One of the most fascinating aspects of the debate over Question 2, the Massachusetts "Death With Dignity" ballot measure on assisted suicide, is the outpouring of personal stories about our encounters with death and dying that it has brought. We don't like to talk about dying. But suddenly, we're doing a lot more of it than usual.
The stories that have arrived in the comments section of this recent post are moving, sometimes heartbreaking, always thought-provoking. One particular recent comment prompted me to ask the writer to expand. She had written:
The issues raised by this ballot question are faced by veterinarians every day. I can only speak for myself but I can say I have never enjoyed euthanising a client's pet. However, I am glad the option is available. The word euthanasia means 'good death.' Perhaps veterinarians' experiences could provide some clarification.
That rang so true that I asked for more. But first, an emphatic preface: This is a veterinarian sharing her thoughts and experiences, but that by no means implies that she is equating putting a pet to sleep with physician assisted suicide in humans. So please hold those objections. She is, rather, offering an insider's valuable perspective on hundreds of experiences in which families choose to hasten the end of a beloved pet's life. And facing head-on an issue that vets don't talk about much, either. Deepest thanks to Westford veterinarian Shelley Fitzgerald for sharing this:
Roxie was a friendly and exuberant two-year-old Afghan hound cross who came into our clinic in 2003 for a small swelling on her cheek. The most likely causes were an insect bite, an infection or trauma. However, the swelling increased in size despite being treated with antibiotics, antihistamines and steroids. Roxie continued to be happy and eat well, but we and her owners were dismayed.
Ultimately the cause of the swelling was determined to be an aggressive form of cancer. We all knew Roxie and her family well, and everyone in our clinic cried when Roxie was euthanized because she could no longer eat.
I have performed hundreds of euthanasias myself and witnessed many more. After nine years, the details of Roxie’s case are still clear and painful. Yet I would not have wanted to see her live in her condition. I was grateful then and still am now that the option to end Roxie’s suffering in a peaceful and painless way was available.
As a veterinarian with 21 years of clinical experience, I have been following the debate over Ballot Question Two — which allows terminally ill patients to request a prescription for life-ending medication — with great interest. Let me first be clear that I am not equating pet euthanasia with human assisted suicide. But there are some similarities between euthanasia in the veterinary profession and the procedure proposed in the ballot measure.
For vets, the clash between perceived ethical and unethical actions which concern some physicians is not as dramatic. In fact, euthanasia is an accepted part of practicing for most veterinarians. Additionally, our roles as both consultant and performer of the procedure place us at the center of the process, and usually alone. Despite the enormous responsibility involved, I believe my charge to prevent and relieve pets’ physical suffering and their owners’ emotional pain has given me a greater respect for life.
One of the startling realizations on my first day of practice was that I would be treating members of the pets’ human families. My roles as medical consultant, confidante and decision maker were barely hinted at during veterinary school. One thing we did learn was to discount the weight of anecdotal evidence. Despite beginning this post with the story of one dog, my advice to families is based on the existing medical knowledge and the majority of the cases I have seen. There are always exceptions. However, when advising an owner whose Bull Mastiff has bone cancer regarding the dog’s reduced lifespan and imminent pain, I hope to be giving them information that will help them make the best decision for their pet.
In the ideal situation, we will have time to discuss the actual euthanasia procedure and disposal of the pet’s body beforehand, if the family is comfortable with this. One of the important goals is to make sure everyone involved realizes that they do in fact have some control over a situation where the disease seems to be the paramount determining factor. Their pet’s life does not have to end in intractable pain. One hopes that the ultimate decision can bring some peace with it.
One of the reasons that the ethical issues surrounding euthanasia are not as critical is that there is less potential for abuse in the veterinary world. The veterinarian has to agree that the pet is terminally ill and/or has a condition which makes it impossible for the family to live with and enjoy their pet. A large elderly dog with incurable incontinence living in a household with a crawling infant would be an example. The evaluation of cui bono (who benefits) is rarely needed.
It is especially difficult to euthanize a pet that one has known and bonded with for years. This is when another of those painful realizations hits. It is not about us, the veterinarians. When I was first in practice, I wished that somehow I would not have to be the one when it came time to put down one of my favorite patients. When I had more confidence and a better understanding of the big picture, I wanted to be there for the pet and the family because I was their doctor and death was part of my role in that pet’s life.
I am glad that Question 2 is appearing on the ballot for a couple of reasons. One is that it has made me realize how taboo these issues are even for us veterinarians to discuss. The other is the opportunity to recall situations where, though the result has been the inevitable death of a beloved pet, I have been able to, by the standards of my profession, alleviate suffering and provide some comfort to the pet owners I have known.
I will be voting Yes on Question 2.
This program aired on November 2, 2012. The audio for this program is not available.