End of life decisions for pets are rarely about money or medicine

One of the hardest things I’ve ever had to do was to consider an end of life decision for my dog, Otis. He ended up passing away naturally, but the thought process was intense. While I certainly understand things from a financial perspective, I hadn’t ever considered the Vet’s side of things. I asked Dr Greg Magnusson to share his thoughts on the financial/medical implications to end of life decisions for pets. 

He writes:

Every time the veterinary profession discovers a new drug, perfects a new surgery, or
hammers out a new medical protocol, a new portion of our patients gets to live a little
longer than they would have without.

Some of these treatments are expensive, especially when specialists become involved,
while others are cheap and easy, like a new formulation of pet food, or a new and easier way to give an old drug.

The trouble with medicine is that there are no absolutes. Only rarely do I get to go into
a room with a pet owner and say “for the price of $XYZ and two weeks of recovery,
I promise I will give you a normal pet”. More often than not, it’s more like “the
initial surgery will cost $XYZ. Based on the literature, if we’re lucky and there are no
complications, the sutures hold, nothing gets infected, the tissue heals perfectly, and we removed everything we intended to remove, 50% of pets with this condition will survive six months, give or take.”

What makes all this especially difficult, then, is not medicine. The medicine will always
say “thou shalt cut off the tumor, perform the radiation, give the chemo”.

Nor is it necessarily the money, though it’s true most end-of-life protocols in pets are
expensive – you’ll likely spend more in your pet’s first and last year than during any
other.

No, what makes end of life decisions really difficult is a combination of predicting the
future, and putting yourself in the pet’s position. Like, for the cost of $XYZ, what are the
CHANCES my pet will survive without pain and suffering, and for approximately how
long? How much is that time worth to me, or to her?

And how does anyone know what pain a pet is feeling? An animal that doesn’t know she is dying will eat until she is physically incapable of eating, will walk until she can’t take another step. That doesn’t mean she’s not in pain. Good quality of life should never be defined as “still capable of taking in food”.

The veterinarian’s job, then, becomes one of therapist, hand-holder, even fortune teller.
None of us were warned about how much these conversations would suck before we
entered veterinary school, few of us are professionally trained in any kind of counseling,
and we all do our best to compensate for the shock once we hit practice (assuming we
don’t burnout within the first few years like many colleagues).

Based on each vet’s individual life experience – religion, upbringing, previous good or
bad case outcomes in similar situations – you’ll get different advice.

Like, is it still a vet’s job to recommend expensive, palliative surgeries for cancer-ridden
patients in cases where there is well documented proof that same surgery is guaranteed to buy the pet no more than a few months of mediocre quality life? Some vets will give that option and stop, as though surgery were the ONLY option, others continue on with “and it’s OK to NOT do that surgery, and euthanize your pet now”.

There is even an entire cottage industry, dedicated to hospice care for pets; veterinarians who spend their whole week travelling from home to home caring for bed-ridden, terminally ill animals. Is hospice care a good idea for a population that is unable to understand why they’re incapacitated? The longer we help our pets live, the more we have to ask ourselves questions that are all too human.

There is unfortunately no easy way for you to know whether your vet will push for
advanced end of life care, or gently guide you to the decision of dignified euthanasia.
Now that you’ve read this story, though, you should understand that every veterinarian
deals differently with the imminent death of a patient. You might consider at least
bringing up the conversation with your current vet, and see how they react. You may be
surprised at how different your beliefs are from theirs, or you may be comforted at how
similarly you both feel about end of life care and where you both intend to draw the line.

Greg Magnusson is a vet in indianapolis at Leo’s Pet Care

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