In total, 426 respondents completed the survey and pressed the “Submit” button at the end of the survey indicating their consent and their participation. Therefore, responses of 426 respondents were analyzed. In order to submit the responses, it was made mandatory to attempt all the questions. So, all the respondents completed all the questions and kept the cumulative proportions of all the questions to 100%.
Characteristics, demographics and relevant training of respondents
The majority of those who responded were males [(69.01%, n=294)
vs. females (30.99%, n=132)] and mainly worked in State Veterinary Services [(62.93%, n=185, males)
vs. (53.03%, n=70, females)]. Male and female respondents who were employed outside of State Veterinary Services listed their nature of job as State University/ICAR Job (At Veterinary Clinical Complex/Farms, etc.) [male (9.52%, n=28)
vs. female (8.33%, n=11)], State University/ ICAR Job (Non-Clinical) [male (7.48%, n=22)
vs. female (12.12%, n=16], Private practitioner (Large/Small Animals) [male (18.37%, n=54)
vs. female (23.48%, n=31)] and Fresh Graduate [male (1.7%, n=5)
vs. female (3.03%, n=4)] (Table 1).
When questioned about the extent of instruction or training they had received in their entire career regarding the resolution of disagreements pertaining to the optimal care for their patients, more female respondents [(33.33%, n=44)
vs. male respondents (28.57%, n=84)] reported they had received no conflict resolution training; whereas more male respondents [(48.64%, n=143)
vs. female respondents (33.33%, n=44)] reported they had received more than 5 hours of training. When questioned about the extent of education or training hours received on the topic of self-care, majority of female respondents [(71.97%, n=95)
vs. male respondents (42.52%, n=125)] reported they had received no such training; whereas more male respondents [(30.61%, n=90)
vs. female respondents (9.85%, n=13)] reported more than 5 hours of training (Table 2).
Causes of ethical conflict
When inquired about the frequency of disagreements with animal owners regarding your preferred course of treatment, 9.52% (n=28) males reported “never” as compared to 3.79% (n=5) female respondents; and 19.70% (n=26) females reported “often” as compared to 11.56% (n=34) males. In these situations, discussion with colleagues followed by discussion with seniors was a way to sort out conflict. However, significantly (P<0.01) higher percentage of male veterinarians (11.22%, n=33) did nothing as compared to females (1.52%, n=2) to solve the issue; and more females discussed the issue with superior officer [(37.88%, n=50)
vs. male respondents (27.89%, n=82)] as well as with their colleagues [(51.52%, n=68) vs. male respondents (47.62%, n=140)] (Table 3).
On being asked about the frequency of requests to perform a task that seems incorrect or inappropriate in the context of their clinical practice, 30.30% (n=40) females reported “never” as compared to 27.55% (n=81) male respondents; and 7.58% (n=10) females reported “often” as compared to 5.44% (n=16) males. Although more female respondents said they “never complied” [(45.45%, n=60)
vs. male respondents (39.46%, n=116)] and more male respondents said “rarely complied” [(30.27%, n=89)
vs. female respondents (25.00%, n=33)] with these requests. Both male and female respondents stated similar responses to our question about “the authority to refuse these requests” as well as “to refuse to provide a treatment that you feel would not produce desired outcome” (Table 3).
Moral distress levels and coping methods
When faced with such scenarios where improper requests were made, a higher percentage of male respondents [(12.59%, n=37)
vs. female respondents (6.06%, n=8)] indicated that they did not take any action (Table 3). A higher percentage of female respondents [(28.03%, n=37)
vs. male respondents (16.33%, n=48)] opted to “discuss with partner or friend” or “seek professional help” [(21.21%, n=28)
vs. male respondents (16.67%, n=49)]. On the other hand, a greater number of male respondents [(47.62%, n=140) vs. female respondents (38.64%, n=51)] chose to “discuss with a colleague”, (P=0.01).
When asked about their conflicting emotions or distress when an animal owner declines to comply with their treatment recommendations, a higher percentage of male respondents [(11.56%, n=34)
vs. female respondents (6.82%, n=9)] replied with “Never” or “Rarely” [(25.17%, n=74)
vs. female respondents (22.73%, n=30)], (P=0.06). The stress levels escalated when the animal owner disregarded the advice given by the veterinarian. Although the majority of respondents experienced mild to moderate distress, a notable difference was observed between females (17.42%, n=23) and males (6.12%, n=18) in terms of significantly more severe distress (P<0.01). A higher percentage of male respondents [(16.33%, n=48) vs. female respondents (9.09%, n=12)] indicated that they experienced “No stress”. In order to cope with these feelings, the results were similar to responses recorded while dealing with the situations about wrong requests. Females coped up with stress mostly by talking with partners or friends, which was significantly higher (P<0.01) as compared to males [40.91% (n=54)
vs. 20.07% (n=59)]. Males were more robust to cope up with stress (P<0.01), as 17.69% (n=52) males did nothing as compared to only 5.3% (n=7) females, who did nothing to cope up with stress.
When inquired about the frequency of feeling distressed or anxious about their work, a greater percentage of male respondents reported “Never” [(13.95%, n=41)
vs. female respondents (7.58%, n=10)] or “Rarely” [(23.47%, n=69)
vs. female respondents (12.12%, n=16)] and more percentage of female respondents reported “Always” [(6.82%, n=9)
vs. male respondents (3.06%, n=9)] or “Often” [(27.27%, n=36)
vs. male respondents (15.31%, n=45)]. Both male and female respondents stated their responses to our question about “frequency of disagreements with other veterinarians in jointly managing a case” as well as “distress caused by this disagreement”. However, female respondents find disagreements with other veterinarians more distressing [(29.55%, n=39)
vs. male respondents (22.11%, n=65)] while male respondents find it more distressing [(58.16%, n=171)
vs. female respondents (53.03%, n=70)] than when you disagree with an animal owner? (Table 3).
25.51% (n=75) male respondents said their ability to feel empathy or compassion towards their patients had decreased over time as compared to 22.73% (n=30) female respondents; and 11.90% (n=35) male respondents said that their level of compassion towards animal owners had diminished with time as compared to 8.33% (n=11) female respondents. 47.28% (n=139) male respondents conveyed that they perceive themselves as prioritizing the demands of animal owners over their patients as compared to 43.94% (n=58) female respondents; and at the same time “Never” felt conflicted about this stress [(33.67%, n=99)
vs. male respondents (28.03%, n=37)] (Table 3).
The aims of this study were two fold, firstly to determine the frequency of moral distress arising from ethical conflict in Indian Veterinarians and secondly to determine the relationship of the frequencies to the demographic variables of gender of veterinary practitioners. This paper reports the results of a large-scale online survey of all registered veterinarians and demonstrates that veterinarians have higher mild to moderate levels of distress on conflict with the animal owner regarding best interest of their patient; and majority of them felt anxious about their work.
Hatch et al., (2011) reported similar findings in Australian Veterinarians having higher levels of psychological distress including depression, anxiety, stress and burnout. Similarly, veterinary surgeons of the United Kingdom regularly face ethical dilemmas and that they find these stressful with implications on their wellbeing (
Batchelor and McKeegan, 2012). Similarly, in various studies conducted by
Batchelor and Keegan (2012) and
Moses et al., (2018), veterinarians have encountered a moral dilemma when they perceive a client’s inability or failure to provide care for the animal patient, with euthanasia representing the most extreme example of this conflict. Furthermore,
Tannenbaum (1993) also highlighted that veterinarians encounter the fundamental ethical aspect that underlies all interactions between humans and animals on a daily basis. In a study conducted by
Kogan et al., (2004), it was observed that female veterinary students possess higher self-expectations compared to their male counterparts. This finding may help explain why female veterinarians face a greater risk of experiencing depression, anxiety, overall stress and burnout. Many women establish excessively high standards of excellence and place undue pressure on themselves to succeed in their careers, which may be linked to increased vulnerability to psychological distress and physical illness (
Caltabiano and Caltabiano, 1994 and
Phillips-Miller et al., 2001). Moreover, unrealistic academic or professional expectations can contribute to an unbalanced lifestyle, leading to physical and emotional exhaustion, depression and addiction (
Firth-Cozens, 1987). For instance, depression can manifest as heightened irritability, diminished concentration, decision-making difficulties and memory impairment (
Firth-Cozens, 1987). Several studies among female medical students and physicians have also identified similar gender differences, revealing elevated rates of distress (
Frank and Dingle, 1999;
Lloyd, 1984).
Hsu and Marshall (1987) discovered that female physicians are 1.5 times more likely to experience depression and eight times more likely to suffer from severe depression compared to male physicians.
The results of the survey further revealed a statistically significant gender difference in the mean moral distress scores of participants. In situations when there was conflict of opinion with owners, discussion with colleagues followed by discussion with seniors was a way to sort out conflict. However, a significantly (P<0.01) higher percentage of male veterinary practitioners (11.22%) did nothing as compared to females (1.52%) to solve the issue. In situations, when veterinarians felt something as non-ethical, most of them preferred to discuss the issue with colleagues followed by superior officers. However, females were significantly proactive to discuss (P<0.01) as compared to males. To compound this, it is inferred that males have a false belief of coping well to the situation or a perceived stigma in seeking help from others (
Addis and Mahalik, 2003). Likewise,
Kogan et al., (2004) discovered that female veterinarians exhibited significantly higher levels of certain attributes like “Effective client relations”, “Effective relationships with staff members” and “Relationships with other veterinarians” compared to their male counterparts.
When the animal owner refused advice from the veterinarian, the stress levels increased. Most respondents were mildly distressed; however, significantly severe distress (P<0.01) was observed for females as compared to males. The female veterinary surgeons of the United Kingdom also reported significantly higher stress ratings than the male veterinary surgeons (
Batchelor and McKeegan, 2012). The research conducted by
Kogan et al., (2004) and
McLennan et al., (2005) had confirmed the presence of a high-stress environment among veterinary students, with implications that 30% of the students in their sample were at a high risk of experiencing burnout. Similarly,
Batchelor and McKeegan (2012) reported that this scenario is a common and stressful dilemma faced by practicing veterinarians. Similarly, in a study on small animal veterinarians of the USA, the female respondents were more likely to find ethical dilemmas stressful
(Kipperman et al., 2018). Subjectively, the higher stress level in female veterinarians could also be because of an additional factor of perceiving their psychological workload to be higher than that of their male counterparts
(Pohl et al., 2022). Females coped up with stress mostly by talking with partners or friends, which was significantly higher (P<0.01) as compared to males. Nevertheless, veterinarians have shown an innate ability to navigate through ethical dilemmas, as observed in the research conducted by Knesl
et al., (2017). Veterinary students were found to approach hypothetical ethical dilemmas with the aim of achieving a fair outcome for all parties involved and exhibited a care-centered approach, displaying empathy towards both the companion animal and the human caregiver
(Quinn et al., 2012). The distress and anxious behavior of respondents overlap and are related, with major distressing episodes of respondents frequently also involving their anxious behavior. Perseverative cognition of these stressful events in their daily life very often leads to anxiety
(Brosschot et al., 2010). This necessitates, whenever and wherever they occur concurrently, interventions and counselling at the personal level or even at the workplace; and increased provision of training and support (
Batchelor and McKeegan, 2012).
Gender differences in how individuals experience moral distress and ethical conflict have extensively been studied in various healthcare professions, including medicine and nursing. Research has shown that women are more likely than men to experience moral distress and ethical conflict (
Fox-Robichaud et al., 2019 and
Hamric et al., 2012). Women may also experience moral distress more intensely and for a longer duration than men
(Hamric et al., 2012). A re-analysis of meta-analytic studies revealed that when faced with conflicting decisions between utilitarian and deontological principles, men tend to exhibit a stronger preference for utilitarian judgments compared to women
(Friesdorf et al., 2015). Additionally,
Austin et al., (2017) proposed that variations in moral distress could be attributed to factors such as differences in values, communication styles and coping mechanisms between men and women. Furthermore, women may be more likely to seek support and engage in discussions about moral distress and ethical conflict compared to men
(Hamric et al., 2012). This may be due to social norms and expectations around gender roles and communication. Similarly, research suggests that women may be more likely to experience ethical conflict in the workplace, particularly in male-dominated fields where their values and perspectives may be marginalized
(DeCastro et al., 2014).
