stage heart failure, as compared to an otherwise healthy animal whose family cannot financially bear the burden of the surgery to fix a broken leg? What about the client who can’t be “bothered” to give insulin to a newly diagnosed diabetic pet, as compared to the family that is moving and can’t take the pet with them? What you would like to do, and what you are asked to do by the practice owner, can be two very different things.

In the moment, we’ve learned to cope with this paradox by justifying our actions to ourselves. Reasons we tell ourselves it’s okay might include being too exhausted to fight for what we believe, or believing that no one else cares, so why should we, or we might as well do the task because someone will. Likely the most common feeling is that it is not our fault, and we had no choice. Perhaps we even feel that we will suffer repercussions if we say no, by losing our job, losing our friendships, or losing face in front of our teammates.

Prevention is key, but is often the lesson learned in hindsight. When interviewing for a job, for example, the values of the organization and the values of the candidate should be expressed and discussed to see if it is a good fit of ethics. Yet many of us find ourselves in the position of feeling this ethics exhaustion in the positions we now hold, and changing jobs is not always the best first step. The incidents that lead up to ethics exhaustion are situations in which we feel moral distress, and the requirement to do what we feel isn’t the ‘right’ thing to do. As we continue to be in situations where we cannot be true to our own ethics, ethics exhaustion sets in.

The American Association of Critical-Care Nurses (AACN) recognizes this concept of moral distress in human healthcare.  In the article The 4A’s to Rise Above Moral Distress, the AACN defines moral distress as 1) you know the ethically appropriate action to take, but you are unable to act upon it, and 2) you act in a manner contrary to your personal and professional values, which undermines your integrity and authenticity. The AACN has developed a protocol to address this “moral distress” in the workplace. It is summarized as Ask, Affirm, Assess, and Act.

  • ASK: this is when you reflect on your present feelings, and ask yourself questions to determine if moral distress is present.
  • AFFIRM: this is when you make a commitment to address the moral distress.
  • ASSESS: this is when you contemplate your readiness to act, considering the risks and benefits.
  • ACT: this is when you implement strategies to initiate changes and manage any resulting setbacks. It is also the step where you preserve your integrity and authenticity.

Working in a practice that is an ethical mismatch can be emotionally draining, or devastating if it fuels us to leave the veterinary profession. There are ways to make it better, and you owe it to yourself and the animals you advocate for to work in a place that demonstrates the values that you live by. For details and further explanation, please visit this document at:

Katherine Dobbs, RVT, CVPM, PHR