A Right to Die

A Right to Die

State of the Profession, 2006
Jul 01, 2006

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.

It's considered a gift for painless death. But what are euthanasia's emotional costs to doctors? Dr. Mary Welle, an Urbana, Ill. practitioner, says emergencies rank as the toughest euthanasias, and who could forget talking to children about pet loss?
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.

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 (see Cost of extending life), 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, the embers are stoked on a slew of ethical questions regarding this profession's role as healer and compassionate killer.

Dr. 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.