Technologies have developed rapidly in recent years. We are now able to offer veterinary medical and surgical treatments previously unimaginable, such as heart valve replacements, orthopaedic prostheses and gene editing.
But with this comes a risk that we get so carried away by our own technical prowess that we lose sight of what ought to be at the heart of everything we do — the welfare and best interests of our equine patients.
What exactly the animal’s best interests are, of course, is not always easy to decide. Unlike a human patient, it is impossible to ask a horse whether he is prepared to undergo treatment which may be stressful and unpleasant in order to prolong his life.
We have no way of knowing what decision an animal would make if faced with various treatment options or, alternatively, a humane death.
We can undertake quality of life measurements in animals, based on behaviour and pain scoring. After treatment, however, would a horse agree that he had a life worth living?
We are reliant upon the decision-making of the horse’s owner and connections, informed by the expertise of the veterinary team. This can produce all kinds of interesting ethical conversations.
Under UK law, animals are “property” — albeit a special kind of property, protected by the Animal Welfare Act (2006). Provided an owner is not contravening the law, they can decide what should be done to their animal.
Sometimes, an owner may decide that treatment should continue when vets feel that it is serving no further purpose and is not in the animal’s best interests. Conversely, an owner may want to stop when the vet feels reasonable treatment options still exist.
In a recent article in The Veterinary Record, an owner described how she rejected further treatment for her horse. She didn’t feel it was ethical to persist with the sole aim that she could carry on riding him, believing his welfare would be compromised by doing so.
An owner spends more time with their animal than the vet does, so while it is our role to offer professional, clinical advice, we should always take heed of their insights. Decision-making about whether or not to treat may also be complicated by factors such as the owner’s family and financial circumstances, and the human-horse bond.
The most advanced “gold standard” treatments are often costly and their use may not be economically possible. This does not mean that some animals won’t do well if they receive treatment that is not gold standard but nonetheless adequate.
Surely, what should be important to all concerned is simply that the horse feels better? However excited we are by new technical capabilities, achieving this aim in a way which protects the horse’s and the owner’s best interests should be the priority.
Where’s the evidence?
Evidence-based practice means using scientific evidence to make clinical decisions and select appropriate treatment, rather than relying on anecdotal information or unreliable reports.
Arguably, the current drive to support all of our clinical decision-making with evidence has led to an increasing number of diagnostic tests.
I was taught at university that diagnostic tests should never be undertaken if the results will make no difference to treatment or outcome. Ethically, even though they might broaden our general evidence base, we cannot justify exposing a horse to the stress and possible discomfort of diagnostic tests — nor the owner to the cost of them — if they will not improve the situation for the individual animal concerned.
Yet we should not be treating animals without a reasonable evidence base for doing so. This is particularly relevant to equine sports medicine, which tends to operate at the boundary of what is accepted practice and what is “novel”, due to the pressure to succeed in the competition arena.
It is recognised that a lack of evidence base for treatments in human sports medicine is not uncommon, since technology advances so quickly. It was suggested at a recent British Equine Veterinary Association (BEVA) congress debate that sport horses competing at national and international level may be receiving treatment that lacks reliable data.
Another cause for concern were anecdotal reports of “maintenance” injections of joints with intra-articular corticosteroids, given without accurate diagnosis of problems.
This type of practice is ethically worrying. Any injection causes immediate, albeit mild, pain — something we usually justify by balancing this “harm” against the perceived benefit of the injection, as in the case of vaccinations.
Without making an accurate diagnosis, however, we cannot know what, if any, benefit treatment may have. If there is no benefit, then the harm is unjustifiable. There is a danger of introducing infection every time joint is injected, with the added risk that repeated injections may be detrimental to joint health. So potentially, by undertaking such treatments without prior accurate diagnosis, we are exposing the horse to lasting harms.
The pressures to treat an animal can be great. Many owners consider their horse as a member of the family and believe he deserves every possible treatment. Equestrian teams have a vested and often understandable interest in keeping their horses competing.
As technologies develop in the human field, the expectation that we make use of such treatments in animals will only increase. We are already using 3D printing to create surgical implants for dogs and corrective shoes for horses.
The publication of the equine genome in 2009 opened up the possibility of tailoring therapy to individual horses, while the ability to edit equine embryos genetically has reportedly been used in an attempt to boost the myostatin gene sequence that contributes to muscle development.
Vets, owners, trainers and team managers — all parties who ought to be concerned with horse welfare — should collaborate to ensure that treatment is evidence-based and in the best interests of the individual horse.
Ref Horse & Hound; 15 August 2019