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Comments on the dilemma in the February issue: When the client is away
  1. Steven McCulloch

Abstract

In the dilemma discussed in the February issue of In Practice, a 12-year-old German shepherd dog (Jasper) presents with vomiting and diarrhoea. A dog minder has Jasper while the client is away. Jasper has long-standing degenerative myelopathy and before the client went away, they expressed concern that he might, at some stage, require euthanasia. The dog minder is uncertain and upset; should you advise euthanasia or wait until the client returns? (IP, February 2017, vol 39, pp 94–95). Simon Coghlan suggested that if Jasper could be kept relatively comfortable, it might be reasonable to treat him and to run some medical tests until the client can participate actively in decision making under your professional guidance. Allowing some time to assess Jasper's response to treatment might be wise. However, respecting client autonomy and respecting the patient's life and wellbeing are both ethically important.

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Simon Coghlan's article demo-nstrates the importance of the empirical, medical context influencing the ethical evaluation of clinical cases. Jasper has long-standing degenerative myelopathy, and his owner has recently expressed concern that he might at some stage need to be euthanased. Given that DM is progressive, this description suggests that Jasper's mobility is not good, and perhaps that his quality of life is questionable. However, the article also suggests that Jasper does still have a life of net positive value, or a life worth living.

Arguably, if Jasper didn't have a life worth living, at least before the onset of vomiting and diarrhoea, the decision to euthanase him should have been straightforward, and made before his owner travelled overseas. Is Jasper likely to recover from vomiting and diarrhoea? The great majority of cases of vomiting and diarrhoea that we see in practice are curable. Therefore, if we treat Jasper's vomiting and diarrhoea, he is most likely to return to his previous state with respect to his quality of life. Based on this line of reasoning, it seems most justifiable to treat Jasper and assess his response, as 77 per cent of those polled believed.

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Of course, if Jasper had a negative quality of life, and his state could not be restored to a life worth living, then it would be more justifiable to euthanase him, given that the primary obligation of vets is, or at least should be, to their patients.

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