He threatened me! Humane euthanasia vs. a clients denial

January 30, 2019
Marc Rosenberg, VMD

Dr. Marc Rosenberg is the director of the Voorhees Veterinary Center in Voorhees, New Jersey.Growing up in a veterinary family, he was inspired to join the profession because his father was a small animal practitioner. Dr. Rosenberg has two dogs and three cats.In Dr. Rosenbergs private time, he enjoys playing basketball and swing dancing with his wifethey have danced all over the world, including New York City, Paris and Tokyo. Dr. Rosenberg has been a member of the Screen Actors Guild and the American Federation of Television and Radio Actors for more than 30 years. He has hosted two radio shows, a national TV show and appeared in over 30 national TV commercials, all with pet care themes.

dvm360, dvm360 April 2019, Volume 50, Issue 4

Heres an age-old issue worth revisiting: What does a veterinarian do when a client refuses to acknowledge that her sick old dog is suffering?

Mrs. Reed had lived with her dog, Remy, for 13 years. They were inseparable. Three months ago, Remy developed a cough. She thought it was a passing cold, but the cough persisted. So Mrs. Reed took Remy to Dr. Higgins' veterinary clinic.

Dr. Higgins did a complete workup. Remy's blood profile was fairly normal for a 13-year-old Lab. The physical exam showed some posterior degenerative joint disease and mild, unexplained weight loss. Dr. Higgins proceeded to take a radiograph of Remy's chest and wasn't surprised to see metastatic lung lesions or, as he called it, “popcorn chest.” He immediately requested a radiology consultation, and within the hour Remy was diagnosed with metastatic lung disease.

Dr. Higgins knew Mrs. Reed would be devastated to learn her dog had lung cancer. When she returned later to pick up Remy, Dr. Higgins spoke to her at length about the condition and its poor prognosis. He was sensitive but honest with his longtime client. He suggested Remy be put on palliative medications that would make him more comfortable and possibly slow the cancer's progression. He went on to tell her that Remy had approximately two to four months before the cancer would take its toll.

Mrs. Reed sat stoically and listened. She didn't believe it. She suggested that the weight loss was a result of Remy not liking his dog food. She was in complete denial.

Nevertheless she wanted Remy to receive the very best treatment considerations. She wanted to see an oncologist and begin an appropriate chemotherapy protocol. She insisted that Remy was a special dog and had always beat the odds in the past. Dr. Higgins assisted her in arranging an oncological appointment.

After extensive testing, the oncologist confirmed that metastatic disease was present in several of Remy's organs. The oncologist offered a chemotherapeutic protocol that would hopefully extend Remy's life but wouldn't cure him. Mrs. Reed pursued this course of treatment.

Mrs. Reed used Dr. Higgins to implement the oncologist's chemo protocol and periodically visited the specialist for treatment assessments. Soon after treatment began, Remy started experiencing some side effects of the treatment along with progressive deterioration secondary to the aggressive cancer.

The next time Mrs. Reed came to his clinic, Dr. Higgins took a moment to counsel her. He explained that his goal as a veterinarian was twofold-to treat his patients' disease but also to minimize their suffering. He emphasized that his patients were never frightened or in pain when the time came.

But Mrs. Reed refused to listen.

She ignored his comments and instead mentioned how Remy was enjoying his new treats more than the cheese snaps she'd been giving to him prior. Dr. Higgins understood the role that denial plays in the grief process. But it was his job to advocate for his patients. It was his professional opinion that the dog's weight loss, respiratory distress and general discomfort clearly fell into the category of suffering. He told Mrs. Reed that the time had come. It wasn't fair to Remy and she needed to make the decision to put him to sleep.

Mrs. Reed didn't react well.

She told Dr. Higgins that she didn't like being threatened, that she was going home and that she would speak to him later. Within two hours, Dr. Higgins received several calls. One was from Mrs. Reed's friend. The other was from her clergyman. At first both were defensive on behalf of Mrs. Reed. But after Dr. Higgins explained the situation, they understood his position and agreed to assist. Later that evening, Mrs. Reed returned to the clinic with her friend, her pastor and Remy.

She'd decided to put Remy to sleep.

But she was also distraught and angry. Through her tears she uttered, “No more dogs for me.” She said she couldn't return to Dr. Higgin's clinic. The memories were too traumatic.

Clearly, Dr. Higgins acted on behalf of his patient. But did he wait too long? Did he handle Mrs. Reed appropriately? Was he too aggressive-or should he have been more aggressive?

How would you have handled this case with Mrs. Reed and Remy? Let us know at  dvmnews@ubm.com

Dr. Rosenberg's response

Every clinical veterinarian has encountered this scenario.

Understanding the stages of grief that pet owners experience when dealing with the death of a pet is critical. It's also important to never forget that we are first advocates for our patients. It's always better to err on the humane side rather than wait too long to make a necessary recommendation. We always hope that pet owners can make the euthanasia decision in a proper and timely manner. When they can't, the veterinarian has to step in.

I think Dr. Higgins may have been a bit too emotionally involved, but he ultimately made the right decision even at the risk of being perceived as threatening.

Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, New Jersey. In his private time, he enjoys playing basketball and swing dancing with his wife. Although many of the scenarios Dr. Rosenberg describes are based on real-life events, the veterinary practices, doctors and employees described are fictional.

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