Because I say so

This blog entry isn’t a rant. It’s a plea.

I got involved in a discussion on euthanasia techniques with a couple of other colleagues – and if there’s a topic that sparks discussion and opinions as much as this one I have yet to find it.

We had our daily seagull brought in. It was aggressive and fighting tooth and nail (or beak and claw) as soon as I opened the box, despite its utterly mashed wing. There was clearly no prospect of it ever being healed and returned to the wild, so euthanasia was the only humane approach so far as I could see.

So far, everyone was in agreement.

Now, in this case, I grabbed the beak to disarm its weapon of choice, then got the wings under control with a towel. I then injected 2ml of pentobarbitone into the liver, drawing back before and during the injection to check there was no blood, air or pentobarbitone coming back into the syringe. The bird was anaesthetised within seconds and arrested after about 30.

In my view, the method I used was quick, kept handling to an absolute minimum, and the bird showed no sign of pain (or even an awareness that I’d done anything to it at all). I have done it like this many times in the past.

One of the vets in the room then said they had been told by a prominent European-level specialist that this method was “unethical”, and that the approved method was intravenous injection.

I have seen this happen quite a few times before: an “opinion-former” (usually someone with a certificate, or even a specialist) will make a decision that they like or don’t like something and make a blanket decree. Colleagues without those extra qualifications then accept this as gospel.

I have seen this applied to practice protocols on euthanasia techniques, suture materials, choice of intravenous antibiotics, sedatives, and more – all without a shred of proper evidence.

I have said elsewhere that I am sceptical about taking “evidence based medicine” as a mantra and sole clinical approach for more than one reason, but primarily because it is easily manipulated by those with a vested interest (Ben Goldacre’s book Bad Pharma is a great and passionate introduction to this field).

However, EBM’s grades of evidence are very useful for quickly comparing evidence – and, tellingly, “Because I told you so” is there with “Because I’ve always done it this way” at the bottom of the hierarchy of evidence.

I have been a vet a long time. I have worked in a few practices, most of which had practice protocols, but none had a “references” section to them – and this is something I’d like to see, because it’s difficult to discuss a protocol when you don’t know what it’s based on.

If euthanasia techniques doesn’t get a discussion going over lunch, then how about this: I still use catgut for ligatures because I’ve always used catgut for ligatures.