Last week was “one of those weeks” in the world of small animal veterinary medicine. Somehow all my cases that had been “circling the drain,” as we so elegantly put it, finally were pulled into its vortex, and we had a wave of euthanasia sweep through my practice. Three animals in renal failure in one day, a congestive heart failure, several cancer patients: the usual supects. It is a challenge to keep your spirits up in veterinary medicine as you hasten the passing of the sick and dying, even as you maintain clinical distance. Each case was different, but there was a certain consistency to what I did, maintaining faithfulness to my oath to relieve animal pain and suffering, through euthanasia if that was the only way to do so successfully. By Friday evening, as I placed my umpteenth (it seemed) fatal overdose of pentobarbital into a cephalic vein catheter while tearful family members held the pet they had raised from a puppy or kitten, or rescued from a shelter, or a dozen other stories, I began to think about this process in the context of human beings. For most people, this very difficult, but expected and necessary, part of my profession is well within the ethical boundaries in relation to animals. What if it becomes ethically permissible in the human medical profession someday? What patterns from my experience may be expected to carry over?
The comparison is imperfect, of course (and, indeed, I hope it would remain so no matter what!). Relationships with animals do not carry the baggage, for good or ill, of our human relationships. But people with their dying pets faced the decision seriously, with a desire to know the “right time,” when a cure was impossible, quality of life issues were substantially diminished, and their pets appeared to be suffering. (As a brief excursus, I don’t know how or if animals suffer; that seems to suggest a level of sophistication that few, if any, nonhumans have, including levels of physical, mental and spiritual dysfunction. That said, a pet euthanasia consultation is rarely a teachable moment for such philosophical sublimities and I just let them know that their pet may be suffering, or at risk of suffering, if they are just in awful condition.)
Most people look to me to give a green light to their choice, perhaps to nudge them past the guilt of a decision. “What would you do if she was your dog,” is asked of me daily, last week by a young married couple clutching an old beagle with inoperable bladder cancer and in end-stage kidney failure. That answer was easy. But they wanted my response to give ethical license for their choice. Legally, animals are “property,” the possessions of their human owners; we even call our clients the “owner” of their pets. Yet people look to us for moral guidance on when to end the life of their property. If human euthanasia is normalized, much more is at stake, and physicians will assume my role. I take comfort that I can provide peace and closure by reassuring my clients that their pet will be better off if we don’t force her to go to the bitter end. I am chilled to think of the comfort that a physician could similarly take in easing the decisions of those left behind to avoid the bitter end for their own family members. My euthanized patients don’t send me heartwarming, career-affirming “Thank You” cards; their families sure do.
I also noted a real, but subtle, dynamic in my staff, one that I think translates to human caregivers as well. My technicians and ward attendants could see full well that these patients would not get better. They heard me pronounce grave prognoses. They knew the patients in their care were dying, and they would find themselves frustrated with the pet owners that tarried on their decision to euthanize. The staff of veterinary hospitals is overflowing with idealists that advocate strongly for their animal patients. Without knowing it, my staff’s body language showed frustration and resignation, and those making the decision could sense the subtle pressure.
Certainly we see nurses and others in the ICU or in nursing homes that advocate for halting treatment they genuinely feel is burdensome to the patient and futile to recovery. Watching a patient slowly die is emotionally and intellectually exhausting. As sad as my staff is to lose a pet in our care, we all know the sense of relief that we feel when the call for euthanasia is made. We’ve usually stopped feeling guilty when we know we’ve done everything we can and that we can hasten the end. It is peaceful and quick, gentle and painless, which natural death so often is not. If human euthanasia is acceptable, expect this same subtle pressure and eventual sense of relief among hospital staff members, too.
This week is better (the positive aspect of losing so many of the moribund in one week is that the circle of life usually swings back the next). But I can’t help but think about the possibilities that the future holds, where human euthanasia is acceptable and even embraced. No, animals are not people ontologically-not yet, at least. But maybe I have seen the future for human medicine from my own vantage point as a veterinarian, and it should concern us all.