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March 01, 2020

AVMA revises declawing policy

Policy discourages procedure but defers to veterinarians on each case
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The AVMA discourages declawing of domestic cats as an elective procedure. The Association encourages the use of alternatives but says professional judgment is key when making a decision as to whether to declaw a cat.

On Jan. 11, leaders in the AVMA House of Delegates updated the Association’s policy on declawing, or onychectomy, to emphasize that the AVMA defers to veterinarians to decide what’s best for each patient and client.

The resolution passed with 84% of the vote during the HOD regular winter session in Chicago.

Dr. Catherine Lund
Dr. Catherine Lund, delegate for Rhode Island, spoke in favor of the revision to the AVMA policy on cat declawing. She said during the AVMA House of Delegates’ January meeting in Chicago that the changes would provide a powerful positive statement, bring the AVMA policy closer in alignment with public opinion, and potentially help demonstrate to legislators that the AVMA evolves with client expectations. (Photo by R. Scott Nolen)

The prior policy, last updated in 2014, indicated the procedure should be a last resort but focused on encouraging client education. The new policy still encourages education on cat behavior, the surgery, and its risks but also clearly calls out the importance of professional judgment when making the decision to declaw or not.

Both versions of the policy state that cats undergoing the surgery must receive pain management.

The House, which represents state and allied associations, is the Association’s main policy-setting body.

Standards and professional judgment

Discouraging elective declawing is consistent with positions from the American Association of Feline Practitioners and American Animal Hospital Association, which also discourage declawing and encourage veterinarians to educate clients about alternatives. The AVMA policy was revised partly in response to states and cities adding or considering measures to ban elective declawing.

AAFP leaders state in their policy that feline declawing is ethically controversial, unnecessary in most instances, and a response to behaviors cats inherit and learn. The AAHA position statement indicates a few circumstances—such as tumors or chronic infections—for which claw removal may be required, but it notes that the Centers for Disease Control and Prevention does not list declawing among potential means of preventing disease in humans.

Ahead of voting to enact the new AVMA policy, delegates debated whether the proposal as a whole or select statements within it would limit veterinary practice, set rigid pain management standards, or bolster arguments in favor of state or city bans on declawing. They also discussed the potential for the AVMA to lead on animal welfare concerns important to the public and speak on behalf of animals.

In July 2019, New York Gov. Andrew Cuomo signed legislation that instituted the first statewide ban on elective declawing in cats. Echoing the sentiments of proponents of the bill, he issued a statement that described the practice as archaic and cruel and causing pain.

Cities including Los Angeles, San Francisco, Denver, and St. Louis have added bans since 2003, when West Hollywood, California, became the first in the nation to prohibit onychectomy except for medical reasons. Banfield Pet Hospital adopted a policy in January that its veterinarians would perform surgical claw removal only out of medical necessity, and the policy will extend to all Mars Veterinary Health hospitals—including VCA and BluePearl—in the first quarter of 2020, according to a company spokesperson.

The Banfield policy states that “Current evidence does not support the use of elective declawing surgery as an alternative to relinquishment, abandonment, or euthanasia.”

Dr. Apryl Steele, alternate delegate for the AAFP, said during discussion of the House resolution that the AVMA should lead by discouraging elective declawing and, if the delegates voted down the proposed change, risked being remembered for failing to do so.

Dr. Neil Moss, delegate for Utah, said he thinks most veterinarians would be relieved if declawing were banned. He said that since a series of laws banned cosmetic tail docking of dogs throughout the United Kingdom, those limits have become noncontroversial.

These bans are region based and include some exceptions for working dogs and medical needs, according to breeding and sporting organizations.

Dr. Sam Miller, alternate delegate for Texas, said that his state’s delegation would have difficulty supporting the change in AVMA policy despite reading in House email discussions that veterinarians perform few onychectomies anymore.

“The concern that a lot of the veterinarians had is that AVMA was going to dictate policy on how practitioners were supposed to practice and starting to restrict some of the things that we can do,” he said.

Dr. Miller cited statements in the proposed policy that it was incumbent on veterinarians to counsel owners and that veterinarians performing the surgery must provide multimodal perioperative pain management. He recommended referring the proposal back to the AVMA Animal Welfare Committee, via the AVMA Board of Directors, for reconsideration. Delegates voted down his proposal.

Delegates also debated whether the statement on professional judgment should lead off the policy, whether the policy would assure lawmakers the procedure would be performed in humane ways, whether the changes could encourage those who want to ban the procedure, whether stating veterinarians must administer multimodal pain management was too prescriptive to accommodate special cases of ill cats, and whether veterinarians should perform elective procedures on cats too ill to receive multimodal pain management.

Dr. K. Fred Gingrich II, alternate delegate for the American Association of Bovine Practitioners, said veterinary organizations should be comfortable with advocating for standards of care. He noted that the AABP enacted new dehorning guidelines in late 2019 that said pain management is part of the standard of care.

If veterinarians are unable to think of a situation where pain management would be inappropriate, the word “must” is appropriate in the policy.

“We should speak for the cat here, and it must be provided,” he said.

Ethical dilemma

Before voting on resolutions, the House divides into groups known as reference committees that deliberate on resolutions or issues and report to the House. The committees may recommend that the House pass, defeat, or modify a resolution, but their advice is nonbinding.

Dr. Enid Stiles, president-elect of the Canadian VMA, told delegates during one reference committee meeting that the CVMA encourages the AVMA to pass the resolution and strengthen its statement. In 2017, her organization published a policy of opposition to elective and nontherapeutic onychectomy.

Dr. Stiles said the CVMA policy has helped advance regulations and end the procedure, which is now allowed in only three of Canada’s 10 provinces. She said members are happy with the change.

“There’s no competition with their neighbor declawing,” she said. “They don’t need to worry about that anymore. They can just do what they’ve been told to do, which is provide excellent medical care for their patients and not worry about medically unnecessary procedures.”

Dr. Stiles said in an interview outside the meeting she has heard that, across Canada, fewer people ask for declawing, and she believes the same is true in the U.S. She also thinks the procedure can contribute to compassion fatigue and burnout among veterinarians who are uncomfortable with declawing but work at clinics where they need to perform it.

Dr. Steele, who was in the same reference committee meeting, said afterward that veterinarians, especially newer associates, are struggling with having to perform onychectomies. Results of an AAFP survey of 1,200 feline practitioners indicated 51% do not declaw cats and slightly more support legislative bans on the procedure, she said.

“What that tells us is they’re ethically opposed to declawing and they’re having to do it anyway,” Dr. Steele said. “Of the ones who do declaw, 75% do it less than once a month.”

The AAFP includes members who work in Canadian provinces with onychectomy bans. Dr. Steele said she has heard only praise from those members.

“You would think that there would be a mix or there would be a loss of revenue, but it has been a relief that they don’t even have to have the conversation anymore,” Dr. Steele said. “I don’t know a single veterinarian that enjoys declawing a cat.”

Dr. Steele later would praise the delegates’ vote to enact the new policy.

“It does take a much stronger stance from the AVMA, and it does require that pain medication be used for cats,” she said. “It was a little bit of a fight, but we’re happy.”

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The revised AVMA policy on “Declawing of Domestic Cats” reads as follows:

The AVMA discourages the declawing (onychectomy) of cats as an elective procedure and supports non-surgical alternatives to the procedure. The AVMA respects the veterinarian’s right to use professional judgment when deciding how to best protect their individual patients’ health and welfare. Therefore, it is incumbent upon the veterinarian to counsel the owner about the natural scratching behavior of cats, the alternatives to surgery, as well as the details of the procedure itself and subsequent potential complications. Onychectomy is a surgical amputation and if performed, multi-modal perioperative pain management must be utilized.