It’s midnight and the veterinary nurse on duty has just opened the door to allow an owner to bring in a very poorly cat. The elderly cat and owner are both regular clients to the veterinary practice, as the cat has been under long-term treatment for kidney and thyroid problems.
This evening, the owner has found their cat collapsed and gasping for breath. They have rushed to the veterinary practice and have beaten the vet who lives a little further away. The nurse can see that the cat is pale, limp and snatching for each breath.
The owner begs for the cat to be put to sleep to prevent any further suffering. The veterinary nurse is highly experienced and can quickly place an intravenous catheter. The nurse has the keys to the ‘controlled drugs’ cupboard and knows the correct dose of lethal injection to quickly complete the euthanasia procedure to end the cat’s misery. The owner is very distressed and so is the patient on the examination room table. The veterinary nurse makes it clear that she is not a veterinary surgeon, but the owner gives their consent, and the cat is suffering.
Should the veterinary nurse put the cat to sleep or wait for the vet to arrive?
What are the legal issues?
Situations such as this occur on a regular basis in veterinary practices across the UK. Veterinary nurses do an incredibly important job, often during antisocial hours, making rapid decisions during highly emotive interactions.
Veterinary nurses must act within the Royal College of Veterinary Surgeon’s Code of Conduct and within the law.
Euthanasia is not, in law, an act of veterinary surgery. It may be carried out by anyone if it is carried out humanely. There are exceptions to this however (animals kept by pet shops or in animal shelters for example, must be euthanased by a veterinary surgeon, or by a person who has been authorised to do so by a veterinary surgeon).
In the above scenario, the main legal issue is the use of a controlled drug to carry out the euthanasia. A veterinary nurse may only administer a controlled drug under the direction of a veterinary surgeon. With the vet in this case absent, the nurse would be using the controlled drug without the vet’s direction. From a professional standpoint, this would breach Schedule 3 of the Veterinary Surgeon’s Act, which the British Small Animal Veterinary Association (BSAVA) also support with the statement that ‘only a veterinary surgeon may prescribe a POM-V medicine’. In criminal law, this is a violation of the Veterinary Medicines Regulations 2013, which states that a prescription-only veterinary medicine (POM-V) may only be prescribed by a veterinary surgeon to animals under their care. In addition, because it is a Schedule 3 controlled drug, this would be in breach of the Misuse of Drugs Act 1971 (something the RCVS and the police take rather seriously when it comes to veterinary pharmaceuticals).
In 2015, the Register of Veterinary Nurses became mandatory, and veterinary nursing became a registered profession. This means nurses are held accountable for their work, actions, and decisions through a regulatory process. Therefore, if the veterinary nurse in this example had proceeded to carry out the euthanasia, they could face legal action (with a fine or even a prison sentence) and come under the scrutiny of the Royal College of Veterinary Surgeons. Nurses may be struck off the register of veterinary nurses, for ‘behaviour that has fallen far short of what is expected of a veterinary nurse’.
What are the ethical issues?
But could a veterinary nurse really be punished so severely for acting in, what their professional peers might agree, was the animal’s best interests?
Under The Veterinary Surgeon’s Act 1966 (schedule three Amendment) Order 2002, anyone is allowed to provide first aid to an animal in an emergency for the purpose of saving life and relieving suffering. It is not necessary to make a diagnosis to provide effective first aid (legally, only veterinary surgeons may diagnose). The veterinary nurse could argue that by carrying out euthanasia, she was acting in the best interests of the cat by relieving its suffering.
However, administering a POM-V is not seen as a first aid measure (Welsh 2003). An RCVS disciplinary committee might take good intentions into account, but there might have been other ways of providing first aid to reduce suffering in this instance (administering oxygen and warmth, for example). Had the nurse administered the lethal injection, it’s always possible for something to go wrong, leading to more suffering consequently. Making the cat as comfortable as possible until the veterinary surgeon arrived might not have been seen as an acceptable choice by the owner, but the veterinary nurse in this case would need to assert that they legally cannot carry out the procedure.
The bottom line…
If this case were to come before an RCVS disciplinary committee, they would hold the veterinary surgeon who was asked to attend accountable for any undue suffering the cat endured, if for any reason they should have attended to the animal sooner. If the nurse had proceeded with the euthanasia without the vet’s direction, it’s more likely that it would be the practice which would be sued for allowing their staff to act outside of the law, even if they were unaware of it.
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