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When is it time to euthanize? A specialist round table on prolonging animal suffering

Posted Sep 22 2008 10:57am

A coven of nine veterinarians united around a table to break bread and suck down wine is never a too-pretty experience once the evening winds down and talk of veterinary disaster cases overwhelms the menu. (Halibut crusted with Indian spices accompanied by heirloom tomatoes in a spicy yogurt sauce and peppery smashed potatoes—with an almond panna cotta for dessert, in case you’re wondering.)

Despite the delicacies, the conversation held sway: Amazing tales of pets whose conditions devolved into frustrating, gut-wrenching nightmares only a veterinarian could properly commiserate with. To wit, last Saturday night at my house was like our own little morbidity and mortality rounds.

Vets can be weird. To co-opt a phrase, we’re “…demented, but social.” Only a group like this could do justice to serious patient misadventures in which mistakes were made, things were learned and ideas could be shared in a non-threatening and respectful environment.

(Trust me, as pet owners you want vets to get together on Saturday nights to write dinners off their taxes and discuss your pets. How else can veterinarians learn from their mistakes if they can’t comfortably discuss them?)

Interestingly, most of the mistakes we were discussing didn’t have much to do with miscalculating doses and fudging diagnoses, as you might expect. They largely centered around our verbal, emotional and ethical pratfalls when it comes to client communication.

In most of these cases, end-of-life decisions were the focus. How veterinarians handle client communication during these crucial last visits can make the difference between serious suffering and the “beautiful death” described literally in the Greek-rooted word, “euthanasia.”

And most veterinarians can relate fantastic stories about having gone about it all wrong. For example, when we deal with owners whose religious beliefs preclude euthanasia; or when we prevaricate and fail to put our foot down (when a good stomping is all that stands between extreme suffering and death).

I have my share of these tales, but it seems my specialist friends beat me, hands down, when it comes to discussing death in detail—in all the wrong ways.

Now, that’s not because I’m any better at it. It’s simply the result of two factors:

1)    I have a long-term relationship with my clients. I know them. I have a handle on what I can and can’t say to them in sensitive situations. My specialist buddies don’t have the benefit of such niceties. They’ve likely only just met the client.

2)    Specialists spend more of their time dealing in more complex cases general practitioners are more likely to refer for more specialized treatment. Let’s face it—these pets are more likely to be very sick. And they’re more likely to die.

My friends are mostly in these unenviable positions. They’re frustrated by some owners’ unwillingness to admit defeat on behalf of their suffering pets. They’re frustrated by many owners’ denial that suffering is present, more so if it’s an understandable denial borne of grief and/or a failure to recognize irrefutable evidence of pain and suffering.

The more cynical among you might assume that veterinarians are primarily motivated by a drive to keep their patients alive—if for no better reason than because it’s how we make money. But none of the vets I know is THAT cynical. Prolonging an animal’s suffering—with no treatment in sight—is wrong, regardless of how the owner sees it.

So what’s a vet to do?

Interestingly, most of us agreed that recusing ourselves from the case is the ideal approach. As in, “I will not be a party to this. I feel strongly that you must make a decision to euthanize or hospitalize for alleviation of extreme pain and suffering. Home care is NOT acceptable. Find yourself another veterinarian if you want to continue to allow her to suffer.”

My lung cancer case last month was a perfect example of the scenario this approach was built for: A client with a dog in severe respiratory distress refuses to accept that euthanasia is the right approach. She wants to take her dog home “to die with dignity.” I respectfully disagreed that “dignity” could be preserved in the face of all that suffering when more humane alternatives are available. Nothing short of a morphine drip and an oxygen cage could have helped this dog—if that.

I should have refused to help her at all. I should have made my case more strongly. I should have said, “My ethical duty is to your pet and I will NOT help you prolong her suffering.” But she would have taken her dog home anyway, right? Maybe not. I wonder.

After Saturday night’s dinner I feel differently about cases like this. Sure, a vet’s job is to help an owner make their own decisions about a pet’s life. But I’d no more euthanize a healthy, happy, well-adjusted animal (an area where I’m comfortable refusing my services) than involve myself in prolonging an irrevocably suffering animal’s life.

Sometimes it takes a good meal and a group of like-minded colleagues to bring home the obvious.
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