VETERINARY surgeons must
identify the limits of what is
reasonable clinical practice, to
ensure that “heroic” procedures
don’t cross the boundary in
becoming ethically unacceptable,
speakers agreed at the BVA
congress.
Noel Fitzpatrick, principal of
Fitzpatrick Referrals in Surrey, has been
at the forefront of developments in
veterinary orthopaedic surgery, having
created new forms of implantable
prosthetic devices for pet animals with
limb injuries.
Along with the widespread acclaim
for this work, he has also received a fair
amount of criticism. He acknowledged
that some of this disapproval came
from within his own profession, which
was “hurtful”, but he said was fully
prepared to justify his actions.
As with any major surgery, the
fundamental question in deciding
whether or not to go ahead with the
treatment was the effect on the quality
of life of the patient. In those cases of
cats and dogs given artificial limbs, the
patient recovered quickly from the
operation and enjoyed both an excellent
quality and extended quantity of life.
Justification queried
Some critics had queried the justification
for carrying out expensive operations on
a pet but he argued that the owners
alone must decide how they want to
spend their own money.
Professor Fitzpatrick argued that the
veterinary surgeon must assess the
current condition and future prospects of each animal. The owners were not
always in the best position to decide
what was best for their animal.
He said that about one in five
patients brought by clients asking for a
total hip replacement for their animal
had to be turned away. Meanwhile,
euthanasia or limb amputation were
both acceptable and appropriate
alternatives when function could not be
preserved.
There were many occasions when it
was ethically right to offer more
sophisticated techniques, he continued,
citing the example of implanting
cartilage cells into the joints of dogs
with osteochondritis dissecans. This
produced superior functional results to
simple surgical debridement of the
damaged tissue, where leaving a hole in
the cartilage would mean inevitable
progression to osteoarthritis.
“Should we be doing something that
causes pain and suffering? Should we be doing the conventional thing? No, we
should get real and move on.”
British veterinarians must reach
some form of consensus on the ethical
considerations that should be
determining the speed of progress in
clinical practice. If they don’t sort out
these issues themselves, they will find
that the responsibility will be taken out
of their hands, he warned.
Health tourism was a fact of life for
human patients and clients might be
increasingly willing to send their animals
abroad if the profession could not make
up its mind whether to provide a
particular treatment at home.
Framework
Dorothy McKeegan, a lecturer in animal
welfare at the University of Glasgow,
outlined a framework for making such
ethical decisions. Above all, it was vital
for practitioners to keep their clients
fully informed of the welfare
consequences of the various treatment
options, she said.
Quality of life must always be the
first priority in deciding which to
choose, extending the animal’s lifespan
was the next consideration but that
should also take priority over the
owner’s preoccupations and the financial
or scientific interests of the practitioner.
Prof. Fitzpatrick agreed fully with
Dr McKeegan’s analysis and supported
her proposal for the creation of an
ethical review committee made up of
experts from all branches of the
profession to provide guidance on the
acceptability of new methods. This
could prove valuable for practitioners in
helping them to reach scientifically and
ethically based decisions.
Morally and ethically sound
“The public expects a morally and
ethically sound profession and we
should be able to deliver that efficiently,
even in the face of ever evolving
technology and possibilities,” he said.
In questions, John Bower, a retired
practitioner from Devon and a former
president of the BVA, argued that
heroic surgical treatments like those
described would rarely cause serious
welfare problems. A far greater concern
was the tendency for practices to
attempt to preserve the lives of old and
chronically sick animals.
It was unreasonable to subject these
animals to invasive diagnostic
interventions and prolonged therapy.
“This to me really is a treatment too
far,” he said.
Dr McKeegan highlighted the
difficulties for owners in assessing how
their animal’s demeanour changed with
age and increasing infirmity. She
suggested that practitioners should ask
their clients to compile a list of five
activities that the animal has always
enjoyed as a means of identifying any
deterioration in its quality of life.
