Ethics of euthanasia
It was a life and death drama.
Practicing in the only health profession sanctioned to end life, Dr. Mary Welle vividly recalls the case.
It might not have been her first euthanasia, but there are some that "just stay with you."
On this Saturday morning, a Golden Retriever, now weighing in at 50 pounds, suffered from end-stage intestinal lymphoma. For one family, this Urbana, Ill., practice sat at the center of the universe as they contemplated life and death decisions.
With it came the natural and predictable emotional flood that follows this type of trauma. The decision. The stress. The emotion. The guilt. The grief.
There were children present — 8 and 10 years old. Like so many others in veterinary practices, it was their first experience with death.
As for this doctor and mother, Welle was touched by the emotion of the case, wishing that she had known the family and dog better, clearly a job hazard.
Her tears flowed with the euthanasia solution.
It's the kind of story played out routinely by veterinarians in this country. And it can rank, DVMs say, as one of the most difficult tasks of practice.
In the course of a consultation, veterinarians are asked to diagnose, heal, offer emotional support — possibly hope — while simultaneously bargain for the costs of care, offer a prognosis, end a life and discuss burial and disposal.
Personally, each case poses its own ethical dilemmas: When should you euthanize? At what cost do you recommend it? Do you refer? Is the euthanasia medically justifiable? If not, do you accept it's ultimately a client decision? If asked to perform convenience euthanasia, would you comply with the client request? Is the animal adoptable? Is a home death acceptable if the pain is managed?
While the price tag is clearly rising on advanced medical treatment, so too has veterinary medicine's ability to prolong life through technological innovation, drug therapies and advances in care. While most veterinarians view euthanasia as a gift offered to terminally ill patients, there are many parallels in the right to die debate engulfing human medicine. While it's not being dubbed as an alternative to euthanasia, veterinary hospice service is emerging as another model. Throw in anecdotal reports that some veterinarians have referred patients to local shelters rather than perform euthanasia on sick animals, and the embers are stoked on a slew of ethical questions regarding this profession's role as healer and compassionate killer.
Bernard Rollin, a Colorado State University ethicist, says it this way: "Oh, we are there. And it's being discussed."
Social forces are also at work asking, in some cases requiring veterinarians to become more of an advocate for the pet, reports Dr. Annette Rauch, a clinical assistant professor at Tufts' Cummings School of Veterinary Medicine.
The result creates conflict.
"What is best for the animal is not what is always best for the owner," Rauch says.
"There is a big range of what individual veterinarians feel comfortable in doing. It seems that younger veterinarians are falling on the side of limited to no convenience euthanasia."
According to multiple sources, the newest generation would much rather serve the pet if it came to a question of convenience euthanasia — a change in attitude from the generation of veterinarians who were taught to serve the pet owner.
But the ethical dilemmas posed by euthanasia, Rauch reports, are nothing shy of gray and inherently unique to each case.
"Some people are legitimately poor," Rauch says. "They can't spend $3,000 on veterinary care. So, we come into conflict. The animal could benefit from surgery, yet the owner simply doesn't have the means to do the right thing."
Dr. Victoria Young, who works in a six-doctor practice in Caldwell, Idaho, says while infrequent, she is asked to perform convenience euthanasia if owner-requested. It could be a behavior problem or a change in family status, but she complies with owners' wishes.
"It's one thing with an animal that has been well cared for, and it is a quality of life issue. On the other hand, the convenience thing, I just want to turn off. I don't want to know anything about this animal. I will do it because they will go somewhere else. I don't want to get involved though. In fact, I don't even want to look at it in the eye."
It's a reality of practice, she adds. In fact, most veterinarians report they are asked to euthanize healthy animals at least a few times a year according to an exclusive DVM Newsmagazine survey.
"There seems to be a big range of what individual veterinarians feel comfortable in doing. It's hard to generalize, but in the past veterinarians felt like they served the pet owner, and if the pet owner requested something, the veterinarian provided the service," Rauch says.
Some veterinarians don't ask questions, others ask a lot of owners who request to euthanize without medical justification. Even with medical justification, how much is enough?
To drive the point home with veterinary students, Rauch explains that she has three cats. She knows that two of them would not be adoptable if she had to relinquish them tomorrow. "I would probably euthanize them, just because I know what will likely happen."
"Being a conscientious veterinarian is a very hard job," says Rollin, PhD. "You may come to work in the morning seeing a healthy animal, convincing a client not to euthanize and telling another client it is too soon. There is stress from all sides. Pediatricians have all of the laws behind them on child cruelty. Look at it from a veterinarian's perspective: Do you report cruelty? What about cases of abuse? When do you recommend alleviating pain and suffering?
"And there is more of it coming. As pets become more important, there will be more variations of these same themes," Rollin adds.
With it, comes responsibility and a price tag to the healer.
"It is probably one of the single most stressful things in practice. Unlike other health professions, people constantly beg you for a bargain or a way out. So, you are asked to compromise your medical decision-making to try to save money," Rauch says.
Welle agrees that finance plays a big role in practice. Being asked to compromise a doctor's ethical principles also causes fatigue and burnout.
"In one examination room, you may be asked to end life, and five minutes later you have to turn around and put on another face for your next client," Welle says. "It can be hard."