Commentary: It’s time for veterinarians to stop mutilating cats’ feet

Commentary: It’s time for veterinarians to stop mutilating cats’ feet

Declawing is a barbaric procedure that violates bioethical principles and sets feline patients on a path to chronic maladaptive pain.

Shutterstock.comI applaud the American Association of Feline Practitioners and the fact that it has (finally) taken an appropriate stand against the mutilation of cats through toe amputation. I am saddened that any compassionate veterinarian would object. It is worth remembering that we are one of the only developed nations on the earth that still allows it.

Amputating the last phalanx (P3) of the toes of cats was once considered a “commodity” procedure, commonly performed by well-intentioned veterinarians. As time has passed and our understanding of feline pain, biomechanics and quality of life has evolved, we now recognize many downsides to this procedure and truly no upside.

For the purpose of this commentary, let’s consider three distinct perspectives on the issue of feline toe amputation:

  • The clinical bioethical perspective
  • The pain perspective
  • The biomechanics perspective.

Clinical bioethical perspective

Cats are sentient beings with moral agency who, it has been recently argued, should be approached with the same consideration as nonverbal children.1-5 It behooves us to consider them within the context of the foundational principles of clinical bioethics.

The four cornerstone principles of clinical bioethics have been described as respect for autonomy, nonmaleficence, beneficence and justice.6 Let’s look at each of these in turn as we examine the clinical bioethics of feline toe amputation.

Respect for autonomy means we must consider cats’ preferences. If cats could be given a choice between being subjected to multiple toe amputations and maintaining intact feet, one can easily make the case that cats would prefer intact toes and feet, avoiding the pain and disfigurement associated with multiple toe amputation.

Nonmaleficence means “do no harm” or “avoid harm.” The question then becomes, does amputating all of a cat’s front toes (P3s) cause harm? Amputation is painful, potentially for the rest of the cat’s life. It also forever alters the way a cat walks, prevents natural (scratching) behavior, and forever prevents the cat from being able to defend itself by fighting or climbing to escape a threat. Clearly toe amputation causes harm.

Beneficence means to act in a being’s best interest. Can we truly argue that amputating all of any cat’s third phalanges of the front toes is ever in that cat’s best interest? It appears that the answer to this question is a self-evident “no.”

Justice is the fourth cornerstone principle of clinical bioethics. Translating this for application in veterinary medicine focuses on fairness. The relevant question to ask is if amputating the third phalanx of each of a cat’s front toes could ever constitute fairness to the cat within the context of its life and lifestyle. Considering all of the compromise that toe amputation creates, as a formally trained clinical bioethicist, I respectfully submit this does not reflect fairness.

Pain perspective

Multiple studies have demonstrated that most cats receive woefully inadequate pain prevention and management for procedures like spays and neuters—procedures far less traumatic than multiple toe amputations. The pain literature clearly demonstrates that acute pain poorly managed at the time of the trauma often leads to permanent pain states. This means ongoing, self-sustaining, chronic maladaptive pain that constitutes lifelong torture.7,8

The few studies that have evaluated either the presence of leftover bone fragments or regrowth of sharp bone spurs after toe amputation demonstrate that an embarrassingly large number of cats suffer from this extra bony tissue.9 These sharp shards perpetually poke at the underside of the skin at the end of each toe stump, making every step like walking on needles or nails.

Finally, we know from pain physiology that when we sever a nerve, there is a high risk of creating self-perpetuating neuropathic pain. Humans most commonly develop neuropathic pain as a result of conditions such as amputation, direct nerve trauma, shingles and diabetes. People who develop neuropathic pain can describe how it feels, so we know the unremitting torture they endure each and every day—tingling, burning, electric-like pulsed pain, pins and needles. We also know that once chronic maladaptive neuropathic pain is in place, these people report ongoing challenges relieving pain.10-12

We know from pain and neurology research that companion animals are “wired” precisely as we are. When nerves are cut—as they are in feline toe amputation—the probability that the cat will develop neuropathic pain is exquisitely high. These cats can go on to develop many different aberrant behaviors. These may include:

  • reluctance to walk on certain surfaces
  • reluctance to jump onto or off furniture, window ledges and so on
  • overgrooming of feet or legs.

These cats must walk on their painful feet!

Biomechanical perspective

Finally, we must consider how feline toe amputation forever alters the biomechanics of the patient.

When a cat is subjected to toe amputation, in addition to having the last bony phalanx removed, all of the surrounding tendons and ligaments that attach to that bone are severed. This changes the architecture of the feet, thus changing the biomechanics of how the feet work. Because approximately 60 percent of the cat’s body weight is carried on the front feet, altered biomechanics changes the way the entire body moves. If we superimpose chronic maladaptive neuropathic pain in the feet onto altered front foot biomechanics, we amplify the downstream implications of the cat moving in an abnormal fashion. The altered biomechanics can significantly interfere with the cat’s ability to exhibit normal cat behaviors.

We also know that the vast majority of cats 10 years of age and older suffer from degenerative osteoarthritis (OA) in at least one joint.13,14 The majority of cats who develop OA in later life have it occur in their equivalent of the human lower back—where the spine and pelvis come together. When the biomechanics of movement are altered, so are the forces generated throughout the body’s joints—in particular the joints of the spine.

The repetition of ergonomically unsound movements over time creates microtraumas to these joints, which can contribute to the development and progression of OA. Then, OA contributes to ongoing chronic maladaptive pain in these cats. As both a board-certified specialist in rehabilitation and a pain expert, I find this completely preventable, endless cycle of altered biomechanics and chronic maladaptive pain to be a call to action.

Conclusion

The bottom line is that amputating the last phalanx of the toes of cats violates those cats on many levels—bioethically; from an acute pain perspective; from a neuropathic pain perspective; from a biomechanical, movement and lifestyle perspective; and from an OA and chronic maladaptive pain perspective. It is time for this arcane and barbaric mutilation procedure to be removed from the veterinary surgical lexicon.

References

1. Andrews K. Beyond anthropomorphism: Attributing psychological properties to animals. In: Beauchamp TL, Frey RG, eds. The Oxford handbook of animal ethics. New York: Oxford University Press, 2011.

2. Copp D. Animals, fundamental moral standing, and speciesism. In: Beauchamp TL, Frey RG, eds. The Oxford handbook of animal ethics. New York: Oxford University Press, 2011.

3. Downing R. They do not deserve to hurt: Closing the gap between what we know and what we do for companion animal acute pain. MS thesis, Union Graduate College, Schenectady, New York, 2016.

4. Nussbaum M. The capabilities approach and animal entitlements. In: Beauchamp TL, Frey RG, eds. The Oxford handbook of animal ethics. New York: Oxford University Press, 2011.

5. Low P. Cambridge declaration of consciousness, ed. Panskepp J, Reiss D, Edelman D, et al. Francis Crick Memorial Conference on Consciousness in Human and non-Human Animals, Cambridge, UK, July 2012.

6. Beauchamp TL, Childress JF. Principles of biomedical ethics, 7th ed. New York: Oxford University Press, 2012.

7. Costigan M, Scholz J, Woolf CJ. Neuropathic pain: A maladaptive response of the nervous system to damage. Annu Rev Neurosci 2009;32:1-32.

8. Dahl JB, Kehlet H. Preventive analgesia. Curr Opin Anaesthesiol 2011;24:331-338.

9. Martell-Moran NK, Solano M, Townsend HGG. Pain and adverse behavior in declawed cats. J Fel Med Surg May 1, 2017; epub ahead of print.

10. Sandkuhler J. Spinal cord plasticity and pain. In: McMahon SB, Koltzenburg M, eds. Wall and Melzack’s textbook of pain, 5th ed. (e-book). London: Elsevier, 2006.

11. Woolf CJ, Salter MW. Plasticity and pain: Role of the dorsal horn. In: McMahon SB, Koltzenburg M, eds. Wall and Melzack’s textbook of pain, 5th ed. (e-book). London: Elsevier, 2006.

12. Woolf, CJ. Pain: Moving from symptom control toward mechanism-specific pharmacologic management. Ann Intern Med 2004;140:441-451.

13. Kerwin SC. Osteoarthritis in cats. Top Companion Anim Med 2010;25(4):218-223.

14. Lascelles BDX. Feline degenerative joint disease. Vet Surg 2010;39:2-13.

Dr. Robin Downing, who holds a master’s degree in clinical bioethics, is a diplomate of the Academy of Integrative Pain Management, a diplomate of the American College of Veterinary Sports Medicine and Rehabilitation, a certified veterinary pain practitioner, a certified canine rehabilitation practitioner, and hospital director at the Downing Center for Animal Pain Management in Windsor, Colorado.

AAFP doesn't buy your excuses to declaw. You should reconsider

While it has been suggested that
onychectomy is acceptable to prevent
spread of zoonotic disease(s) to immune-
compromised people,
current research
demonstrates the greater value of proper
hygiene and parasite control in the
prevention of most common zoonoses. In
households where cats come into contact
with immune-compromised individuals,
extensive education about zoonotic
disease potential should be discussed
and documented in the medical record.
Of note, the Centers for Disease Control
and Prevention does not advise declawing
cats owned by HIV-infected persons;
rather, these individuals ‘should avoid
rough play with cats and situations in
which scratches are likely.’

There is no current peer-reviewed data
definitively proving that cats with destructive
behavior are more likely to be euthanized,
abandoned or relinquished. The decision
of whether or not to declaw should not be
impacted by these considerations.

It's still wrong to declaw and you know it.

As a vet, I do my research. For those of you who are still rationalizing your declaw fees by saying you're helping the cats or the people, please reconsider.
1. It is well-established by all the major human health organizations (and the rest of the non-declawing world, for that matter) that declawing a cat does not protect human health! The CDC, NIH, US Public Health Service, Canadian Medical Association, and Infectious Diseases Society of America all agree that declawing is "not advised" for the protection of immuno-compromised people like those living with HIV/AIDS. On top of that, there are people living in countries where declawing is prohibited and they are not dying of cat scratches! Sheesh! (Btw: Cat Scratch Disease comes from flea poop getting in any wound.) So now you can't use that as an excuse.

2. If you think that it is ok to declaw because you're saving a cat from being thrown out, think again. Declawed cats, yes, we are talking about the cats you declawed, are more likely to lose their homes because they become biters (they have no other mode of defense) and they stop using the box because their raw paws hurt too much to dig in the sand! You are not saving lives! Honestly, if you were, do you think someone as educated as Dr. Downing would be fighting declawing?

The best thing you can do in my opinion, and I know because I have done it, is list your practice as a no declaw hospital. This has brought me tons of new clients, has increased hospital morale, and has increased my profits. Not declawing is far more profitable than declawing ever was! Seriously. Try it. It won't be long before the public catches on and a declawing vet will be considered a bad vet. The writing is on the wall. I dare you to stop. You'll be thanking me.

WoW

That is the most self agrandizing dribble I have observed in a professional setting in a long time. I will not review the many areas of your article that are ludicrous, factless, and wrong because others have already done so very well. I will compliment you on your self esteem to print without shame such pious, arrogant, judgmental blarney. Your judgement and scorn of others in reality reflects on your own inadequate pain control modalities or poor surgical skills if you truly cannot perform a digit amputation in a humane manner without damaging the patient now and forever! I pitty a great dane with digital cancer in your care. Practicing in a very high income, indoor only feline environment, the majority of our feline patients are declawed and would not have their happy, healthy, loving homes if you were around to shame them and their veterinarians out of the proceedure. In fact, in the shelters, the most sought after cats are those already declawed. Its bad enough when lay people that dont understand good surgical techniques and quality pain care spread this misinformation and scorn but to come from a respected professional is even worse. How do you convince clients you can treat their pets surgically without pain and lasting damage for other procedures. Humans have various cosmetic procedures by choice and at high financial costs if they feel it will improve their lives or their childrens' lives. I believe the cats would choose a cosmetic altering over euthanasia any day.

AAFP says this

While it has been suggested that
onychectomy is acceptable to prevent
spread of zoonotic disease(s) to immune-
compromised people,
current research
demonstrates the greater value of proper
hygiene and parasite control in the
prevention of most common zoonoses. In
households where cats come into contact
with immune-compromised individuals,
extensive education about zoonotic
disease potential should be discussed
and documented in the medical record.
Of note, the Centers for Disease Control
and Prevention does not advise declawing
cats owned by HIV-infected persons;
rather, these individuals ‘should avoid
rough play with cats and situations in
which scratches are likely.’

There is no current peer-reviewed data
definitively proving that cats with destructive
behavior are more likely to be euthanized,
abandoned or relinquished. The decision
of whether or not to declaw should not be
impacted by these considerations.

Stop Declawing-I agree

This is so well written and true. Declawing is illegal in most other countries because it is cruel and painful. It does not help a cat at all and causes harm. If all veterinarians stopped declawing, people would use the methods now available- softpaws, trimming nails often, providing plenty of scratching posts and pads etc. There are so many cats who are taken to shelters after being declawed because of behavior issues caused by the pain after being declawed. It is wrong for veterinarians to deliberately cause a cat pain purely for the guardians benefit.

Declaw debate, AGAIN

Dr Downing, I understand that you are a highly accomplished, respected and well credentialed individual but I do not believe that the 28 letters that come after your name allow you to admonish the well respected, accomplished veterinarians that disagree with your view on declawing. There are too many points in your article to cover them all but I will address some of the most important to me. Let me first address the “foundational principles of clinical bioethics”. I do not claim to know much about this field of study but I do feel the principles you have outlined can be scrutinized by even the “lay veterinarian”.

You say we must have “respect for autonomy” meaning we must consider the cats’ preferences. You say “if cats could be given a choice between being subjected to multiple toe amputations (which in itself is not correctly stated for the surgery being performed)…. one can easily make the case that cats would prefer intact toes….” Okay, and by the same logic one could say that the cats would prefer to NOT be confined indoors for the entirety of their lives or to not have their testicles removed or any number of other restrictions we may impose on our pets as domesticated animals that share our homes and lives.

You say we must adhere to “nonmaleficence” or “do no harm” or “avoid harm”. You contend that declawing is potentially painful for the rest of the cats life, permanently alters its gait and permanently alters its natural behavior making it unable to climb trees or defend itself. In my 30+ years of practice , I have declawed innumerable cats and have yet to knowingly have a single patient be in chronic pain or walk impaired in any way. And I have followed these patients from kittens through their mid and even late teens. Additionally, I know many declawed cats that climb trees and even hunt and catch birds (much to our dismay). And when we talk about being able to defend itself, I have heard this argument ad nauseam. My own declawed cat has escaped outdoors and engaged in fights with my good neighbor’s clawed cat and my neighbor’s clawed cat is always on the losing end. I know because of which cat I am treating for bite wounds. Cats or dogs that wish to engage in a fight with a declawed cat have no idea that the cat is declawed. The declawed cat still goes through the same defensive postures, hissing and swatting. If the two engage, the fight becomes about teeth not claws. I always treat cats for cat BITE abscesses not cat CLAW abscesses.

“Beneficence” you define as acting in a beings best interest. You say “can we truly argue that amputating….the front toes is ever in that cat’s best interest? It appears that the answer to this question is a self-evident “no”. Well, that is your opinion. Veterinarians like myself are of the opinion that declawing is infinitely more desirable than DEATH. And please do not retort with all the “options” for declawing as those of us in private practice that deal with real life every day know that most of those “options” just do not work for the average cat owner or just are too impractical. Let’s face it, many people own cats because in most cases they are easier than dogs. Owners don’t have the time or money to invest in behavioral therapy, constant nail trimming, soft paw placement, etc.

“Justice” You say “translating this for application in veterinary medicine” ; this phrase by itself is like putting a square peg in a round hole. What is the definition of “fairness” as it relates to our pets? We can all define that differently. To some of us, having a labrador retriever confined to a 10th floor apartment is not fair. Leaving a pet home alone all day while an owner works 12 hours is not fair. Being confined to a crate for hours (or more) is not fair. Is keeping a cat confined indoors fair? Most veterinarians would favor that for the overall health and welfare of the cat yet why are we now so pre-occupied with environmental enrichment to combat problems like feline house soiling and FLUTD. With all that said, I contend that declawing a cat so it can live a full, long, happy life instead of being euthanized IS VERY FAIR.

And I love this one! You site “studies” that have evaluated either the presence of leftover bone fragments or regrowth of sharp bone spurs after toe amputation” to demonstrate “an embarrassingly large number of cats suffer from this extra bony tissue”. Nobody is advocating that incompetent veterinary surgeons perform this or any other surgery. I have done my fair share of referred “botched” declaws, fracture repair, CCL repairs and even spays and neuters. So what does that prove? It proves some veterinarians should not being doing surgery, not that the surgery should not be done when performed correctly.

Veterinarians who believe that there is a proper place in veterinary medicine for declawing have no problem with those that dislike or refrain from doing declaw surgery. We just wish the opposite was true; that those who do not believe in the procedure would allow those that believe in the value of declawing to be allowed to perform surgery in a professional manner without being treated as unethical veterinary pariahs.

Declawing vs Circumcision

Just wondering about the ethics of Circumcision as a cosmetic procedure. Just wondering???

Declaws

Dr. Downing's view is typical of the kind of irrational thinking that is afflicting veterinary medicine more and more. Cats have moral agency and should be compared to non verbal children??? We have to respect a cat's preferences? Cats need justice and fairness? Then I suppose Dr. Downing would have to agree that spays and neuters must be banned as well. I doubt a cat would agree to having their sex lives and "rights" to reproduce taken away. And how does Dr. Downing explain why cats get this elevated status, and not cows, chickens, pigs and other livestock? From her "clinical bioethical perspective" I assume we should all be vegans and would be "saddened that any compassionate veterinarian would object". The only issue I have with declaws is to make sure they are done properly, i.e. leaving the proximal P3 intact so the weight bearing surface of the toe remains. That, and of course appropriate anesthesia and post op pain protocols. Dr. Downing and others like her need to stop trying to turn animals in to people.

Don't infringe on MY rights

If you don't like the procedure, don't do it. Stay out of my right to practice the way I see fit.

When Declaws are useful

While I 100% agree declaw procedures need to be done correctly and with excellent pain control, I staunchly disagree that declaws never have a benefit. Many pet owners simply cannot have a clawed cat, such families with newborns or small children, the immunocompromised, or the elderly with thin skin and taking anticoagulants. For the cats of those owners, the declaw is the difference between having a home or not. If my personal choice was to lose the ends of my fingers, or to live homeless and away from my family, or be euthanized, I would more than willingly accept the nickname "stubby."