The moral dilemmas in veterinary medicine are endless. Given their ubiquity, is it any wonder I’m often asked this slightly indiscreet question: “What would you do if you were in my shoes?" Or even more pointedly, "How would you treat her if she were yours?”
Here's a recent scenario as example:
One night last month Fifi started breathing kind of funny –– heavy-ish and sort of like she couldn't quite catch her breath. Her owners brought her in the next day and we localized the problem to her heart. A cardiologist then stepped in and recommended a slew of medications Fifi absolutely will not take –– not without a fight. Several preparations of each drug have been tried and all efforts have been thwarted.
Enter the moral dilemma: Fifi has a terminal cardiac condition. Nevertheless, medication may well prolong her comfortable life several months –– perhaps even a year. But in light of the battle to medicate her, her owners have begun to ask: “Are we doing more harm than good? After all these years of being treated like a queen, she must wonder why we’ve turned on her.”
It’s a common enough scenario. Consider the young dog with lymphoma whose owner questions the prudence of chemotherapy; the emaciated cat who requires pills, pomades or pricey radioactive medications to treat her wayward thyroid gland; and the twelve year-old dog whose twisted stomach requires risky emergency surgery if he’s to be saved.
Plenty of pet owners have never before found themselves in such an overwhelming predicament. It may even be the very first time they've been asked to ponder any personal sort of life and death decision. It makes sense, then, that many of them might choose to ask a very human question.
I call it the WWVD? question. As in, “What would your veterinarian do?”
Which is always an impossible line of interrogation, of course. After all, the circumstances of any individual’s personal life, the nature of their attachments, and their own personal morality –– among other vital variables –– are bound to differ from any given veterinarian’s. To wit, your culture, your household circumstances and your religion will likely differ from mine.
What’s more, what I would do for my own pets is not only based on a very personal set of values you may not hold dear, it’s also founded on a point of view that’s purposely rooted in a certain degree of dispassionate science. Sure, we feel for your pets, but it’s our job not to feel so much for your pets that it clouds our clinical judgment.
Further, as a veterinarian I will almost undeniably see your pet’s suffering through the lens of someone who sees a lot of animal suffering. Though it’s only my perspective I’ll offer here, I believe strongly that veterinarians have a tendency to become somewhat inured to a certain degree of suffering.
For example, it’s my take (which I believe is strongly influenced by my professional POV) that the temporary suffering endured by animals during limb amputation surgery is much less significant than the collective suffering experienced by frequent veterinary visits for the definitive treatment of many limb-sparing surgeries.
For that matter, I’m also less likely to consider the mild and temporary side-effect to chemotherapy (experienced by about 25% of our patients), to be significant compared to the benefits of most chemotherapeutic protocols. (Note: This does not apply to the 5% of patients who suffer serious side effects. Those patients are those for whom I would personally recommend against continuing chemotherapy treatment, regardless of its future benefits.)
Then there’s the financial aspect to consider: Let’s be honest –– what I pay for veterinary services is not the same as what you would pay. Sure, it’s still more than 50%. While that can add up when we’re discussing radiation therapy, root canals and rehab for cruciate ligament tears, it undeniably accounts for a big difference in affordability.
In other words, when I offer my opinion I might well be leading you astray from what’s right … for you and your family. And I’d never want to do that, especially when it concerns life and death decisions like the ones that typically lead up to this line of questioning.
Which raises one final point you should keep in mind should you ever want your veterinarian to answer this very personal WWVD? question: Be aware that, in many ways, the very act of stepping into your very personal shoes goes against how we were trained to practice. In fact, it’s probably considered unethical to volunteer our what-would-we-would-do-if-we-were-yous without a client’s permission.
Nonetheless, I recognize that it’s a sign of trust and respect when my clients raise this question. And while I don’t mind answering (which is not the case with all veterinarians, mind you), I do so very guardedly, making sure that my client understands why my ultimate decision might be very different than theirs –– and why it may even differ from my professional recommendation.
Yes, I know my clients are paying me for my professional opinion. Yes, I know they rely on me to be honest. Yes, some of them even expect my professional opinion to be largely informed by my personal point of view. But the question still makes me somewhat queasy –– especially when it comes from a client I don’t know so well.
All that said, I don’t believe it’s ever wrong for you to ask for a more personal slant if you believe it’ll help you make a better decision. Just keep these pointers in mind: ask nicely, acknowledge that you’re putting them in a potentially uncomfortable position and then fire away. Not every veterinarian will want to answer directly, but we’ll all do our best.