Your cancer patient is euthanized and you want a fluid sample. Your veterinary colleague demands that you get the pet owners' OK first. Is it really necessary?
The Gatz Veterinary Center is a six-staff-member, progressive facility with an excellent reputation in the suburban community it has called home for 17 years. Although they don't hold specialty board status, several of the veterinarians have specialty interests.
For example, Dr. Leeds has developed an interest and expertise in oncology during his 14 years at the clinic. He consults regularly with the oncology department at the nearby regional veterinary college and attends continuing education in oncology whenever the possibility arises.
Dr. Leeds has been treating Alfie, a 9-year-old Labrador retriever, for lymphoma for seven months using a standard chemotherapeutic protocol and monitoring Alfie's status on a regular basis. While Dr. Leeds is off duty, Alfie develops acute respiratory distress and is brought to the hospital. The clinicians who see Alfie determine that he has a substantial amount of fluid in his chest.
These pet owners have been through a lot with their beloved retriever, and they decide that his distress, coupled with his guarded prognosis, is too much for their best friend to bear. Instead of opting to drain the chest fluid, they choose humane euthanasia.
The doctor attending to Alfie calls Dr. Leeds and informs him of the owners' decision and the euthanasia. Dr. Leeds understands and agrees with the decision. He is glad he's been able to help Alfie thrive and survive during the past seven months.
Dr. Leeds asks Dr. Ho, the clinician on duty, to take a small sample of the fluid from Alfie's chest so that he can microscopically evaluate the number and presence of neoplastic cells in the exudate. He thinks this could assist him in future management of similar oncology cases.
Dr. Ho agrees that the aspirate would be valuable but she thinks it necessary to call the pet owners and ask their permission to pursue the postmortem sample. Dr. Leeds believes that obtaining a small-needle aspirate is not invasive and does not warrant disturbing grieving pet owners. This leads to a discussion of the ethical boundaries related to obtaining postmortem information with or without a pet owner's permission.
Dr. Ho isn't comfortable taking the sample without the owners' permission and respectfully declines to do so. Dr. Leeds returns to work the following day and the two clinicians have a discussion about the deceased patient and how to pursue similar situations in the future.
Dr. Leeds reiterates his position that taking a postmortem fluid sample is not invasive or disfiguring. It isn't as if he wants to do a necropsy, which would substantially alter the dog's remains. He agrees that procedures should not be performed on patients without owner input and permission, but in this case, he maintains that Alfie is deceased and therefore no longer a patient.
Dr. Ho counters that Alfie's owners have trusted the staff at the veterinary center to treat their dog only upon full disclosure of a planned treatment protocol. In addition, she believes that upon Alfie's death, the veterinary center has been given custody of the remains to see that they are disposed of in the prescribed manner. While the hospital is in custody of the body, she says, it's an ethical breach to acquire or invade the remains without the owners' permission.
In order to facilitate matters, Dr. Leeds agrees to call Alfie's owners and request permission to take a small sample in the interest of helping future patients. The owners, however, are still distraught over the loss of their friend. They understand Dr. Leeds' interest but respectfully decline to have Alfie participate in any postmortem examination.
Dr. Leeds is disappointed and does not understand the clients' decision. After all, he has taken excellent care of Alfie and only wants some closure to his medical efforts. Dr. Ho is glad the request has been made. This way the hospital knows and can truly honor and respect the pet owners' wishes until the body leaves the confines of the veterinary center.
In this case, medical treatment and care are not a concern for Alfie after he has been euthanized. At that point, the issues center on professionalism and honesty. Dr. Leeds has rendered compassionate veterinary care in exchange for a fee for this service. It has been understood either verbally or in writing that medical procedures are performed on the pet only with the pet owners' permission. Plus, after the dog has died, they've paid an additional fee for processing of the pet's remains.
Veterinarians have an ethical responsibility to consult with the pet owner before continuing any form of medical inquisition on the body. It's true that fluid aspiration would not have defaced the remains, and it's also true that it could have been done without anyone finding out. This is where questions of ethics and, more importantly, trust come into play.
If the pet owner cannot completely trust the veterinarian with all aspects of the care and handling of a pet, confidence in and respect for the individual doctor and for the profession as a whole will eventually break down. It's easy to respectfully request a pet owner's permission to perform a postmortem procedure.
Bottom line? I would not touch a pet or its remains without this permission. To do so would violate the trust I've worked very hard to establish.
Dr. Marc Rosenberg is director of the Voorhees Veterinary Center in Voorhees, N.J. He is a member of the New Jersey Board of Veterinary Medical Examiners.