Vets urged ‘have the conversation’ to avoid the risk of ‘overtreatment’

Vets should not rush to offer complex treatments to clients and should discuss issues such as quality of life and euthanasia with them earlier, BVA Live delegates have been told.

Clinicians debated the issues in the interactive session, “When is enough, enough? How do we define overtreatment?”, at the NEC in Birmingham.

Contributing from the floor, on the example of referring a cat with a broken leg for a complex repair versus amputation, BVA past-president Robin Hargreaves suggested vets “feel a bit embarrassed about saying ‘We could chop its leg off’”, adding: “I think we’re not allowing [clients] to have the conversation.”

Another vet agreed, adding: “I do get the impression sometimes [vets feel] if we can do something we should, and that’s not always right.”

Owner hesitancy

University of Cambridge student Rudi Bruijn-Yard posed the question: “I’m extremely excited to potentially one day specialise in surgery and look for innovation, but is in every instance innovation necessary, and should we always be offering that to clients?”

Owner hesitancy to euthanise was also identified as a potential cause for overtreatment.

Former Dogs Trust veterinary director Paula Boyden said: “One of the big things is we shouldn’t see euthanasia as a treatment failure. So [vets need to be] actually having that conversation with a client.

“You can’t get informed consent from an animal, so we have to be the advocate for them.”

‘Welfare harms’

BVA senior vice-president Elizabeth Mullineaux agreed, noting that as a wildlife vet many cases she treats result in euthanasia.

She added: “I’m increasingly hearing that actually euthanasia has got welfare harms – it takes away the right to live – so I think in animals, there is a push almost away from euthanasia, and I find that’s quite hard.”

Another vet from the floor suggested clinicians should broach the subjects of euthanasia and quality of life much earlier, potentially even at puppy and kitten consults.

She said: “We only talk about quality of life with an owner when the animal’s quality of life is becoming poor, and for some owners, as soon as you use any of those words, they know where you’re coming from and you can see them get defensive.

“I think if we started to talk about it and use some of the tools when the animal had a really good quality of life, it would become an easier conversation.”

‘Absolute gift’

Mr Hargreaves agreed and suggested it would help re-frame the way pet owners think about euthanasia.

He said: “I challenge anybody to give me a cause of death that is more pleasant than being put to sleep.

“The big thing is to change people from thinking ‘will I?’ back to ‘why will I?’ When and why, not if.”

He concluded: “You should be able to reconcile people to the same frame of mind that it’s appropriate, it’s kind, it’s the best option you will have, and you’re quite right, you must do this when they’re well, not when they’re [unwell].

“You can get people to think it’s a wonderful gift we have that we can do this, and what a fantastic thing it is that I’ll be able to do this in the future when it’s required. Get that frame of mind – it’s not a black cloud, it’s an absolute gift.”