A two-year-old male cat has presented out of hours at a private clinic for depression and straining to urinate. Handling and being picked up in particular causes it to vocalise. Examination reveals a blocked bladder and the signalment, history and clinical presentation together suggest urolithiasis. Unfortunately, the owner does not have the £600 to £1000 required to stabilise, catheterise and hospitalise her pet for the weekend. The owner is upset because if she could afford the treatment, her pet would likely live a full life afterwards. It is also a difficult situation for the veterinary surgeon, who may have to euthanase the animal for these reasons, but what other options could the practitioner consider?
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Steven McCulloch graduated from Bristol in 2002. Since then, he has worked in small animal practice in the UK and Hong Kong. He holds a BA in philosophy from London University and is currently working towards a PhD in veterinary and agricultural ethics at the Royal Veterinary College.
Issues to consider
The first issue to consider is the cat's medical state, as this affects the options available for management. The animal cries when touched and especially when it is picked up, looks very depressed and is immobile, so the assumption is that it is in pain and suffering. Suffering can be defined as a profoundly negative mental state, the cause of which has overridden the individual's ordinary physiological and behavioural coping mechanisms; therefore, if that suffering cannot be alleviated, it is morally justified to euthanase the cat. Hence, an animal should be euthanased first because it is suffering and secondly because the suffering cannot be resolved.
The cat is suffering so the first criterion for morally justified euthanasia is satisfied. However, the second criterion is more ambiguous. If the cat could be stabilised and unblocked without significant irreversible complications, the second criterion is not satisfied in a medical sense. Indeed, the animal's suffering is reversible and, since it is young with a full life ahead of it, there is a moral obligation to initiate treatment. However, the client does not have enough money to pay for therapy, so the second criterion is satisfied in a financial sense. It is this ambiguity that contributes to a practitioner's cognitive dissonance that these all-too-common situations cause.
Let us assume that it is feasible and, in a practical sense, unproblematic to refer the cat to a charitable veterinary clinic that has resources available to treat the patient. The distance between the two clinics will influence how long it will take for the cat to be treated – it might be 10 minutes if the clinics are close by or, conversely, it could be three hours due to travel time and other circumstances.
Perhaps another issue to consider is the client's situation. Of course, if the client is being insincere and can actually afford treatment, then intuitively it seems at least prime facie wrong to treat her pet at a reduced cost. Pet insurance is also an issue; if the client could have afforded to spread the cost of treatment through insurance, it was the client's irresponsibility that has led to this difficult situation. However, holding the client to account will only punish the cat most of all, since it is the pet that will be euthanased if a hard line is taken, despite being blameless for its unfortunate predicament.
Therefore, there are both empirical (factual) and moral issues to consider. The most important empirical issue is the cat's physical health, which can be ascertained by a thorough physical examination. The moral issues can be cast in terms of a system of prime facie duties of the veterinarian. The first and foremost duty is to the animal under his or her care, as clearly stated in the RCVS Guide to Professional Conduct. This means that duties towards the cat override all other duties. These include those to the client, colleagues in the charity clinic and oneself.
Possible ways forward
Broadly speaking, there are four options for the private veterinarian to consider: euthanasia, referral to a charity clinic with no prior treatment, referral to a charity clinic with conservative treatment, or treatment at reduced cost at the clinic.
If the owner cannot afford treatment at full cost but charitable assistance is available, it appears morally problematic to recommend that her pet is euthanased. This follows on from the duty towards the patient overriding all other duties. Referral to a charity with no treatment also appears to be problematic, as the cat is suffering now and it is not desirable for it to suffer for a period of time during a car journey. Precisely what treatment is administered depends on context, but analgesia and possibly mild sedation (eg, an opioid such as buprenorphine) are a necessary minimum.
It seems obvious that the last two options, compared to the first two, are preferable from the cat's point of view. Indeed, treatment at the private clinic is optimal for the animal as it would not need to travel to another clinic. However, the possibility of this option depends on the will of the partners or senior management within the private clinic. Supererogatory acts such as this can be criticised for encouraging irresponsible behaviour (eg, unable to afford veterinary fees, no insurance) and might also be construed as unfair to those who pay the normal fee. It is for this reason that the particulars within the context of this situation are important. Arguably, if one of the last two options was undertaken in all such cases, then it could lead to abuse of the system, as well as a feeling of disgruntlement and injustice by those made to pay the full price.
Readers with views to contribute on ‘Financially strapped owner with a suffering cat’ should e-mail them toso that they can be considered for publication in the next issue, or fax comments to 020 7383 6418. The deadline for receipt of comments is Friday, July 15. Please limit contributions to 200 words.
THIS series gives readers the opportunity to consider and contribute to discussion of some of the ethical dilemmas that can arise in veterinary practice. Each month, a case scenario is presented, followed by discussion of some of the issues involved. In addition, a possible way forward is suggested; however, there is rarely a cut-and-dried answer in such cases, and readers may wish to suggest an alternative approach. This month's dilemma, ‘Financially strapped owner with a suffering cat’, is presented and discussed by Steven McCulloch. Readers with comments to contribute are invited to send them as soon as possible, so that they can be considered for publication in the next issue. Discussion of the dilemma ‘Pet insurance problem’, which was published in the May issue of In Practice, appears on page 298.
The series is being coordinated by Siobhan Mullan, of the University of Bristol. It is hoped it will provide a framework that will help practices find solutions when facing similar dilemmas.
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