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Quality vs. Quantity

Armed with advanced technology and a duty to save lives, knowing when to embrace death remains a gray area for some veterinarians


July 17, 2008
By: Jennifer Fiala
For The VIN News Service


Armed with advanced technology and a duty to save lives, knowing when to embrace death remains a gray area for some veterinarians

Chicago — When Dede Brownstein’s beloved cat began showing signs of constipation and a poor appetite, she didn’t have a clue what ailed her 18-year-old companion.

Neither, it seemed, did veterinarians. Specialists, endoscopies, countless tests and $6,000 later, the cat still suffered despite doctors’ best intentions. When several months of diagnostics yielded no clear diagnosis, Brownstein made the overdue and heart-wrenching decision to end the life of the distressed patient.

“Our cat was clearly at death’s door, yet we got no advice on ending his life from the specialists trying to save him,” she recalls. “We were trying to feed him through a tube when he didn’t want to be fed. He was screaming, on the floor and peeing all over himself. I’m sure that all he wanted to was to curl up and die peacefully somewhere.”

Brownstein’s experience might appear isolated, but Dr. Alicia Karas, anesthesiology professor and head of Tufts University’s Pain Clinic, insists the Chicago-area owner isn’t alone. Veterinarians, she explains, are trained to keep animals alive and many are not versed in having end-of-life conversations.

“As veterinarians, we hope to stave off death,” she says. “So recognizing that death is the ultimate gift to relieve suffering can be overlooked when we have all this technology to prolong life. If you value the human-animal bond, it’s difficult to recommend or even consider euthanasia and accept the end of that relationship.”

Philosophical issue

No one knows that better than Dr. Michele Gaspar, a board-certified feline specialist who practices in a small Chicago referral practice. When it comes to ending the lives of chronically ill animals, it’s a journey Gaspar says she takes with her patients. Her philosophy — which puts greater value on quality of life rather than quantity — didn’t develop overnight. It came with years of experience and watching serious illnesses plague animals as well as family members.

“I had a watershed moment during an oncology rotation in veterinary school,” she says. “After seeing my sister-in-law die from a terminal disease, I came across this 13-year-old cat with invasive cancer that had just gone through this extremely aggressive surgery. As I sat there watching her, I thought to myself, ‘People have to deal with this, but we can end suffering for our animal patients.’”

That attitude doesn’t come naturally for many veterinarians, especially those who have not yet dealt with death or suffering from a personal aspect. Gaspar, who recalls making many difficult euthanasia recommendations, admits that embracing death is no simple task.
It involves a tangle of religious and spiritual beliefs as well as fears for both the client and the practitioner, Karas says. “I think there are veterinarians who don’t really believe in euthanasia under any circumstances.”

New attitude?

Yet the idea that death is not the ultimate loss is an emerging conversation, Karas says. She points to a growing number of courses on euthanasia for veterinary students and lectures on how to facilitate death. Last March, the University of California-Davis School of Veterinary Medicine held the nation’s first symposium on hospice care.

“I think these lessons will help arm us to have the death discussion with clients and not impose our viewpoints on them,” she says.
And that’s a good thing, contends Brownstein, a feline lover who says she’ll never own another cat.

“I have a lot of guilt,” she says. “I feel like I put this animal that I adored through so much unnecessary pain, and I made him suffer. Worst of all, I didn’t help him have a good death.”




VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email news@vin.com.



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