Abstract
AAFP Position Statement
End of Life Issues in Feline Medicine
Veterinarian's responsibility
It is the ethical and moral responsibility of every veterinarian to advocate the welfare of the patient.
This is the veterinarian's primary responsibility.
The veterinarian must make every effort to assist the patient to enjoy the Five Freedoms (see AAFP position statement on general principles of feline welfare at www.catvets.com). Critical to this effort is the effective assistance to avoid pain and suffering.
It is unethical for the veterinarian to encourage the administration of therapies or diagnostics that benefit the practitioner at the expense of the patient.
It is unethical for the veterinarian to deliberately exploit the bond between patient and client in order to generate a financial benefit.
Current considerations in modern feline medicine
The significant bond between the cat and the client has dramatically increased, which the AAFP has long recognized. Cats can provide important emotional support and companionship to the client.
Sophisticated diagnostic and treatment modalities currently exist which can significantly enhance the quality of life and lifespan of cats.
Because of the widespread availability of these diagnostic and treatment modalities, many clients are willing to seek and demand these advanced modalities and invest significant financial resources in the process.
The emotional bond between the client and the patient may be so strong, and the immediate situation so confusing, that a client may be unable or unwilling to critically appreciate the prolonged suffering a treatment modality might produce.
It is the responsibility of the veterinarian to guard against the owner wishing to continue with treatments, at the expense of the patient's quality of life.
The existence and availability of a therapeutic or diagnostic modality is not an ethical argument for its use.
From time to time the AAFP will respond to emerging new knowledge or issues that are of concern to veterinary professionals caring for cats. Our position statements, which represent the view of the association, are available at: www.catvets.com/professionals/guidelines/position/
As the patient's advocate, the veterinarian's primary responsibility must be the cat's welfare, should its quality of life and the client's wishes be at variance. Courtesy of Dr Susan Little
Quality of life
It is the goal of every veterinarian to maintain and enhance the quality of life of the patient.
An enhanced quality of life depends on a preponderance of pleasant rather than unpleasant affect in the life of the patient. Maximizing quality of life must remain the goal. Diminished quality of life is induced by a variety of discomforts of physical and non-physical (behavioral/emotional) origin.
Enhancement of quality of life may be achieved by alleviation of discomfort, supporting essential functions (food and water ingestion, ability to walk, ability to urinate and defecate, avoiding decompensation of a disease state), promoting social interactions, and providing a safe and secure environment.
Pain management:
Measurement of pain in cats may be difficult. Ignoring pain in the patient simply because it is difficult to measure is inexcusable;
The outdated theory that pain management should be restricted in order to reduce the activity of the patient is an incorrect and inappropriate rationalization which needs to be permanently abandoned in veterinary medicine;
Failure to acknowledge, recognize and control pain in the patient is unethical, and significantly impairs the quality of life of the patient.
Quality of life considerations should remain a continuous dialogue between the veterinarian and the client.
Euthanasia
Poor quality of life of the patient is the most important factor in selecting euthanasia.
Euthanasia of the terminal patient is humane because ending the life of the patient will prevent additional suffering and unnecessary pain.
In veterinary medicine, euthanasia may be defined as the humane method to end patient suffering. The death of the patient is the unfortunate and unavoidable effect of this action.
Convenience euthanasia:
The client may request euthanasia for their cat because taking care of it is an unacceptable inconvenience. The AAFP is opposed to convenience euthanasia. It is not in the best interest of the patient, and it is not in the best interest of the veterinary profession to perpetuate an image of itself as willing to kill a companion animal ‘on demand’.
The veterinarian should respond to these situations by reminding the client that their cat is a valuable member of the family, deserving respect, love and medical care.
The veterinarian must remain the patient advocate when a healthy, well-behaved cat is presented for ‘on-demand’ (convenience) euthanasia.
If all reasonable alternatives have been presented and discussed with the client, the veterinarian is encouraged to follow their own moral and ethical code in determining the course of action.
Other ethical considerations regarding euthanasia:
Inappropriate behavior (especially aggressive behavior) is a reasonable stimulus for the client to request euthanasia. The veterinarian is encouraged to explore the causes and conditions for these behaviors, and discuss alternatives to euthanasia.
The client may be financially incapable to afford even modest veterinary care. In addition, the client may be physically, medically or emotionally incapable of providing care for the cat. The veterinarian should not hold themselves responsible to determine these capabilities to provide for the cat. However, the veterinarian must act as the patient advocate and explore with the client all available alternatives to euthanasia.
A headstone and urns of ashes underline the strength of the bond many owners enjoy with their cat. On occasion, this bond can cloud a client's appreciation of their pet's suffering. Courtesy of Margaret Melling (left) and Dr Susan Little (below)
Owner's refusal to euthanize:
The client may insist upon treatment for the patient while failing to appreciate the unavoidable suffering and diminished quality of life such treatment may produce.
Once the quality of life issues have been raised by the veterinarian, and the client continues to insist that treatment be provided, the veterinarian is encouraged to follow their own moral and ethical code in determining the course of action.
It is the ethical responsibility of the veterinarian to advocate the best interests of the patient by reminding the client about quality of life issues. In veterinary medicine, the goal is quality of life, not quantity of life.
Footnotes
Appendix
Submitted by Bill Folger DVM MS DipABVP (Feline), Rachel Addleman DVM DipABVP (Feline), Ilona Rodan DVM DipABVP (Feline) and Vicki Thayer DVM DipABVP (Feline)
Submitted by Bill Folger DVM MS DipABVP (Feline), Rachel Addleman DVM DipABVP (Feline), Ilona Rodan DVM DipABVP (Feline) and Vicki Thayer DVM DipABVP (Feline)