Clinical excellence or over-treatment? Q&A with Discussion Forum speaker Polly Taylor
At this year’s Discussion Forum, we’ve invited speakers from the veterinary and medical professions to explore how we can balance the pursuit of clinical excellence with the kind of over-treatment that leads to compromised welfare. To give us an insight into the topic and what will be covered during the session, we talked to speaker and veterinary specialist in anaesthesia, Polly Taylor.
AWF: What sparked your interest in the topic?Polly:
The realisation that the accepted “best” treatment of the disease was not always the best treatment for the pet – or its owner.
The distress & dilemma caused to junior anaesthetic residents who were expected to anaesthetise sick, old patients for complex, heroic surgery when euthanasia would have been far more appropriate.
Modern day pretence that death is avoidable and euthanasia a failure. The assumption that the right course of action is always prolongation of life - without taking into account the quality of that life.
Glorification of heroic, gimmicky surgery that does not take into account the patient’s best interests.
Seeing owners made to feel guilty if they don’t “do everything” to treat their sick and dying pet - to the point of re-mortgaging their house for a few months more of miserable existence whilst undergoing unpleasant (for the pet) treatment.
AWF: Why is this topic particularly relevant now?Polly:
In the recent decade or so, meteoric developments in technology (e.g. imaging, stem cell technology, molecular biology, materials, computer power, instrumentation) has enabled complex and spectacular treatments which would have been impossible a few years ago.
The pet animal has become ever more anthropomorphised, being treated as an equal infant or child member of the human family.
Social media disseminating information quickly, widely and indiscriminately.
AWF: What are the key issues of your topic?Polly:
Treatment must put the animal’s best interests first.
“doing everything” is not necessarily the right action.
When complex invasive treatment with doubtful outcome is proposed a panel of all stakeholders, including an advocate for the animal, should discuss the ethics of the case (e.g. clinician, nurses, owner, anaesthetist, animal advocate who is not necessarily the owner, lay person).
Experimental surgery with as yet unknown outcome must be regulated to protect the patient. It should either be conducted under the Animals Scientific Procedures Act or, if it really is Recognised Veterinary Practice, be subject to ethical and peer review.
The veterinary profession should follow the medical profession’s ethical review process for all clinical trials and attempts at novel surgical techniques (not just for drug trials).
Euthanasia is not failure. It is a privilege of the veterinary profession.
Crowd funding is dangerous as there is no peer or ethical review of the proposed procedure and it may harm the patient and its owner.
AWF: What are you hoping delegates will take away from your session?Polly:
Treat the patient, not just the disease.
Make a system for ethical review of difficult cases in your own clinic.
Stop and think before using a new surgical technique - don’t be swayed by publicity to carry out “cool” surgical techniques without a) being sure this will benefit the animal and b) being competent at the procedure.
Don’t assume that prolonging life is always the best for the animal.