Vetnuus | December 2024 7 Leading Article surgeon advising on ‘the structural, physiological, medical, surgical and welfare needs of racehorses and sport horses and the restoration of normal form and function after injury or illness’ (adapted from American College of Veterinary Sports Medicine and Rehabilitation2). The questionnaire was based on a similar survey of sports medicine doctors,3 adapted to include areas already raised as potential ethical concerns.4 The questionnaire was reviewed by five council members from the British Equine Veterinary Association (BEVA), and the Research and Education Officer from a Welfare Charity, and further revised. The complete set of questions featured in the questionnaire, along with their respective answer options, including both structured choices and opportunities for open-text responses, is provided as a supplementary item (Questionnaire S1). The questions encompass various aspects of the respondent’s clinical veterinary work, ethical challenges, conflicts of interest, opinions on medications and treatments, clarity of obligations set by governing bodies, priority areas and considerations regarding reputational risk.The questionnaire entitled‘Equine Sports Medicine Ethics’ was open for completion for a 10-week period between September and November 2021. Equine veterinary surgeons practising in the UK were eligible to respond and the questionnaire was promoted by BEVA to its members, via veterinary social media posts, and to the membership of an online continuing professional development provider. Answers to open-ended questions were analysed thematically. Quotes are used for two purposes throughout this paper; first, to capture the particular theme expressed by several respondents, and second, to ensure that the voices of the respondents are maintained and expressed. Data is presented as counts and percentages. A Wilcoxon signed-rank test was used to assess if there were differences in whether respondents perceived the duties/obligations of veterinary surgeons to be well defined by the governing body during the competition period compared with the between-competition periods. A p-value of <0.05 denoted statistical significance. 3 | RESULTS 3.1 | Respondents Ninety-seven respondents completed the questionnaire, however, not all respondents answered all questions. Respondents (n = 93, 96%) varied as to the proportion of equine sports medicine that comprised their veterinary work: for 21.5% of respondents 25% of their work was dedicated to clinical equine sports medicine, 28% was in the 25%–49% category, 28% in the 50%–74% category and 22.6% did more than 75% of their work within sports medicine. Fifty-seven respondents (59%) had post-graduate veterinary qualifications. A large proportion (n = 62, 64%) of respondents also provided veterinary services at competitions/races. Respondents provided veterinary services to horses in a variety of equestrian disciplines with considerable variation as to the proportion of time working in each discipline. The mean proportion of time spent in each discipline was: showjumping 28%, eventing 25%, dressage 24%, racing 22%, polo under 2%, endurance and driving under 1%. 3.2 | Stakeholder responsibility When respondents (n = 95, 98%) were asked the degree of responsibility they felt towards varying stakeholders, the highest was to the horse, with 82.1% of respondents selecting‘I feel complete responsibility towards this stakeholder’ (Figure 1). This was followed by 58.5% selecting complete responsibility to themselves and 46.8% selecting complete responsibility to their veterinary practice, followed by the Royal College of Veterinary Surgeons (RCVS) at 34.0%, owner, rider and trainer at 28.4%, 23.2%, 14.7% respectively, and other governing bodies and organisations (Federation Equestre Internationale [FEI] [18.5%], British Horseracing Authority [BHA] [16.5%], BEVA [14%]). 3.3 | Ethical challenges There were 86 responses (89%) to the question ‘What (if any) do you think are the ethical challenges facing veterinary surgeons who provide equine sports medicine services?’, with many respondents listing several ethical challenges. Three responded that there were no ethical challenges. Responses were categorised into general ethical themes, leaving a small remainder of specific issues. The most common general ethical challenge covered conflicts of interest, pressures on the veterinary surgeon and competing interests, and was stated or alluded to by 50 (52%) respondents. The primary area was balancing the horse’s health and welfare with the client’s wishes, in particular for the horse to compete. Responses included: ‘Finding the correct balance between the horse’s welfare and its continuing to compete at the highest level’, ‘managing conflicts of interest between stakeholders’ aspirations and the welfare of the horses’, ‘placing horse welfare second to performance’. A common example of this was conflicts between ongoing competition and the need for rest or retirement: ‘Owners requesting ongoing treatment and management of injuries in order to allow the horse to continue competing at a high level, where it might be more appropriate to drop to a lower level/retire the horse’. Some respondents noted client demands around treatment: ‘meeting the needs of the client without allowing them to dictate treatment’ while others noted there was pressure to provide a ‘quick fix’ and to ‘patch up’ a horse for it to compete or be sold. Some respondents identified conflicts with competition integrity: ‘pressure to accept horses [in competitions] that are not fit to compete’, ‘treating horses to improve performance but adhering to the ethos of clean sport’, ‘ensuring that sports are conducted transparently with the horse’s welfare paramount’. Intra-articular medications (excessive use, inappropriate use, pressure to use) were specifically mentioned by 19 respondents. A high prevalence of lameness, or chronic lameness was mentioned by 10 respondents. Furthermore, a lack of owner/trainer recognition of lameness, and disregard for lameness was mentioned: ‘chronic lameness and owners expecting to continue competing regardless’. Equine veterinary surgeons’ (n = 95) self-reported responsibility to various stakeholders when practising in equine sports medicine.
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