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Call for strengthened guidance on treatment

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By Adele Waters

The RCVS should step in to the debate about veterinary overtreatment and set guidelines for the profession to help it identify treatment parameters in the case of new treatments or heroic surgery.

That was the call from Polly Taylor (pictured), vet and European specialist in anaesthesia and analgesia, at last week’s Animal Welfare Foundation Discussion Forum in London.

She said public expectations about what vets could do for animals had grown, driven by technological advancement as well as popular TV programmes featuring ambitious veterinary treatments.

The net result was an increasing appetite to treat animals, even when it may no longer be appropriate to do so, she said.

But it also meant vets were often working in the grey area between recognised veterinary practice, as sanctioned under the Veterinary Surgeons Act, and experimental procedures or research, which fell under a separate licensing regime, ie, the Animals (Scientific Procedures) Act.

‘I think the RCVS needs to make clearer what should be done about that middle road, the individual case that needs some sort of treatment and something exotic could be done but at the moment you don’t know whether it really falls under the Veterinary Surgeons Act … there is a grey area and I do think it would be perfectly possible to come up with some clearer guidelines about what to do.’

She said the profession was ‘getting carried away’ with apparent clinical excellence – doing the things that it thought it was meant to be doing. ‘But just because we can, does it mean we should?’ she asked.

The forum heard there was a ‘zeitgeist of concern’ about overtreatment in the profession. Vets had not spoken out until now because they didn’t want to ‘upset the apple cart’.

We are not brave enough to say ‘I think this is going too far’

‘We are not brave enough to say “I think this is going too far”,’ said Taylor. ‘It’s also something that has crept up on us – it isn’t something that has suddenly occurred and I think … it’s escalated. I think we are not entirely to blame for not having noticed it but I think we probably do need to do something about it now.

‘We need peer review – what I would call a sanity check – [to ask] “Is this really sensible?” or “Does it really make sense to do this particular treatment on this animal?” We need ethical review and we also need premeditated and recorded constraints to protect the welfare of patients.’

Under their oath or declaration, vets are bound to always put the animal’s interest first but Taylor asked: ‘Are we doing that? Are we getting carried away with this cool stuff? Looks good, gets on TV and gets in the press but are we really doing our patients any good through this? The animal’s best interest should be at the top of the list when we are carrying out veterinary treatment.’

Under their professional code, vets also have a duty to ensure their intervention is always appropriate and adequate. In addition, they are now encouraged to use an evidence-based approach – ‘to do everything you possibly can’ to make an accurate diagnosis and to treat the animal, according to all the available evidence, said Taylor.

‘But I would argue that the correct or best treatment is not always the right treatment,’ she said. ‘We are treating the disease and not the patient … but what about the quality of life of that animal?

‘Think about major surgery on an old animal that’s got numerous comorbidities. It’s now got a lung tumour and if you take away that lobe, it will no longer have the lung tumour but will it really prolong good life?’ she said. While new and exciting treatment options were constantly being delivered, euthanasia was ‘also a treatment option, not a failure’.

RCVS president Amanda Boag, who was also at the meeting, said the RCVS was currently working on a solution.

‘The RCVS is taking this very seriously … we have a very active working party looking at the interface between the ethical review panel and recognised veterinary practice subcommittee. We had a kick-off meeting a couple of months ago and we have another later this month to look at that aim … to try to find a better structure to deal with this.’

– See also ‘My View’ on p 745 •

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