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How far should you go?

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A PANEL discussion during a press conference at this year's BSAVA Congress was of interest, not just in bringing into a more public arena a debate that has been going on within the veterinary profession for some time, but also in raising questions about what might happen in the future. The discussion, entitled ‘Just because we can, does it mean we should?’, considered the question of how far vets should go in treating companion animals given the range of options now available. As the BSAVA pointed out before the press conference, ‘Companion animals are living longer, healthier lives than ever before, in large part as a result of advances in veterinary medicine, sophisticated diagnostic tools, new technology and improved nutrition. The growth of the pet insurance industry has also broadened the scope of treatment options available to many pet owners.’ Such developments could clearly benefit animals and their owners, but they also presented a dilemma for veterinary practice teams, not least because owner expectations were higher and, while some owners might be desperate to keep their pet alive, the animal's welfare was the prime concern and, in some instances, euthanasia might be the better option. The panel discussed various aspects of this dilemma, exploring how the veterinary clinical team and their support staff could manage client expectations, make the most of the clinical options available to them and maintain the animal's welfare as their top priority (see pp 400-401 of this issue).

Among the many points made during the discussion was that there is no ‘one size fits all’ model for veterinary treatment of companion animals and that decisions have to be made in terms of the individual patient and its circumstances. In fields such as oncology, for example, studies might have shown that a certain form of treatment might benefit, say, one in 10 animals but, for clinicians faced with a patient, there was no way of knowing whether it would benefit that particular animal. In this, as in other fields, quality of life considerations were all important but the cost of treatment also had to be taken into account and, as one panellist put it, discussions with owners had to focus on ‘pain, prognosis and price’. Practical considerations also had to be taken into account, such as whether the owner was in a position to take their animal to the practice at regular intervals for what might be a prolonged course of treatment, or to look after it properly afterwards. The importance of good nursing care was also emphasised during the discussion, with the point being made that, without it, the effort put into, say, a heroic surgical intervention might be wasted.

The need to involve clients in decision-making was also highlighted, with one panellist arguing that, ultimately, it was the owner who was responsible for the welfare of their animal, and that the role of the veterinary team was to assist the owner in making the right decision for their pet. Discussion of the options should be evidence-based, but the situation was complicated by the fact that in the veterinary field, to a much greater extent than in the human medical field, evidence might be lacking or inconclusive. With growing interest in evidence-based veterinary medicine, that could change in the future but, with limited resources being available for companion animal research and comparative studies, it will be a long time before the evidence base available to veterinary clinicians begins to match that available to their human medical counterparts, if indeed it ever does. In this respect, it was interesting to hear a remark from one of the panellists that, at some point in the future, as veterinary data collection improves, insurance companies might start to use the information in an expanding veterinary database to question some of the decisions being made by clinicians, as already happens to some extent in the human medical field.

It is interesting to reflect on how, in recent years, discussion of some of the dilemmas confronting human and veterinary clinicians has tended to converge. Euthanasia may not be an option in human medicine, but end-of-life issues continue to be the subject of much debate. Not so long ago, the cost of treatment, while clearly a constraint on veterinary practice, seemed not to be a limiting factor in the human medical field, whereas now, at least to some extent in certain instances, the reverse may sometimes be true. Human and veterinary medicine will continue to present different challenges but, given the current enthusiasm for One Health, this, perhaps, is an area where the two professions might usefully learn from each other.

There was an interesting debate during the panel discussion about the role of television programmes in raising owners' expectations of veterinary practice and changing people's perceptions of what might be achieved. Opinion appeared mixed, with some suggesting that such programmes were good in terms of showing what the veterinary profession could do and highlighting some of the difficult decisions that might have to be made, and others arguing that presenting cases as drama might not accurately reflect the everyday reality of most practices. It was also suggested that there was a tension between presenting developments as breakthroughs and the reality of research, which was usually a slow incremental process.

Overall, the discussion did much to highlight some of the dilemmas being raised as companion animal medicine continues to advance. Scientific progress is unlikely to stop and the range of options available for diagnosis and treatment will continue to expand. The cost of treatment will always be an issue, as increasingly seems to be the case even in the publicly funded NHS. With increasing knowledge, clinical decision-making is likely to become more evidence-based, but clinical judgement, coupled with good communication with owners and a clear understanding of the particular circumstances of each case, will always have a role.

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