Nowhere is this issue more front and center than in the ER.
An article in a veterinary trade magazine got me thinking about euthanasia and how veterinarians have to use this gift responsibly. It may seem odd that I am describing the act of taking a life as a ‘gift,’ but that’s just what it is in most cases. If we are euthanizing in the true spirit of the word (it breaks down to the Greek roots of ‘eu’ meaning ‘good’ and ‘thanatos’ meaning death – a good death) we are releasing pets from a life that is no longer worth living, or a life that cannot be lived without undue pain. No one likes to do it, but we see euthanasia as a necessary part of what we do.
That’s the positive spin version: relieving animal suffering, something every veterinarian has taken an oath to do. Like any power, this one can be corrupted to serve a different master. Instead of ending suffering and fostering humaneness, euthanasia can be used for convenience, as a way to circumvent the responsibilities of pet ownership.
Telling apart a sincere desire to end an animal’s suffering vs. a dodge to avoid the emotional, time, and financial hardships of caring for a sick pet has never been easy for a veterinarian. In the past few years, financial hardship has really increased the difficulty in making the call. The line has gotten blurry of late as more and more people are struggling with the costs of routine and necessary items like food and the mortgage. More and more, the expenses of caring for a sick pet have pushed people to make the difficult decision to euthanize a pet.
Nowhere is this issue more front and center than in the veterinary ER.
For routine care, most pet owners have established a relationship with their veterinarian over several years and already have built a level of trust. Communication is easier, financial policies may be more flexible, and the diseases tend to be more routine - not every single one, but on average. In the ER, we have the disadvantage of being new and unproven to most owners, and the trust must be built up on the fly. Also, the conditions that we treat in the ER tend to be the ones with a heftier price tag and a more uncertain future. Contrast a dog going in for a mild cough to the veterinarian the family has been seeing for 15 years to an older cat who goes into the ER for bloody vomiting and trouble breathing, and you’ll start to see the nature of the problem.
Where there is a void of trust and information, as in many ER cases, people tend to not want to gamble when money is tight. We end up euthanizing lots of patients we could have saved if there was more money available for therapy. Many people will opine that veterinarians should not charge as much for their services, or have a sliding scale based on a pet owner’s ability to pay, but most veterinary practices operate on a razor-thin profit margin to begin with. It is a sad fact of economics that we have to tolerate the occasional financial euthanasia rather than chip away at a practice until it goes under from discounting fees. A practice that stays open and charges appropriately for what it does can do more good than one that helps a few with reduced fees, but folds under the fiscal pressure. The needs of the many outweigh the needs of the few, to steal a line from Mr. Spock.
The biggest challenges come from very involved and attached owners who just don’t have the finances to even attempt to fix a complex case. These are the cases that feed burnout and leave both doctors and owners feeling poorly about their decisions.
They are an almost daily occurrence in the ER.
Part of this responsibility lies in generating options for people; I think this is one area in which veterinarians routinely falter. This can be hard to get right: what is right for a very involved and/or wealthy pet owner may be diametrically opposed to what is right for an owner who is financially limited or one who doesn’t believe animals should receive a certain level of care. We get so beat down by the constant refusal of high-end therapies that we have to fight to remember to always offer them. Being turned down when I offer dialysis for the 15th time this month - in some cases withstanding that withering ‘it’s just an animal’ glare - is hard to keep up with. But the 16th time I do it this month, it may just be the patient and owner who will thank me for offering it.
The veterinarian’s job in protecting this gift is to spend enough time with the owners so we are certain that they have had a chance to ask questions and explore whatever options may be open to them. I usually like to give people four to six options for care: from the extreme end, interventions like dialysis, on down to simple basics that keep a pet alive while hopefully avoiding unneeded pain and suffering. But sometimes the options realistically are limited to two: intensive care or death. Veterinarians need to be able to spend enough time, and listen enough, that clients feel they have not made a snap yet utterly irrevocable decision that they will later regret.
The owners’ job is to ask enough questions to fully understand the options and to accept the financial and emotional consequences of each option. Sometimes their choices boil down to taking the one that will provide the least regret.
When circumstances dictate that euthanasia is the best choice for a patient and his family, veterinarians want to make sure that the path taken to get there is the best one for all concerned, and that we have done what we could to avoid abusing this gift. It can be done; it just takes communication, time and persistence.
Like anything good in life, a good death is worth working for.
Sara Nadolski, DVM
October 18, 2016
February 28, 2013