Yesterday one of my clients came in with her two year-old Yorkie. The dog had spent the last four weeks and the lion’s share of ten thousand dollars in and out of multiple specialty hospitals.
After coming down with granulomatous meningoencephalitis (GME) the day before Thanksgiving, she’d failed to recover measurably. She could not stand. She could not see. She couldn’t even lay down without rolling over disorientingly. To make matters worse, she wasn’t really able to control her bowels well, either.
Despite the best efforts of everyone involved, this was looking like a lost cause. Had she been a human we’d persevere to no end. Because she’s a confused little dog with limited ability to tell us how she feels or what she wants, we have the luxury of making decisions for her based on what we perceive.
The specialists had faded out of the picture about two weeks ago. “There’s nothing more for us to do.” So they sent her to a rehabilitation specialist. At over $100 a day, every day, this dog was getting the best care she could get in the area.
When I called to check up on her earlier this week, however, the owner completely broke down over the phone. Despite the upbeat attitude of the doctors and staff at the rehab hospital (who told her, “we don’t believe in euthanasia here” when she asked about the possibility), this owner had finally forced herself to admit that her dog was not recovering.
During the call, she admitted that, “I didn’t want to come see you because I knew you’d know right away she wasn’t getting any better. And when they said no to euthanasia I was able to cling to my unrealistic hopes. But when you see her I think you’ll agree it’s time.”
Today I euthanized her at her home. I agreed with the owner. It was a dignified solution to a dreadful disease.
Now I know what you’re thinking: “We don’t believe in euthanasia here.”? What the heck is that all about? Don’t vets believe in euthanasia?
Well…that can be a sticky subject for some vets. The vast majority of vets are proud of the fact that we can relieve suffering and wouldn’t hesitate to do so in this case. It’s never easy to euthanize a two year-old, but this dog was sick enough for any thinking person to see she was never going to be anywhere near normal again. It’s not only completely defensible, this situation is sufficiently grave as to practically demand euthanasia after a month of miniscule improvement.
Nonetheless, a small minority of vets feel it’s not their place to discuss euthanasia. They believe it’s such a personal decision that it’s one the owner must arrive at on his own. An even tinier minority takes the above vet’s view that even Terry Schiavo-esque pet cases should not be euthanized, believing it’s God’s will that the animal was rendered thus.
I think that’s weird. Though I can respect this view when it comes to humans, it seems unduly harsh to expect an owner to deal with the 24/7 care, the angst and the grief that comes from seeing your pet this way day after day. Not everyone can handle all that.
And how about the cruelty visited upon an animal who is confused and disoriented? Is that not enough of a reason? What if she were in pain? I just don’t get this at all.
In this case, I also believe this vet’s view is exploitative—not to mention self-serving. $100 a day for the rest of a dog’s “natural” life is a pretty big-ticket item, even for an owner who can afford it (and this one can).
I can understand not offering euthanasia because you believe it's best for an owner not to feel influenced by your personal morays. That position may be a tad odd, but it’s utterly defensible, nonetheless.
Still, my preference is always to let owners know all their choices, even if one of them takes their pet physically away from them forever. Without offering this option, many owners will never feel the freedom to consider it, assuming they’d be judged harshly by their vet should they be the first to bring up the E-word.
Humans are funny creatures. There are as many ways of thinking about and dealing with death as there are individuals in our species. That makes my job harder, for sure, but it’s a challenge made easier by knowing that all I can do is make available everything my profession has to offer Ultimately, I think that position acknowledges the plurality of human belief while minimizing animal suffering to the greatest degree possible.
Dolittler
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It is so very sad but I'm glad you were able to help this little one pass peacefully. Here is another reason to have a vet that not only knows you and your animal but has similar views as to what constitutes quality of life.
Thank you for helping them.
Jules December 21st, 2007 03:54:00 PM
It doesn't matter that the owner can afford it, though- that's just plain exploitation.
I feel for the owner- what a hard decision to make just before the holidays :( It's hard enough any other time of the year, but this time of year- it just seems harder to make that decision. I'm glad she had a good vet to call upon when she was finally ready to let go of her little pup.
Trish December 21st, 2007 05:48:00 PM
As someone who lives in a state where human euthanasia is currently legal, I have already thought about my end of life choices, as well as my animals. I have a fairly detailed advanced directive as well, and I wish that I had more options available (like to advance direct euthanasia under certain circumstances.) I would not like to be alive and in severe pain and unable to understand why I was in pain with no future hope of getting out of pain or understanding why I am in pain. As is, I'm much more aggressive about treatments for my dog who has figured out the link between going to the vet and feeling better later (this is the same dog who will beg for Rimadyl when in pain and refuse it if offered if not.) I'm much more conservative about treatment for the animals who view treatments as torture. I can't imagine not offering euthanasia as an option and I appreciate vets who are willing to talk about it. I'm very glad you were able to help this poor yorkie!
Juli December 21st, 2007 06:17:00 PM
I agree that the prolonged treatment was exploitation.... "we don't believe in euthenasia, cause we make more money this way" is what they should have said.
I hope to God that if my boys are ever in a state that is hopeless and stressing, that if I am too caught up to recognize it, that my vet would knock me out of my fog and lay out the facts AND my options. I know she would, actually---my vets are awesome.
And I don't believe your pet has to be in pain to be euthenized. I had viral labrynthitis for about 6 weeks and that was the first time I realized WHY terminally ill people kills themselves sometimes. If there is enough stress and confusion, with no hope ofgetting better, I would let my guys go.
AGADORE'S MAMA December 21st, 2007 07:17:00 PM
Euthanasia is a blessing and a curse!
A blessing because we can end pain and suffering.
A curse because to reach that final decision, the owner knows he/she will be left to deal with their own pain and loss.
That responsibility is a given when you take on the care of an animal. The owner usually knows when it's time to let go. The animals eyes, body language tell you.
I have had to put down far too many. When I stop grieving for those lost through age, illness, accident and can no longer shed a tear or feel compassion as they exit this life, then it is time to give up animals and take up knitting or basket weaving.
Judy December 21st, 2007 08:35:00 PM
Wow, I can't believe a vet would refuse to euthanize... or waffle on it to the point where it was equivalent to refusal.... When my greyhound had his brief terminal illness this summer, one of the greatest kindnesses my vet (old-school guy in his late 60's, who I love dearly!!) was able to offer me was to say gently, that last day: "I think it's time."
In my grief and confusion - even though I thought it was time, knew it was time - having the reassurance of a professional agreeing with me did -and still does- wonders to ease my soul.
Thank you, Dr. K, for what you do every day. I have an idea of how hard it is, and thank you for it.
Stacey December 21st, 2007 09:42:00 PM
But offering euthanasia before the owner is ready for it, or before the owner feels the pet is ready for it, is traumatizing as well. When my first bird had kidney failure, the vet who was treating her mentioned euthanasia while she was not exhibiting significant pain (the vet himself said he didn't think she was in pain, though I disagreed), she was eating well, and she was enjoying time spent with me. Mentioning it that early shows a lack of professional judgment, lack of personal skills, and implied a lack of caring about the animal's well-being.
I'd much rather euthanasia is offered later than earlier, as it's a decision that cannot be unmade.
zandperl December 21st, 2007 09:51:00 PM
Vets need to tell the options. EVERY vet. Otherwise, some people wont want to think about the possibility. However, if that really is the only option, then they need to be told. I don't believe in "it's God's will.." when a puppy is sitting there dying from Parvo. That's horrible to even think.
It's sad that such a young dog had to be put down, but it really does sound like she/he wasn't going to get better. Instead of waiting for God's will, she let you ease that dog's pain in it's own home with it's owner.
I've hated putting any of my animals down, but I really had to. I've only had to do it with 2 of them; one was a cat with leukemia and the other was a rat with a tumor on her lung. All I can hope for now is that the two dogs I have now don't have to go through any terminal ill problem until they hit old age with gray/white muzzles.
ashleigh December 21st, 2007 10:00:00 PM
zandperl: That's always a stressful decision--when to bring it up. I have a fading pup in the hospital right now. I can't get her peritonitis under control no matter what I do. My next step is to get into her abdomen and place drains--something the surgeon had counseled me against during her first surgery (to remove a foreign body). The bill is up to almost $2000 already and I'm scared I may lose her no matter what I do. Should I mention euthanasia as an option? This is a pup. I want to fight as hard as possible on her behalf but the expenses are getting huge and the owner is a cop (not a high-priced attorney, for example). The pup is clearly suffering, but this round of new antibiotics may just do it. When do I offer? Do I assume he knows? The family acts like they're so willing to fight this that I haven't mentioned the elephant in the room yet. What to do...
Dr. Patty Khuly December 22nd, 2007 08:26:00 AM
Hi Dr.
Have the owners come in for a consultation. Put all the pros and cons on the table. Let them make the decision whether to pull out all the stops or end it. The main point you have to get across to them is that you support their decision what ever it is. It then becomes a "shared" burden. That will be the mental life saver for them.
Judy December 22nd, 2007 09:41:00 AM
Dr. Patty,
I agree with Judy. You can't make the pup get better. You can only do what you do and hope that it works. Letting your clients know exactly what's on your mind - pup is suffering, but perhaps next round of antibiotics will work - can only help them. I think it's the unrealistic picture some people have of vets (and people Drs.) being able to fix any problem that leads to resentment and law suits. It's up to them how to proceed, but if any animal is suffering without seeming hope of recovery a vet must let the client know it's time to let their friend go.
CathyA December 23rd, 2007 06:24:00 AM
My opinions will be forever strong on this subject, having experienced first-hand the blatant and cruel deception a handful of veterinary professionals will stoop to , keeping a companion animal alive. It is beyond comprehension how a vet would argue and convince an owner that requests euthanasia for her elderly and hopelessly dying dog that she is not "doing the best for her pet".
And then to top it, once euthanasia is agreed to, a vet will euthanize in the owner's presence without warning or informed consent, by inhumane means of toxic chemical in lieu of humane drug.
I post this as warning to anyone that lives in New Hampshire, that this is indeed excused by the State and has persisted for years. One may visit my web site to learn details, and are welcome to ask questions. My name will link to my page.
Barbara A. Albright December 23rd, 2007 10:22:00 AM
Never an easy decision, but it should be made by the owner, ultimately, with as much information as the vet can give. Will the pet recover? If so, will they be cured, or will their quality of life be affected for the rest of their days? What medical help will they need daily? Is the owner willing to do that?
I guess its a little easier with an older animal, but the same principles apply - quality of life, and that includes pet and owners.
Robin December 23rd, 2007 05:06:00 PM
I feel so very sorry for the owner of that dear litle dog, but disgusted at the exploitation of the vet, he was in it for the money not for the thought of that poor little dog suffering, He should be struck off the list of vets, and please anyone knowing that vet should report him and advise everyone to keep well away from him, more like a money grabbing creep to me
Marie Willcox February 22nd, 2008 06:47:00 AM
In my opinion, euthanasia, no matter how it is dressed up -- is murder. If the vet hasn't ruled out the cause, or there's no extra time in the schedule, or did something wrong -- the obvious solution is to recommend it and put the onus on the owner. In the current environment of medical secrecy, it quite often is not considered a last resort but a quick way out.
john jones October 18th, 2008 01:46:00 PM
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