Moral distress, resilience and human spirituality in the veterinary clinic.

The spiritual health of veterinarians is challenged by moral distress that expresses a conflict between personal core values and clinical practice. The morally resilient veterinarian experiences and addresses moral distress in constructive ways that express care for patients, owners, colleagues and society. As such, moral resilience is a positive aspect of spiritual health that can be built through reflections and dialogue on the ethical, existential, spiritual and religious questions raised by veterinary practice. Veterinarians often face complex moral dilemmas when attempting to balance the interests of animal patients, their owners, the veterinary business, surrounding society, and themselves. When it is not possible to accommodate all these responsibilities, moral distress may occur, a state associated with compassion fatigue, burnout and depression. Human spirituality concerns a person's central relationships with the self, others, nature, animals and "the sacred" giving meaning, purpose and values to life. Consequently, moral distress affects not only physical, social and mental health, but also spiritual-existential health and well-being, as it disrupts these core relationships in a way that defies simple technical and practical solutions. We argue that strategies to increase moral resilience (and thus spiritual health) should include conversations with peers and mentors aiming to articulate experiences of moral distress and reinterpret their meaning. Since moral distress in a veterinary clinic involves emotions, values and ideas about the human-animal relationship, resilience-building reflections and conversations must address existential themes like personal responsibility, guilt, acceptance, forgiveness and moral agency. These questions cannot be answered by scientific knowledge alone, but involve personal faith perspectives (secular-existential, spiritual or religious). Consequently, veterinarians, both individually and collectively, should increase attention to the broader existential context of clinical work in order to cultivate moral resilience and enhance spiritual health.