The use of complementary and alternative treatments by veterinarians

The use of complementary and alternative treatments by veterinarians

Policy type: Policy
Reference
: 1f

Status
: Current
Date ratified
: September 2017

The New Zealand Veterinary Association believes that complementary and alternative treatments should be subject to the same science based assessment of efficacy as conventional veterinary therapies. If such evidence is not available, those promoting such treatments should refrain from making unproven claims about their efficacy.

It is the professional responsibility of veterinarians to consider the scientific evidence that validates the efficacy of any form of therapeutic treatment that they recommend and to ensure that their client has provided informed consent before choosing that treatment option for their animal. The NZVA supports the view point of the majority of our members - that it is important for clients to seek advice regarding the use of complementary or alternative therapies from an experienced veterinary practitioner to ensure that the available information on the efficacy of the treatment has been discussed prior to the client proceeding with any such treatment.


Explanation

For the purposes of this policy complementary and alternative treatments include those health care practices that are not considered a part of traditional veterinary practice by the profession. A wide range of treatments exist under the umbrella term complementary and alternative therapies which makes it difficult to offer a blanket definition.

Complementary treatments are used alongside conventional medicine whereas alternative treatments are used instead of conventional medicine. Some of these therapies or modalities are based on principles that are not recognised by conventional medicine, but have an established evidence base and have been proven to work for a limited number of health conditions. Others have no scientific or medical evidence to support their use and they may be unsafe or cause harmful side effects especially when used irresponsibly.

As with all areas of veterinary practice, ensuring the welfare of the animal is paramount. The Animal Welfare Act 1999 requires every person in charge of an animal to ensure that the physical, health, and behavioural needs of the animal are met in a manner that is in accordance with both good practice and scientific knowledge; and, in the case of an animal that is ill or injured, to ensure that the animal receives treatment that alleviates any unreasonable or unnecessary pain or distress.

Veterinarians at all times must fulfil their obligations specified in the Code of Professional Conduct and it needs to be noted that veterinarians involved in alternative or complementary treatments or diagnostics have additional obligations specified in the Code of Professional Conduct, Veterinary Services part 6:

In considering the use of alternative or complementary methods of diagnosis or treatment the welfare of the animal is paramount. Where a veterinarian chooses to use alternative or complementary methods of diagnosis or treatment the client must be able to make an informed decision about whether to proceed. Therefore the veterinarian making this choice must inform the client of:

a. The nature of the alternative treatment offered; and
b. The extent to which it is consistent with conventional medicine.

Furthermore part (c) of the explanatory notes states:
Where a client is making a choice between conventional treatment and alternative or complementary therapies, the veterinarian should present the client with the information that a reasonable client, in that client's circumstances, would expect to receive about the treatment the veterinarian is recommending. This information includes an explanation of all treatment options available including an assessment of the expected risks, side effects, benefits and cost of each option. This allows clients to make an informed choice.

In the absence of credible evidence of efficacy veterinarians should not make unproven claims of any treatment nor use it in place of a therapy which has proven efficacy without the informed consent of the owner. Similarly the veterinarian must ensure that the welfare of the animal is not compromised by any treatment recommended by them as a registered professional, regardless of the owners’ directive. The NZVA encourages further scientific research on the efficacy of complementary and alternative therapies. When published, peer reviewed scientific evidence demonstrates that any given practice, whether complementary or conventional, is ineffective or that it poses risks greater than its possible benefits, such ineffective and unsafe philosophies and therapies should be discarded.


Guidelines

Complementary and alternative veterinary medicine should only be practiced where appropriate in the context of a valid veterinarian-client relationship and only by veterinarians educated or trained in the modalities employed. The following guidelines apply:

  • The veterinarian should establish a diagnosis based on, accepted principles of veterinary medicine i.e. by principles that have been demonstrated by appropriate research methodologies to have a high level of accuracy and proven benefits.
  • In assessing the patient, the veterinarian must obtain a complete history and perform a physical examination, sufficient to make or confirm a generally recognised diagnosis and, in doing so, meet the standard of practice generally accepted of the profession.
  • When a veterinarian proposes complementary methods of treatment, he/she is obliged, as with any procedure or treatment, to explain to the client the range of options available, including conventional treatments, an assessment of the expected risks, side effects, benefits and cost of each option so that the client can make an informed decision.
  • Clients must be made aware of the likely effectiveness of a given treatment according to recognised peer-reviewed veterinary medical publications, notwithstanding the individual beliefs of the veterinarian. They must also be told the degree to which tests, treatments or remedies have been evaluated and the degree of certainty and predictability that exists about their efficacy and safety.
  • Informed owner consent should be obtained prior to the use of any therapy, including complementary and alternative therapies before proceeding with any proposed treatment/course of action.
  • If the client requests complementary treatment, the veterinarian has an obligation to assess the animal’s condition and to ensure the outcome will provide a suitable welfare outcome for the animal and advise the client accordingly.
  • Where clients enquire about or elect to use complementary therapies which are beyond the knowledge of the veterinarian, it is recommended that the veterinarian:
    o ensure that the clients choice is informed and respect such a choice
    o explain their professional requirements to recommend treatments which are known to them to be effective for the condition/disease identified and indicated for the health and welfare of the animal
    o where the veterinarian does not feel comfortable providing advice regarding such a complementary therapy they should consult with a veterinarian with knowledge in complementary medicine or consider referral to a veterinarian with relevant experience in this field.
  • Where the client requests treatment that the veterinarian considers not to be the treatment of choice, the veterinarian should monitor the patient to ensure its welfare is not compromised. If the animal’s welfare is compromised or if it does not respond to treatment, the veterinarian must encourage the owner to seek a more appropriate option, be referred to another veterinarian for a second opinion or elect euthanasia. If the owner does not follow the advice, and animal welfare is compromised as a result, the veterinarian must take action that may include notifying the appropriate animal welfare agency.
  • NZVA does not endorse the use of any treatment, nor the making of therapeutic claims, where there is no proven efficacy and where the theoretical foundations proposed for such treatments have not been substantiated and are inconsistent with established scientific knowledge.

References and legislation

Veterinary Council of New Zealand (2011) Code of Professional Conduct