The upcoming considerations are decisively modified reflections on the different conceptualization of health initially introduced by Martin Huth (2016).
In what follows, three frames or models of health will be introduced as structural models. Similarly to Linda and Ezekiel Emanuel’s four models of the relationship between physician and patient (1992), they are not intended to present exact descriptions. As structural models they are neither existent in pure form nor as entirely separated from each other. They serve as types to capture the differential normative infrastructure of veterinary medicine.
The models are developed by means of a narrative heuristics: Imagine three siblings, Olivia, Felicity, and Steven, in different relations to animals. Each of them is concerned about health. However, this concern is rooted in and determined by different perspectives and needs that entail different (practical and ethical) expectations towards veterinarians. It will become visible that health and likewise veterinary medicine are embedded in a “world made in various, sometimes overlapping, but rarely coherent, practices. That is, if we believe that things [e.g. health, M.H./K.W./H.G.] are made through their relations, or change as they relate to one another” (Hinchliffe 2016: 30). We will argue that each of these cases opens a particular perspective on health and disease and entails a specific set of moral expectations. Each of these perspectives and its normative implications presents a particular frame of health in veterinary medicine.
Olivia is an official veterinarian who is currently concerned with an outbreak of foot-and-mouth disease (FMD). She is in charge of decision-making concerning appropriate countermeasures against the backdrop of relevant legal regulations, public expectations, and customary practices. Moreover, she knows that she acts according to economic constraints of livestock farmers and on the basis of laws that protect economic ends and even prefer them to animal health.
Her sister Felicity is a dairy farmer. She is, from her point of view, economically dependent on the veterinarian’s competence to maintain her cows’ capacity to be productive. Diseases like mastitis or fertility disorders build a vital threat to her since her (and generally) calculations are tight. At the moment, she has to cope with a case of Bovine Ovarian Cyst that hinders one of her cows to become pregnant which would of course be indispensable for lactation.
Steven, their brother, is a trained philosopher who is animal-loving. He considers his pug a true family member. From his philosophical stance, he is convinced that his pet dog is a conscious being with interests and has an independent moral status.Footnote 6 He likewise expects the veterinarian he is consulting to acknowledge this moral status without compromises. Recently, it has turned out that his dog is overweight.
The Objectivist Conceptualization of Health: Health as Part of a Whole
Basically, Olivia as an official veterinarian finds herself in the frontline of combatting epidemics and zoonoses. At first glance, the current outbreak of FMD might even appear as a benign case of decision-making with regard to combatting infectious diseases since it is conceived of as an epizootic, not as a zoonosis (human infections are rare and usually show a mild course). By contrast, take the examples of H5N1, a Highly Pathogenic Avian Influenza Virus (HPAI, building a possible threat for human populations; Degeling et al. 2016) or of Campylobacter infections (causing diarrhea after the consumption of poultry, hence, a food safety issue; Hinchliffe et al. 2017).
Pertinent expectations towards Olivia and her colleagues are visible in public debates as well as among experts in the field and comprise e.g. public health in general, food security, economic concerns, and animal welfare. To deal with these variegated expectations, it seems crucial to abstract from individuals’ experiences and weigh different health-related matters. These matters are not recognized equally but differentially (Huth 2018). In case of the outbreak of a severe zoonotic disease, most people would consider it cynic to put the bird population before e.g. children (who are particularly susceptible to dangerous infections). Consequently, the management of zoonoses appears to be unambiguous concerning the decision-making in favor of humans. One tends then to tacitly reduce the animals to threatening zoonotic vectors, that is, objects caring pathogens that are to be eradicated (Haraway 2008). This reductionism mirrors a particular understanding health. From a naturalistic point of view one can proceed from the fact that there is a possible transmission of pathogens from animals to humans and vice versa. Similar bodies show a similar and interconnected etiology. Unsurprisingly, OH initially emerged within the field of combatting infectious diseases. In the wake of its commitment to OH, the AVMA exemplarily emphasizes the intertwining of humans and animals with regard to health: “[O]f the 1461 diseases now recognized in humans, approximately 60% are due to multi-host pathogens characterized by their movement across species lines. And over the last three decades, approximately 75% of new emerging human infectious diseases are defined as zoonotic. Our increasing interdependence with animals and their products may well be the single most critical risk factor to our health and well-being with regard to infectious diseases.” (AVMA 2008: 3).
To put it pointedly, from this perspective, our relation to animals consists in a shared susceptibility to microbes and our spatial proximity to them. Therefore, Olivia can address the question what she ought to do as an official vet under the aegis of OH. It is obvious that the AVMA refers in this case to an understanding of health and disease within the transmission paradigm (Hinchliffe et al. 2017). In a naturalistic air (similarly to Boorse’s approach), disease traces back to a contamination of a previously unadulterated body with pathogens (Huth 2018). Neither the species nor the individual and particular manifestations of an infection make the difference. The pathological phenomenon as well as any kind of ailment is conceived of as secondary. Hence, subjective illness (the lived experience of being sick) is in tends to be concealed by disease (the “objective” existence of an aberration, in this case an adulteration).Footnote 7 The body is reified as an object that should not be adulterated and disturbed by detrimental microbes. Olivia’s pursued targets of interventions are bodies (objects) and microbes.
Consequently, countermeasures comprise locking out (by material barriers) or, in case of an outbreak, eradicating pathogens. This is possible by means of medical treatment; OH can serve as a valuable basis for this as it supports the development of drugs and other kinds of treatment of one disease by referring to different species (human and non-human) and transferring knowledge from one to the other.
One could argue that vaccination would be the most effective way to avoid the “pathogenicity” (Hinchliffe et al. 2017: xiv) of specific microbes. This can be regarded as part and parcel of the mentioned barriers to protect humans and animals from contagion. However, vaccination frequently turns out to be too complicated, too expensive or too insecure (Mepham 2016). Hence, the eradication of pathogens remains a crucial countermeasure in the face of infectious diseases. Notably, hosts are in such cases primarily conceived of as (mere) zoonotic vectors. By taking this stance, the subjectivity of the host becomes concealed, the animal becomes a mere object. Therefore, the eradication of pathogens can and does frequently entail the eradication of the actual host or even the possible host. Though there is frequent criticism of practices of (prophylactic) mass culling in public debates and in the academic ethical discourse (Cohen and Stassen 2016; Mepham 2016; Degeling et al. 2016), this is often countered by pointing out the allegedly unavoidable need of these practices against the backdrop of scientific (and thus supposedly incontestable) evidence (Latour 1999; Hinchliffe 2016: 30). Within such an objectivist understanding of disease (and health), illness or animal welfare and even animal lives come into play as a secondary moral issue only. Thus, (prophylactic) culling is a legitimized (although not entirely uncontested) measure to combat infectious diseases.
Let us now turn to Olivia’s present problem she has to deal with: an initial outbreak of FMD. Basically, zoonotic diseases appear more pressing than FMD and other mere epizootics. But from an ethical point of view things might turn out to be even more challenging. The relevant EU directive is unmistakable: “Food-and-Mouth disease is a highly contagious viral disease (…). Although foot-and-mouth disease has no public health importance, due to its exceptional economic importance, it is on the top of list A diseases of the Office International des Epizooties (OIE)” (Directive 2003/85/EC). Against the backdrop of such a frame, animal bodies are weighed against economic needs. From the beginning of 1992 on, vaccination of animals against FMD has been banned by the EU because it was alleged that (a) in vaccinated animals, like in infected individuals, antibodies are detectable which is a hurdle for the distinction of those vaccinated and those who are sick and contagious; and (b) even vaccinated individuals potentially transmit the virus (Bergevoet and van Asseldonk 2013). Instead, mass culling (of infected and of healthy animals for prophylactic reasons) presents a usual step in combatting FMD. Well-known examples for these policies are the outbreaks of FMD around the turn of the millennium in Great Britain and the Netherlands (Mepham 2016; Cohen and Stassen 2016).
The triad animal – owner – vet is framed and normatively charged by this kind of description. The detection of the FMD-virus causes a state of alert (it is a list A disease). Olivia is expected to respond by measures that are considered appropriate for such a state of alert: eradicating the virus by all means and provide for all contingencies. This also entails prophylactic stamping out suppressing the (moral) relevance of the individual animals’ experiences and interests in survival. Although some research outcomes even suggest that the “necessity” of preventive culling is only given under specific circumstances, such as displaying clinical signs for a time period longer than 0.5 days, because transmission is not possible prior to this duration (Charleston et al. 2011: 728), a quick and effective procedure is deemed necessary to definitely provide for all contingencies. It becomes visible that the objectivist frame tends to conceal not only other frames but also research outcomes that do not conform to those practices that sustain this very frame. The “outbreak narratives” (Hinchliffe 2016: 29) shield themselves against suggestions of other legitimate responses to FMD.
To sum up, the objectivist conceptualization of health in veterinary medicine consists of a reductionismFootnote 8 that excludes the animals as individual experiencing subjects as well as particular, socially determined relations between humans and animals. Instead, we have bodies that are in a potentially dangerous proximity. Combined with an “alert narrative”, this reductionism leads to practices that are literally radical when it comes to combatting pathogens: either the microbes are locked out or eradicated, that is in case, the hosts and even the potential hosts are eradicated. As a hegemonic frame, it shields itself against other frames as well as scientific insights that do not conform to its essence. Olivia’s practice as official veterinarian is determined and considered as justified by the prerequisites provided by this frame.
The Functionalist Conceptualization of Health: Health as Instrumental
One of Felicity’s cows has a Bovine Ovarian Cyst (BOC). Such a cyst does usually not cause any suffering but inhibits fertility. Felicity’s main expectations towards veterinary medicine, thus, emerge neither from a concern about contagion nor from a concern for illness, that is, a “subjective feeling state of the individual referred to as symptoms” (Hofmann 2002: 653). Nevertheless, health is supposed to be pursued by a veterinary intervention: Felicity economically relies on the cow’s ability to become pregnant (as precondition for the lactation performance) and conceives of this ability as part and parcel of health.
The statistical normality as sign for health reoccurs now in connection to productivity. While in Boorse the normalcy is a purely statistical one, Felicity identifies health with normal performance. Similarly to the objectivist frame, we can assume that the animal body is first of all a mere body, an object, but now its functions are most important. Against the backdrop of a human economic dependency on animals’ productivity and efficiency due to tight margins, expectations towards veterinary medicine are mainly to maintain or restore efficient production. In turn, productivity becomes a sign for health. Veterinary interventions are thus justified by a diminished productivity, be it a slower growth in fattening pigs, be it a lower amount of eggs in chickens, or be it the absence of pregnancy in dairy cows.
From a historical perspective, food shortage as a looming existential problem shaped expectations towards veterinarians. After the Second World War, a substantial food scarcity occurred against the backdrop of a proceeded (however, significantly impaired) industrialization and capitalism. This led to the emergence of the production paradigm in agriculture (Thompson 1994) which formed a frame of health still of practical and moral significance. Food shortages appeared to be prior, and therefore “many argued that if veterinarians were to maintain their ‘rightful place’ on the farm, they had to embrace and assist intensification” (Woods 2013: 9). Nowadays, dairy farmers and other stakeholders in agriculture face tight margins and, thus, depend on efficiency guaranteed by bodily functions conforming to a given standard.
This functionalist frame is not only visible in practice when veterinarians meet expectations of dairy farmers or related professionals. Even in scientific papers, the descriptions of pathologies appear to be reliant on tacit presuppositions derived from the production paradigm. To make this visible, we review the paper Ovarian Cyst in dairy cows: old and new concepts for definition, diagnosis and therapy (Jeengar 2014). In this text, the BOC is described as “a major cause of reproductive failure in dairy cattle” (ibid.: 63). Pregnancy is the precondition of lactation performance. The BOC has become regarded as a widespread problem particularly in the last decades. The selection for production in breeding (pursuing a high lactation performance) has had the side effect of a susceptibility to this pathology (ibid.). The cows become prone to BOC due to breeding lines that should basically achieve the goal of maximizing profit. This is by far not the only pathology caused by intensification. “The emphasis on more outputs for less input systems has led to animal breeding programs that harness physiological traits favoring higher production at the expense of animal welfare issues such as lameness, mastitis, and dystocia.” (Kimera and Mlangwa 2016: 2944). Hence, Felicity in her role as client of the veterinarian and her cow as patient can be considered as “products” of this particular frame.
The perspective of the animal and her illness or wellbeing does not and need not play a role. Jeengar even states that one should refrain from calling it a pathology: “Cysts are often diagnosed in the absence of clear clinical signs, therefore the term ‘Cystic Ovarian Disease’ no longer seems appropriate and should be replaced by the term ‘Cystic Ovarian Follicle (COF)’ which does not necessarily implicate a state of disease.” (Jeengar 2014: 64).Footnote 9 Here we can see that not only the illness/well-being of the animal plays a minor (if any) role but actually the basic physiological mechanism is not as important as the outcome for production. Beyond the absence of illness, the animal might be even called healthy in terms of the objective conceptualization of health. Reproduction is just a matter of time, the aberration from a normal state is just a phase, but it is too much time for the production process the cow is part of. This is also visible in the treatment recommendations the authors are giving in their article: Manual rupture of the cyst is not the gold standard “because it may result in trauma and haemorrhage”. The problem here would not be the suffering for the animal but the fact that trauma and haemorrhage are again factors which play a role in “contributing to fertility reduction” (ibid.: 66).
To sum up, we can indicate that within the functionalist frame the instrumental nature of health is the primal concern of veterinary interventions. Health serves as a means to other ends, such as productivity, and gains its value in light of the end. A body is conceived of as healthy if it conforms to production statistics (e.g. lactation performance) instead of to a given species norm. This leads to another, however similar, kind of reductionism within this conceptualization of health. The BOC presents a relevant example to show that aberrations without any kind of symptom can be an indication for veterinary medical treatment. Suffering can but need not play a role for justifying veterinary interventions. Some “objective” pathologies might even be considered as inevitable in livestock animals and thus not as reason for veterinary interventions (e.g. mild behavioral problems).
The Sentientistic Conceptualization of Health: Health as Well-Being
We are now turning to Steven and his incipiently obese pug. At first glance, it might appear as besides the point to consider companion animals and their owners in a paper that is concerned with veterinarians as professionals in food chains. However, the aim of this section is to make visible a particular frame of conceiving health that is also significant in animals that appear in food chains. The example of the obese dog serves as vehicle for showing a different structure of justifying veterinary interventions than in the objectivist and the functionalist conceptualization of health. While these rely on the focus on bodily mechanisms that are compromised, the sentientistic conceptualization emphasizes the experience of the individual subject in terms of wellbeing or suffering.
Steven consults the veterinarian because he is attentive to his dog’s bodily state and recognized the overweight in a quite early stage. For Steven, it is clear that it is not the mere fact that the animal’s body contains too much fat tissue (compared to statistical average) that makes him contact the veterinarian. He considers himself obliged to take measures against the overweight because it is public knowledge that obesity potentially causes severe health problems like e.g. heart diseases, breathing difficulties, or metabolic disorders. However, for Steven it would be sufficient that the pug were restricted in his ability to move to consult the veterinarian. As a philosopher adhering to the pathocentristic paradigm (in which the ability to suffer puts moral obligations upon us) he considers being deprived of exercising satisfying capacities as a moral problem he has to respond to as animal owner.Footnote 10 Hence, the triad of animal – owner – veterinarian is embedded in a frame of health that is focused on illness in contrast to wellbeing. Illness presents an understanding of pathologies that emphasizes the individual experience of the patient (Hofmann 2002; Carel 2008, 2014). It is neither the “objective” aberration from a statistical normality nor the adulteration with microbes or the obstacle for gaining productive competitiveness that justifies veterinary interventions. The main aim of veterinary practice is the alleged wellbeing of the individual. This seems to be at odds with the kind of reductionism visible in the concept of OH adhering to an objectivist understanding of health. However, Sandøe et al. (2014) attempt to understand obesity in companion animals under the aegis of OH (although this concept emerged in the field of infectious diseases). Rooted in a “shared lifestyle” (ibid.: 612) of humans and animals, veterinary interventions are targeted towards pathological outcomes of breeding and keeping animals in ways that are detrimental for the individual’s health. Sandøe et al. show that a shared etiology can refer not only to the contamination with microbes but also to social factors of health. However, we doubt that the original concept of OH fully complies with the notion of health that is at stake if we understand obesity as welfare issue. Proceeding from an objectivist understanding, OH is basically focused on (shared) bodily mechanisms.
Finally, we want to point out that the sentientistic frame in veterinary medicine is particularly significant when decision-making with regard to euthanasia is at stake. In some cases the termination of animal life is even conceived of as fundamental moral obligation (Grimm and Huth 2016: 96). If the alleged suffering of a family dog exceeds the level of what we consider acceptable, a preferably painless killing is deemed to be the morally right treatment. Notably, there is an increasing tendency to establish companion animal hospices and palliative care for animals; however, the question remains when we are obliged to kill an animal to avoid “unnecessary” suffering (Mullan and Fawcett 2017: 100).
To sum up, we can argue that this frame of health is focused on the individual experience of the animal as rationale for veterinary interventions. This approach to health is frequently called holistic as its logic is directed primarily to wellbeing but inevitably also embraces bodily functions (Nordenfelt 2006). However, this frame presents a kind of reductionism as it considers illness and wellbeing as prior; the body’s functions count “only” insofar as they are the condition of possibility for wellbeing.Footnote 11 Moreover, the body is even pushed to the margins of considerations at what moment decision with regard to euthanasia must be taken.
Three Frames of Health Overlapping in Practice
It would be a profound misunderstanding to conclude that these frames operate in pure juxtaposition. The aim of this paper is to point up different frames of health; therefore, we have described them in their difference. However, in practice they are overlapping.
First, take the example of (prophylactic) mass culling of livestock animals in the case of an outbreak of an infectious disease. We have indicated that such a practice mirrors an objectivist conceptualization of health. Yet such a practice does not go unchallenged when people refer to the sentientistic frame of health. Animals and their lives and wellbeing are part of the public debates about a decent reaction to such outbreaks. Animals are dominantly regarded as beings with a moral status, and thus the measures of stamping out are potentially seen as exaggerated and too drastic (Cohen and Stassen 2016). Moreover, there is the frequent claim to perform culling as painless as possible.
These concerns are also visible in the pertinent EU directive: “One of the Community’s tasks in the veterinary field is to improve the state of health of livestock, thereby increasing the profitability of livestock farming and facilitating trade in animals and animal products. At the same time the Community is also a Community of values, and its policies to combat animal diseases must not be based purely on commercial interests but must also take genuine account of ethical principles.” (Directive 2003/85/EC). This appears to be a clear statement. However, the practical outcome of this emphasis of ethical principles (whatever they may be) is frequently reduced to the intention to stamp out as painlessly as possible.Footnote 12
Second, in practice, there is also a considerable overlapping of the functionalistic and the sentientistic conceptualization of health in livestock farming. If we take examples like lameness, mastitis, and dystocia – that are also considered as outcomes of breeding that seek to increase productivity – the rationale for veterinary intervention can also be the concern for the animals’ suffering caused by these diseases. Moreover, like Steven when caring for his pug, livestock farmers could also be concerned about overweight and the pernicious outcomes for the animals’ wellbeing. However, it is important to note that this would not be possible in an arbitrary way. Focusing on fattening pigs, the concern about obesity can – if at all – only occur from an uninvolved point of view.Footnote 13 Pig farmers are dependent on their animals’ weight, and the relevant health problems usually occur at an age that fattening pigs will not reach. In turn, someone who keeps dairy cows or sheep could consider herself to be responsible to care about overweight beyond the logic of an optimized use of animal bodies.
Third, it is clear that companion animals are not always treated according to the logic of the sentientistic frame of health. The breeding, keeping, and also veterinary treatment of pets can be intended to accommodate aesthetic predilections (Rollin 2006: 50). Pugs, to stick to our example, show in the usual breeding lines an increased susceptibility to the brachycephalic syndrome causing severe breathing difficulties (Sandøe et al. 2014: 107–8). Veterinarians can only try to treat the pertinent problem. Thus they do not change this practice; on the contrary, they economically benefit from it and sustain it by curing the pernicious outcome of such breeding. Yet this does not insinuate that veterinarians would opt for cruel breeding practices. Moreover, veterinarians are often confronted with a request that frequently causes moral distress: convenience euthanasia (Rollin 2006: 54). Such a request does not betray a sentientistic but rather a functionalistic understanding of an animal and her health: Either the animal contributes to my comfort or I want to get rid of her.
Finally, we want to point out that euthanasia frequently mirrors a sentientistic understanding of health. In livestock animals as well as laboratory animals (consider the “humane endpoint”), the termination of animal life is (like in companion animals) considered as moral obligation to avoid unnecessary suffering (Grimm and Huth 2016). If the alleged suffering of a family dog, a dairy cow, or a rat in the laboratory exceeds the level of what we consider acceptable, a preferably painless killing is deemed to be the morally right treatment. Similarly, zoonotic vectors are arguably reduced to their role as a potential threat to health. However, there is a virtually unambiguous consensus that the methods of stamping out should guarantee minimum stress and pain for the animals (Mepham 2016).