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Straight talk
Take time to help clients make a thoughtful, compassionate decision about the care of a dying pet


Money matters

These days, money is tight for many Americans, and when presented with the prospect of thousands of dollars in surgeries or other treatments for a pet, it's an insurmountable obstacle for some clients. Difficult conversations can ensue when a client inquires about euthanasia due to the potential economic burden. "Economics are important no matter what," acknowledges Knutson. "On the human side of medicine, as we age, there may be a point in time where either you take your medicine, or you can't afford to and you don't."

In dealing with similar situations with pets, Knutson again advises having a quality-of-life discussion. "Is this something that absolutely needs to be fixed to have the quality of life the pet would want? If the answer is yes, and the client can't afford it, we try our best to adopt the pet out to someone who can afford the procedure," she says, before moving on to potentially euthanizing the pet.

When, perhaps, a puppy is suffering from parvo, and it will cost $10,000 to $15,000 to fix it, and even then with uncertain results, this, Knutson says, can put some clients in financial ruin, and a frank discussion needs to occur. "You need to sit down with them and ask, 'Does this really make sense?' A lot of times, the answer is no," she says.

Adams encourages veterinarians to be open and proactive about costs. "Clients are frustrated when cost discussions aren't initiated by the veterinarian," she says. "Both the cost from a well-being (standpoint) and also the future prognosis of the client are important." She advises vets to be attuned to verbal clues about financial considerations and then acknowledge these.

For Knutson, who has the luxury of seeing many of her patients five times a year in her practice's wellness center, open and honest discussions are commonplace, and many of her clients are willing to go the extra economic mile for their pets.

"I've had a lot of clients who say they'll get a second job—clean houses or work in a coffee shop—to pay for their pet's care," she says. And it's not just her clients, but Knutson herself who made economic changes for her pet. "I had a cat that was really sick and had to take it to Wisconsin (for treatment)," she says. In making a decision, Knutson remembers thinking, "If I give up my Starbucks for this many years, I can do it. And that's what I did."

However, Knutson acknowledges that this isn't always the case. "It's easy for me to give up a vacation if it means I can keep my pet alive," she explains. "But to some people that would not be acceptable."

When a veterinarian is steadfast in his or her belief that a pet can be saved, Adams suggests continuing the discussion. "Acceptance doesn't always mean agreement. Tell the client, 'Thank you for being honest about cost issues. I'm struggling with being asked to euthanize him because I know we can make him better."

Adams recommends offering the option of trying to place the pet with another family. But, if a client is insistent, she says it is important to fully grasp the philosophy of a practice. Some practitioners, she says, will work hard to determine alternatives to euthanasia, but others may easily perform the procedure. "More long-standing practitioners may be more willing to euthanize because they have seen so much more and can't be in the business of saving everything," she acknowledges. But, the key, she adds, is, "Can you go to bed and sleep at night?"

Managing end-of-life communications with clients is essential, and Adams says veterinarians aren't always doing the best they can.

In a current study, Adams and one of her graduate students are assessing this topic. "There is a lot of asymmetry in our profession," she says. "We think we are doing a better job of managing communications than we are. We speculate there may be quite big disparities between what we think we are doing and what we are actually doing."


Source: DVM360 MAGAZINE,
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