End-of-Life Decisions: Telling Your Vet No
“My dog needs to be put to sleep,” said the voice on the
other end of the phone. “She has cancer, and we consulted with an oncologist,
and we had an ultrasound done.” Before I could say a word, he continued: “We
already asked about chemotherapy, and they said it would be $5,000, and after
going through it with my cat already, I’m not sure I can do it again.” He paused
for breath, waiting for my response.
“I’m so sorry about your dog,” I responded. “What is her
name?” The man hadn’t even had a chance to tell me that, so rushed was he to
convince me that this was the right decision for his family before I could
suggest another course of treatment.
It happens a lot in this line of work.
I never truly understood how often clients feel put on the
defensive about their choices for terminally ill pets until I began my work as
a hospice and home euthanasia veterinarian. I don’t believe it’s intentional on
the part of most veterinarians, but the truth remains that there can be a big gap
between veterinarians and owners when it comes to communicating about terminal
disease and end-of-life care.
Why There May Be a Disconnect
Veterinarians are trained to cure disease. When you present
a pet to us with a problem, our goals are simple: try to diagnose the problem and help
you solve it. This is what we are prepared to do every day, and we do it well.
In the past couple of decades, it has gotten even better. Between increased
specialization and improved technology, pets can enjoy a level of care that
rivals our own in many ways.
But not every pet owner wants to battle terminal disease to
the bitter end. This amazing level of care comes at a financial cost, which may be out of
reach for many pet owners. And in addition to the cost of treating terminal
illness, many owners simply do not want to put their pet through the stress of
aggressive therapy that will not eliminate the disease.
The most aggressive therapy does not always equal the best
course of treatment, and that decision can only be made by an informed owner
who has all the necessary information in front of him. It’s a vet’s job to provide
information, to empower you to make choices right for your family and your pet,
including how to keep your pet as comfortable as possible through a terminal disease when the
family elects not to pursue treatment.
Too often, pet owners feel like they are unable to say, “I
don’t want to do that.” They may be concerned about appearing uncaring,
embarrassed to say they really can’t afford thousands in veterinary bills, or
they just may not be aware that palliative treatment is a valid alternative.
Many veterinarians are gradually getting better at offering hospice care and
palliative treatments to clients, but the field is still relatively new, and all
too often, owners are unaware it exists.
So how can owners be prepared for a conversation about end-of-life issues without walking away feeling guilty?
1. Take the time you need to understand what is
The diagnosis of a terminal disease can be shocking,
especially when it comes out of the blue: a limping dog who has not a sprained
leg but bone cancer, for example. If this is not an emergency situation, don’t
feel as though you need to make any decisions during this initial consultation.
It will take some time to digest. Many owners find going home and taking time
to research and talk leads to a much more constructive conversation the next
2. Don’t be afraid to set your limits at the
start of the conversation.
Most veterinarians will tell you every option available to your
pet; it wouldn’t be fair of us to make any assumptions about what you are or
are not willing to do. That being said, if you know you are not interested in
pursuing chemotherapy, for example, don’t be afraid to say so. Not all owners
have a lifestyle that would allow them to care for a paralyzed dog. Defining your
limits will help us focus the conversation on the needs of your specific
3. Ask about palliative care.
Choosing not to pursue curative
therapy is not “giving up,” nor is it an inferior choice — just a different one.
Palliative care, where the focus is not on curing disease, but on making a pet
as comfortable as possible, can be just as involved as curative-based protocols, but with a
different goal. Providing pain management, maintaining hydration, managing mobility, decreasing
nausea and maintaining caloric requirements are all ways we can help pets with terminal
disease. Taking care of these humane needs fulfills our obligation to care for
our pets just as much as electing to go the distance with a specialist.
When my cat Apollo suddenly developed a saddle thrombus last
year, I was devastated. In this emergency condition, a large blood clot forms
in the aorta and lodges right where the blood vessel divides to provide blood supply to each rear leg. The single blood clot can suddenly cut off blood supply to both rear legs. It’s
known to be excruciatingly painful and difficult to treat. For those pets who
do survive, recurrence is extremely likely.
I took Apollo to my local specialty hospital to confirm my
suspicions. If my diagnosis was correct, I planned to make the decision
to euthanize him.
The cardiologist broke the news to me with a sympathetic
sigh after performing an ultrasound. “He has a 50 percent chance of surviving the
night,” he informed me. “I’ll get an estimate together for overnight
hospitalization, but it will probably be about $2,500. Given his heart
condition, I would anticipate two to three months or so before it happens again.” Before
he could go any further, I stopped him. “No,” I said. “That’s not the right decision for us.”
Palliative care lasted only a few hours in our case, but it was all we needed
to give the children a chance to say goodbye.
The doctor didn’t sneer or call me a bad owner or ask why
I bothered coming in if I wasn’t going to take his recommendations. He reached
over, put his hand over mine and simply said, “That’s what many people choose.
And I support your decision.”
4. Don’t be afraid to ask questions or seek a second opinion.
If you’re worried that your vet will push a treatment
with which you’re uncomfortable, try
to have some specific questions or statements that can help you express your concerns without being
confrontational, such as, “What is the benefit of that course of treatment
versus comfort care?” And remember, if your vet has a compelling reason to
recommend treatment, it’s his or her job to convince you of its worth.
Alternatively, be comfortable emphasizing the fact that your concern is quality of life, not quantity of life. If a vet is very
opposed to hospice care and you cannot come to a consensus, consulting with a vet who works in that field may be an option for
an alternative opinion.
As we learn more about how to keep pets comfortable at the
end of their lives, more owners will be empowered to say “no,” not with guilt but with confidence and an understanding that you love your pet just the same
no matter what you choose.
Pet Health Insurance Can Help
Unexpected veterinary bills can make caring for your pet challenging. Don’t let financial stress get in the way of making the best decisions for your pet. Pet health insurance can cover surprise costs such as veterinary visits, prescription medications, and life-saving procedures.
Review personalized options for your pet below:
Dr. Jessica Vogelsang is
a practicing veterinarian in San Diego, California. After working in emergency
and general medicine for a decade, she recognized the need for better
end-of-life care options for pets and now works as a hospice veterinarian with Paws
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