"Suicidal empathy": When compassion becomes a threat to veterinary medicine

A veterinarian in Spain once made a decision driven entirely by compassion. While preparing to vaccinate a dog against rabies and administer its routine multivalent vaccine, she combined both products in the same syringe rather than give two injections. Her reasoning was simple: one injection would mean less discomfort for the dog—and the owner, who would be less upset at watching their pet being injected twice.

She was not saving money or shortening the appointment. She believed she was being kind.

The dog died that night.

Whether the mixture caused its death is a separate clinical question that would require proper investigation. But the decision itself is revealing: the wish to minimize emotional discomfort shaped a procedure that should have been governed by pharmacological compatibility and product information. As the World Small Animal Veterinary Association (WSAVA) vaccination guidelines explain, different vaccines should not be mixed in the same syringe unless the product information specifically supports it.¹

I often think about this case when I consider what I call suicidal empathy. It means empathy that, left without limits, destroys what it was meant to protect, namely clinical judgment, patient welfare, and the professional’s own wellbeing. I don’t use the term lightly. I’m aware the word carries weight in a profession that knows suicide far too well, and I use it with that weight in mind.

Nobody teaches this in a communication course. But in my experience, many teams take home a distorted lesson: that every client complaint, however unfounded, is a verdict on our empathy. The distinction that gets lost is this: Empathy is understanding what the owner feels. Validation is agreeing that what they feel should decide what we do. The first is an essential professional duty. The second is where the trouble begins.

Reported for recommending euthanasia

A few weeks ago, I examined a 21-year-old cat in acute renal failure. The history, examination, and laboratory findings pointed to an extremely poor prognosis. Treatment was theoretically possible, but the likelihood of a meaningful recovery with acceptable quality of life seemed extraordinarily low. I recommended considering euthanasia as the option most likely to prevent further suffering.

The owner told me her cat had always been a fighter and that she believed he still wanted to live. She argued that a truly empathetic veterinarian would explore every possible treatment, and she questioned whether I was empathetic enough. I told her I understood why she wanted to keep fighting for an animal who had been with her for 21 years. I recognized her fear and her grief, but understanding those emotions did not change the findings. My empathy could shape how I explained the prognosis, how much time I gave her, and what support I offered. It could not turn a very poor prognosis into a favorable one.

After hours of discussion, she made a formal complaint against me. Not for a misdiagnosis, nor for a treatment error. The complaint was that I had proposed euthanasia for a 21- year-old cat in renal failure.

Her grief was real and deserved compassion. Her complaint, as a judgment of my clinical care, did not deserve validation. I can’t know what drove it. Genuine clinical failures do happen, and complaints remain an essential way to hold veterinarians accountable, but the desire to find someone responsible can be psychologically understandable without being justified.

Berg and Vickers examined 47 complaints about animal euthanasia submitted to the Swedish Veterinary Disciplinary Board between 2018 and 2022.² Only 2 led to disciplinary measures, and the recurring themes were communication difficulties, client attitudes, and emotional attachment. A complaint, in other words, does not necessarily mean wrongdoing.

Here is the pattern that worries me. When a team treats every complaint as proof that it wasn’t empathetic enough, the next clinician who meets a cat like this one will think twice before saying the word euthanasia. The veterinarian in Spain followed the same logic, only one step earlier: she revised the procedure before anyone had a chance to get upset. She yielded in advance. I held firm. Both of us paid a price.

Defensive medicine—the emotional kind

Some time ago I wrote about how defensive veterinary medicine was gradually replacing the profession that attracted me. My concern then was protocols, regulators and litigation. I now suspect a quieter form is developing alongside it: emotionally defensive medicine, in which we modify recommendations not because the evidence has changed but because we want to soften their impact or avoid a confrontation.

In my experience, it looks like this. We hospitalize animals that are unlikely to benefit from it, simply because admission reassures the owner. We run tests that won’t change treatment because they ease the fear that something was missed. We continue treatment past the point where its burdens outweigh its benefits because nobody wants to start the conversation about stopping. None of these choices is wrong in every case. The question is whether the intervention is justified by the patient's welfare, the owner's informed preferences, and the evidence—or mainly by our wish to avoid conflict.

The risk is a cycle. A complaint shakes the clinician's confidence, and the next similar case brings more tests, longer treatment, or a vaguer prognosis. Gibson and colleagues found that UK veterinary professionals described complaints as leading to distraction, disengagement, and defensive strategies,³ which fits what I see. The most troubling part is that this behavior is often praised as compassionate and client-centered. It rarely feels irresponsible while we are doing it. It feels like doing everything possible.

The hidden contribution to veterinary burnout

We usually explain burnout through long hours, low pay, emergency duties, and staff shortages. Those matter, but they don’t fully explain the emotional weight of clinical practice. There is also the exhaustion of repeatedly defending a reality nobody wants to accept, the anxiety of bracing for a hostile reaction, and the sense of being personally responsible for emotions that medicine cannot resolve.

In my experience, the mechanism works in stages. First, we learn that an unwelcome recommendation can trigger a complaint. Then we start anticipating the reaction before the appointment even begins. Each difficult conversation costs more than the last, and each complaint, even an unfounded one, chips away at our confidence. Eventually, some of us withdraw: we hedge, we over-investigate, and we avoid the prognosis conversation. Withdrawal looks like caution, but it’s often exhaustion.

The research does not test this chain directly, and I do not claim it does. But it is consistent with it. Prato-Previde and colleagues found that moral distress—the conflict between what professionals believe is right and what is demanded of them—was associated with emotional exhaustion and depersonalization among Italian veterinarians.⁴ Romão and colleagues' scoping review identifies client conflict, unrealistic expectations, and end-of-life conversations as recurring relational pressures.⁵ Gibson and colleagues add that complaints themselves lead to disengagement.³ None of these studies measures "excess empathy." What they suggest is that the emotional demands of the client relationship are an occupational stressor in their own right.

This is where suicidal empathy does its quietest damage. We ask veterinarians to be compassionate without ever disappointing the owner, to give evidence-based advice while avoiding unwelcome conclusions, and to respect the owner’s autonomy while remaining personally responsible for the outcome. No one can meet all of these demands at once. When they collide, the clinician absorbs the cost. The most exhausting part isn’t the difficult conversation itself, but believing we have failed whenever it ends in distress.

Empathy needs boundaries, not abandonment

This is not a plea to return to paternalism. Shared decision-making and better communication have been real advances. Owners have legitimate preferences, budgets, and views on risk and quality of life. But respecting autonomy doesn’t mean presenting every option as equally appropriate, and empathy shouldn’t oblige us to endorse choices we believe would harm the animal.

Some practical steps for the practice manager and the clinical team:

• Say what you recommend. Present the options, then state your own recommendation plainly: "I recommend…". Neutrality is not kindness when the owner needs guidance.
• Separate complaints from grief. Review each complaint for what it actually contains. Some are legitimate and demand change. Others are grief or frustration looking for a target, and those call for support, not concessions. Understanding a complaint is not the same as endorsing it.
• Support the clinician. After a complaint, a senior colleague should check in with the clinician before they face a similar case, not after something goes wrong.
• Review difficult cases as a team. Discuss prognosis conversations the way we discuss surgical outcomes: openly, without blame.
• Redefine success. Judge a consultation by whether the owner received accurate information, understood the options and was supported in an informed decision, not by whether they left reassured.

What empathy can and cannot do

I do not believe veterinary medicine needs less empathy. It needs a clearer idea of what empathy can and cannot do. Empathy lets us recognize suffering, build trust, and guide owners through some of the hardest moments of their lives. It cannot change a prognosis or make two vaccines compatible, and it does not make us responsible for another person’s grief.

The veterinarian in Spain did not mean to harm her patient. She wanted a routine procedure to be less unpleasant. The cat’s owner was grieving, and that grief deserved care. But care is not agreement, and understanding is not validation. When we confuse them, sometimes the patient pays the price, sometimes the veterinarian does, and very often both do.

Ultimately, empathy was never intended to change reality. Its real purpose has always been something far more modest, and precisely for that reason, far more valuable: helping people confront that reality without having to face it alone.

References

1. Squires RA, Crawford C, Marcondes M, Whitley N. 2024 guidelines for the vaccination of dogs and cats – compiled by the Vaccination Guidelines Group (VGG) of the WSAVA. J Small Anim Pract. 2024;65(5):277–316. https://doi.org/10.1111/jsap.13718
2. Berg C, Vickers H. Complaints to the veterinary disciplinary board related to the euthanasia of animals. Front Vet Sci. 2024;11:1480106. https://doi.org/10.3389/fvets.2024.1480106
3. Gibson J, White K, Mossop L, Oxtoby C, Brennan M. 'We're gonna end up scared to do anything'. Vet Rec. 2022;191(4):e1737. https://doi.org/10.1002/vetr.1737
4. Prato-Previde E, De Mori B, Colombo N, Pelosi A. Willing but Unable. Animals. 2024;14(24):3691. https://doi.org/10.3390/ani14243691
5. Romão ME, Beheshti SR, Scoccianti S, Barello S. Veterinarian–Client Communication as a Driver of Burnout. Vet Sci. 2026;13(5):411. https://doi.org/10.3390/vetsci13050411