Mr. and Mrs. Fromme are excellent pet owners. They live in the household with their 11-year-old daughter, 7-year-old son and Mr. Fromme's elderly father.
Grandpa Fromme is very attached to Hans. Five years earlier, when he lost his wife, they grieved together. Up until this year the elder Fromme would bring Hans to their long-time family veterinarian, Dr. Shusted, for regular checkups and vaccinations. In recent years Hans has become incontinent and now is deaf and not seeing well. The dog's recent problems have led to his vocalizing in a high-pitched manner and soiling the house. This disturbs the entire family. Grandpa Fromme asked his son to take Hans to see Dr. Shusted to see if he could help with the situation. The elder Fromme knew that Hans's days were dwindling, but he wanted to do everything possible for his pet.
When young Mr. Fromme took Hans to see Dr. Shusted, he asked that Hans be examined and evaluated. Dr. Shusted examined the dog and performed a complete workup, including a senior blood profile and urinalysis. Unfortunately the dog's renal numbers were rising. In addition the dog's blood sugar was now over 350 and his blindness was due to diabetic cataracts. Although Hans was still eating and alert, Dr. Shusted concluded that he was in early chronic renal failure and was now diabetic.
Dr. Shusted explained all of this to Grandpa Fromme's son. He told him that proper diet and medical support would assist—but not cure—the renal disease and that the diabetes could be treated with twice-daily insulin.
The younger Mr. Fromme told Dr. Shusted that he felt the dog was now old and becoming a burden to the family. He admitted that he was attached to the dog but that he and his wife would have to shoulder the increased care and monetary obligation. He added that his dad was no longer able to meet Hans' daily medical requirements. At this point he asked Dr. Shusted if he would speak to his father and tell him that Hans was dying and needed to be put to sleep for humane reasons. He asked for Dr. Shusted's understanding for their family's situation. In reality, the young Fromme explained, Dr. Schusted wouldn't be lying to his father—after all, Hans was slowly dying.
Dr. Shusted agreed to talk to Grandpa Fromme about Hans' medical situation, but he said he could not lie to him because he was in fact the owner of the dog. He did agree to massage the truth to make the information less traumatic for the elderly pet owner. He would explain the medical findings and describe how serious the diseases can be. In addition, he would mention that certain treatments were available but that this was a time when euthanasia had to be seriously considered.
The young Mr. Fromme was not satisfied with Dr. Shusted's discussion plans. He felt this would be very upsetting to his elderly, infirm father. Dr. Shusted understood but maintained his position that he had to be forthright with the pet owner.
Did Dr. Shusted act in an ethical fashion by informing the elderly pet owner of his dog's condition—against the recommendations of the pet owner's adult son and caretaker?
Dr. Rosenberg's response
There is no doubt that young Mr. Fromme cares very much for his father's feelings and senior fragilities. It was natural to want to shield Grandpa Fromme from the pain associated with the poor prognosis and complexities of Hans's medical conditions. But the elderly are a lot tougher than many give them credit for. They've lived many years and have suffered triumphs as well as tragedies. Yes, it's sad to tell Grandpa Fromme that his dog's health is failing. In addition, he must be told that he's not able to care properly for the pet and that his family is not in the position to meet the pet's needs. But the truth is necessary for the family to discuss and ultimately resolve the situation.
Dr. Shusted has an obligation to the pet owner to be both honest and professional. He should inform Grandpa Fromme that his dog has two serious diseases that cannot be cured and can only be maintained at best. The treatments would be time-intensive and involve some additional monetary commitments. Ultimately, there are two options on the table. A decision to meet the pet's needs would be one. Euthanasia would also be an option if the family's resources do not allow adequate treatment of the medical conditions. This information presented in a professional manner serves the best interests of the pet owner and meets Dr. Shusted's ethical obligations.
Note: All names presented in this column are fictitious.
Dr. Rosenberg is director of the Voorhees Veterinary Center in Voorhees, N.J. He is a member of the New Jersey Board of Veterinary Medical Examiners.