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EVERY practitioner is at some time faced with a decision about whether to provide a treatment rather than leaving a patient untreated or performing euthanasia. Some treatments may seem to be pioneering interventions; others are conventional regimens. Both risk constituting overtreatment.
Overtreatment constitutes any treatment that is against a patient's interests. This may include reparative and prophylactic surgery, medicine, behavioural therapy, diagnostic procedures or referrals ( Table 1 ). Overtreatment is a 'malady' that causes acute or chronic physiological imbalance, injury or suffering.
Veterinarians' duties to ensure the welfare of their patients make avoiding unjustifiable overtreatment imperative. But veterinarians must also avoid undertreatment (symmetrically defined as a failure to provide treatment that would be in a patient's interests). Two stages in clinical decisionmaking can help avoid both: accurately evaluating patients' interests and making clinical decisions using those evaluations.
Evaluating patients' interests
There is no prescriptive list of overtreatments. So, before offering any procedure, it should be evaluated whether a treatment is in a patient's best interests. This evaluation can be done by weighing up the benefits and harms in terms of patient suffering and longevity. Overtreatments include any treatments that have a worse harm-benefit balance than more conservative options such as no treatment. For example, diagnostics are overtreatment when the risks outweigh the benefit of the expected results in determining treatment choices.
Treatment options should also be compared with euthanasia. Continued life is only beneficial if the resultant life is worth living. So, any treatment with a...