Cosmetic surgery: customer service or professional misconduct.

In this article “cosmetic surgery” is defined as any medically unnecessary surgical procedure. Whether cosmetic surgery is viewed as part of the customer service provided by a veterinarian or falls under professional misconduct depends entirely on the location of your practice. In human medicine, cosmetic surgery is usually requested by a person who is not comfortable with the way she or he looks. The individual may believe that his or her nose is too long or too short, ears too large, that there are too many freckles, wrinkles in overabundance or in the wrong place, or a variety of other perceived “blemishes.” If successful, the surgery leaves the patient feeling good, with improved self esteem, and generally a better quality of life. In animals, cosmetic surgery is requested by the owner of the patient. It is believed to always be without benefit to the animal since we are unaware that dogs are particularly perturbed if their ears are too floppy or their tails are too long. Furthermore, many behaviorists believe that intact ears and tails play an important role in canine communication (1,2,3). If successful, cosmetic surgery leaves the patient missing parts of their anatomy, usually the tails, ears, or the ends of their toes. Oh yes, and some dogs awake from anesthesia having lost their voice, permanently. Interestingly enough, cosmetic surgery is not just a sign of our times. In the late 1800s and early 1900s there are references to creating Manx cats through tail‐docking. There are also tales of “ear reduction surgery” on some Persian cats to produce the small kittenish ears required by show standards (4). In its position statement on cosmetic surgery, the Canadian Veterinary Medical Association (CVMA) opposes surgical alteration of any animal for purely cosmetic purposes and lists tail docking (horses, cattle, dogs), tail nicking in horses, ear cropping in canine species, as well as onychectomy in species other than the domestic cat (5). How we treat animals varies considerably around the world, from countries where even the basic needs of animals such as food, water, shelter, and care are not met to countries where cosmetic surgery has been discouraged or illegal for more than a hundred years. Mahatma Gandhi is credited with having said, “The greatness of a nation and its moral process can be judged by the way its animals are treated” (6) and this statement is often repeated by activists to draw attention to animal practices that seem out of place based on the social ethics of the country. It is worth considering whether cosmetic surgery performed on animals in Canada violates our social conscience. Here are a few facts and statements to ponder: The World Small Animal Veterinary Association states: “Surgical operations for the purpose of modifying the appearance of a companion animal for non‐therapeutic purposes should be actively discouraged. Where possible, legislation should be enacted to prohibit the performance of non‐therapeutic surgical procedures for purely cosmetic purposes.” Most Canadian veterinarians responding to a CVMA survey considered tail docking and ear cropping for cosmetic reasons to be unacceptable (7). Ear cropping is illegal in Australia, New Zealand, and many European countries (7). Tail docking is illegal in Norway, Sweden, Cyprus, Greece, Switzerland, Luxembourg, Finland, and parts of Australia (7). In the United Kingdom, dogs with cropped ears have been ineligible for competition under Kennel Club rules since 1898; that is, for 110 years (7). In Germany, declawing of any feline, debarking, and tail docking all have been illegal for over 25 years. While it may be helpful to look at legislation from other countries for guidance on dealing with cosmetic surgery, Canadians need to define how to approach this issue themselves. Frank discussion is required among Canadian veterinarians and their professional associations about how to practice veterinary medicine when moral obligations to patients conflict with owners’ desires for convenience. Why, for instance, does the CVMA simply not oppose onychectomy in the domestic feline without any caveats? Why do fee guides from provincial associations list “combo deals” so clients can save money if they have their cat declawed at the same time as spay or neuter surgery? “There is a higher court than courts of justice and that is the court of conscience. It supercedes all other courts” (6). So why are we still performing cosmetic surgery? Among the more common explanations and excuses are “If I won’t do it the animal will be euthanized or killed.” “To please our clients.” “I am afraid our clients may go somewhere else for this service.” “If I don’t do it someone else will.” This leaves us with the question of who truly benefits from cosmetic surgery? “The moment there is suspicion about a person’s motives, everything he does becomes tainted” (6). Cosmetic surgery is becoming a more and more contentious issue throughout North America. Animal welfare organizations representing millions of individuals generally oppose cosmetic surgery. Younger generations of veterinarians embrace the right of animals to live their lives without being subjected to unnecessary surgery. The sooner our profession realizes and accepts the changes sweeping through our society and acts accordingly, the better. A profession as old and trusted as ours should be leading, not following. We should serve our clients but not be slaves to their every whim without regard to our patients. After all if we do not keep our patient’s interests in mind, who will? It is time for our profession to take a stand for what is right. “An error does not become truth by reason of multiplied propagation, nor does truth become error because nobody sees it” (6). A cat has claws, most dogs bark. All animals come with certain “accessories.” If a person is unable or unwilling to deal with a particular set of “extras,” then maybe another choice of companion should be suggested. Instead of a cat why not get a bunny, or an aquarium. The choices are almost endless. Or should we be so bold as to suggest that maybe certain individuals are not qualified to share their lives with another creature? Perhaps owning an animal might be better thought of as a privilege and not a right. In any relationship there needs to be willingness to compromise. I suggest that it is time for pet owners to take responsibility for their decisions and actions, too, just as we must do as veterinarians. In the end, I trust we will all make the right decision when presented with the request to perform an unnecessary surgical procedure on one of our patients. And, in time, our day‐to‐day decisions will determine what we consider cosmetic surgery to be, whether we view it as “customer service” or “professional misconduct.” “Be the change that you want to see in the world” (6). In closing, I would like you to review the following familiar words and consider how they might influence your actions while you are practicing veterinary medicine.

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