What do we owe these animals in our care?

November 29, 2022 1:36 PM

"How much would you pay to save your cat's life?" On cats and kidney transplants (warning: extensive talk about pets dying)
posted by box (17 comments total)

Although this article is framed almost entirely in terms of dollars, I can't help but see the parallels to end-of-life care for humans and the powerful temptation to say "do EVERYTHING possible" (sometimes in direct contravention of the patient's stated wishes) when palliative care would be vastly more humane.

I certainly wouldn't make a blanket statement about all of the cases in the article but I think at least some of them were not making a rational decision about the best interests of the animal.
posted by allegedly at 2:47 PM on November 29, 2022 [3 favorites]

Much like with humans, it's probably a question of "can I afford this?" and "what is the quality of life for them if I do this?"

I can't speak for spending whopping amounts on animals since that never came up with mine, but my mom finally decided to pull the plug on my dad when he got kicked out of the rehab hospital (paid for by insurance, 200k/month) and they said they'd put him in a nursing home (24k a month out of her pocket), with absolutely zero quality of life going on for him. Even my optimistic, hopeful mom had to agree that wasn't worth the price to literally keep him alive as a vegetable in bed. Also, y'know, not having that money.

I admit reading this article, I did think "how the heck do you handle organ transplants on animals and the anti-rejection drugs?!" Now you know.
posted by jenfullmoon at 2:59 PM on November 29, 2022 [2 favorites]

We're serial cat owners, and we get'em used (young adults) from the city shelter. We're on cat #3. Cat #1 when young, injured his back foot outside, naturally outside of regular vet hours. We took him to emergency care, they sewed him up, then we changed his foot dressing daily, washing it and squirting hydrogen peroxide through a wound drain (he was a big feisty tom, and yet he let us do all that to him...). The foot healed up. He was around for another 16 years, til a deep vein thrombosis paralysed his rear half. Another emergency clinic, they couldn't (or wouldn't) operate on him so... euthanasia.

Cat #2 developed a thyroid problem (requiring special food) and became diabetic (requiring 2x daily insulin injections). She had a crisis or two, which needed x-rays and ultrasound to assess. She was with us roughly 15 years, til diabetes made her too weak to stand. Another euthanasia.

Cat #3 - she's the sports model, always wanting to play. Very healthy and active, and great teeth (amen). She might outlive us.

What do we owe the animals in our care? Food, shelter, kindness, and a stimulating life. Basic medical care to maintain health. Interventions if they will maintain the animal's quality of life, and if we can afford them, otherwise... to minimize their suffering.

(and no, I'm not comfortable with swiping a donor organ from a healthy animal. That's just human selfishness inflicting itself on a helpless creature or two, whether or not the donor animal manages to have a full life)
posted by Artful Codger at 4:27 PM on November 29, 2022 [5 favorites]

Fascinating article, thanks for sharing. In my lifetime, vet care for domestic pets have evolved from “The Far Side horse hospital comic” to full blown hospitals with MRI machines, aqua therapy pools, the works. Anything you could offer a human patient is available for a kings ransom to families with pets. At least the vets in the article seem to consider the quality of life for the cat on the receiving end of a transplant; I shudder to think the less scrupulous vets who push their clients into a second mortgage for questionable procedures when euthanasia would be far more kind.
posted by dr_dank at 4:53 PM on November 29, 2022 [1 favorite]

I have many conflicting feelings about all of this business.
Also, I am a little shocked to see the first patient in this article is 16 and put through such a potentially painful, disorienting and difficult surgery.
posted by Glinn at 5:37 PM on November 29, 2022 [8 favorites]

We've euthanized two sick old dogs in the last couple years, and it's been a wrenching decision both times for different reasons. But it's been very striking what a relief it can be to let a suffering loved one go without putting them through "trying everything" to get a few more months together. You can really see the pain leave the body as life does. We just let my dog go last month because he was losing both his appetite and control of his back legs and he hates, HATES cold, wet weather. We knew he wouldn't survive to see another spring, and we said, jeez, we could force him to stick around through another winter, slipping on ice and hating every minute, or we could let him go in a sunbeam. The choice was obvious to us.

I think it's a negative development for animal welfare overall that the options for pet end-of-life care are becoming more like humans' options. And that's leaving aside entirely the whole question of whether organ "donation" without consent can ever be ethically justified.
posted by potrzebie at 5:42 PM on November 29, 2022 [16 favorites]

I took our twenty-three year old beloved cat to veterinarian for euthanasia when the kidney failure was catastrophic. The vet said disapprovingly, "Don't you want to do everything possible?" and I said, "Not very long ago I went along with my mother when she decided to stop eating and drinking, and I sat with her when she was dying" (Mom had Parkinson's and was on the verge of being tube fed). The veterinarian was taken aback and stopped arguing with me.

Current cat (fifteen, but we got her, starving, out of the back yard) has crippling arthritis, bad kidneys, cataracts, and possible glaucoma, but she's happy. She sleeps, eats, uses the litter pan, and gets petted. The veterinarian said the treatment for the glaucoma if it gets bad is to remove the eye, and I nodded but I will wait to make that call. We did have all her remaining teeth removed a few years back. That was worth every penny, but the first few days of recovery were awful for her and I really don't think she has the reserves for another go-round like that.

There are so many creatures that need us, and part of what they need from us is to let them have a life and not project our own fears onto them, just as I would hope we would do for human beings (we're even worse for other human beings, honestly). Yes, as the article says, kidney failure is like "being poisoned from within" but guess what, most ways of dying are pretty darn hard, whether you're a human or an animal.
posted by Peach at 6:37 PM on November 29, 2022 [12 favorites]

Our sweet kitty Joel went into heart failure as a fairly young cat. The emergency vet told us they could work on her overnight, and if they could stabilize her, then she could be treated with drugs, would require lots of vet visits for monitoring, and her heart would most likely fail again. We might have months or a year or two. My kneejerk reaction was YES, save her, treat her.

My husband brought me to my senses. Over the course of that day she was in awful distress and was clearly terrified... We might buy a little more time with her, but she would have the stress of all the vet visits, and, then, ultimately, she'd have to go through this pain and fear again. And she would never be able to understand why. It was an awful, awful, awful, decision to have to make, but I'm confident now that letting her go was the right thing to do.
posted by BrashTech at 7:14 PM on November 29, 2022 [11 favorites]

That was an extremely well written article. It did a fantastic job of fairly examining all sides of a difficult topic. I feared it would portray anyone who would put their pets through this kind of procedure as some kind of privileged loon, but everyone came of sympathetically, while still acknowledging the controversial elements of these type of treatments.

One of the difficult parts of veterinary medicine having advanced so far is that it is challenging as a pet owner to know exactly what the right thing to do is when it comes to care for your pet. For me, because of the permanence of euthanasia I’m always waiting for a vet to tell me explicitly “I would recommend putting her down”, but I’ve rarely had it put in succinct terms like that. So when I am given a list of treatment options, I just assume that is the right course of action, even though in some cases I suspect in hindsight it may have just prolonged suffering (and vastly lowered my checking account). I had a dog with diabetes, who I had been giving twice daily insulin injections to for seven years who essentially stopped being able to stand or really move, and the most the vet would say is, “If this were a human patient, we would call his condition critical”, but I was the one who had to make the call to put him down (in fairness to the doctor, he happened to be the one place open on a Sunday, so didn’t know much of the dog’s history).

Last year we had to euthanize another dog of ours just shy of her 17th birthday. Her final year she had a number of medical issues, we spent a fortune on various tests and a multitude of medications (among other things she was having seizures with some regularity). When we took her in, clinging to life, on Christmas Eve last year, the vet at the emergency pet hospital gave us the closest I’ve ever received to “permission” by saying something along the lines of “At this age it is just as humane to euthanize as it to try to diagnose and treat whatever might be ailing her” which I appreciated.
posted by The Gooch at 8:25 PM on November 29, 2022 [7 favorites]

The Gooch, the trick is to bring in a palliative care/hospice vet well before the situation gets dire. They are much more focused on holistic quality of life than a generalist vet whose mindset is more about recommending a treatment for a specific ailment (and billing out accordingly - not that this is their primary motivation, but it's not NOT a motivation) regardless of whether that would represent an overall step down in the animal's comfort or happiness. I don't think even a hospice vet will usually tell you straight out "I recommend you put this animal to sleep" but mine definitely explicitly told me that in my position she would not force my dog to live a life he wasn't appearing to enjoy any longer. My dog declined very quickly at the end and I was in a bit of shock and denial about it, but my hospice vet was able to be more clear-eyed and have a lot more perspective because she'd been working with us for months, in our home, with long and detailed visits, and seen how he'd declined.

Of course, being willing to hire such a vet at all is an implicit admission that you know your pet doesn't have long, and there are limits to the amount of heroics you'll authorize to keep them around. If you're in a place where you'll hire a vet for end of life care, you're no longer really open to looking for a kidney donor or trying aggressive chemotherapy.

I absolutely think palliative/hospice vets are saints walking among us. Ours cried with me when I made the decision. Some of the kindest people I've ever met, doing some of the most difficult work I can imagine.
posted by potrzebie at 10:43 PM on November 29, 2022 [6 favorites]

A pet’s personality/temperament and the extent of the bond between them and their human caretakers does play an important role in what sort of measures are reasonable to take for a very sick or injured pet, in my experience. I had one cat who got quite sick and basic imaging showed a mass - so likely cancer, though small possibility that it was a more easily treatable infection. But further diagnostics would have required IV fluids and a hospital stay just to stabilize him first (I had less experience with cat medical care then, so didn’t catch warning signs earlier). My bank account at the time certainly influenced the decision to euthanize that cat, but also the hospital stay and diagnostics would have been quite stressful for him.

I also didn’t catch my second cat’s heart disease until it was so advanced that edema of his lungs and chest cavity was impacting his breathing. Urgent trip to my local vet yielded the diagnosis that he had hours to days left, but - whether my vet had a feeling that he might just be the right cat to pull through, or whether it was just really difficult to deliver such sudden and major bad news - the vet also gave me the long shot option of stabilizing the cat temporarily by draining the fluid from his chest cavity via needle, then me driving him up (in the middle of the night, across semi-closed borders during the pandemic, where the local vet and the vet college small animal hospital staff helped me get together the documentation needed to let me through) to the small animal emergency hospital at the regional (internationally reknowned, if I understand correctly) veterinary college for evaluation by their kitty cardiology specialists.

This cat has always been a good patient - it’s not that he enjoys being poked and prodded at his regular vet visits, but he tolerates it with reasonable humor. He also has a high degree of trust in me. He’s very smart, as cats go, and was able to figure out the connection between the ear drops I had to give him when I first adopted him as a stray kitten (which he initially quite disliked, as most cats would) and his feeling better. And we had many more years of building up an ongoing trust relationship than I had with the cat of the first story (though even in the same amount of time, I never had as close a bond with the first cat). So I knew that a day or two in the hospital would be a reasonable trade-off for this particular cat if it could give him even a couple more weeks of comfort and loving care from me at home. (Also, he’s okay with car rides, unlike many cats, so that part wasn’t a huge stressor.) But that’s definitely not the case for a lot of cats.

The kitty cardiologists gave him months to a year, and a bit of a cocktail of medications to take once to twice a day. My vet gave me a checklist to help make the decision of when the balance of quality of life had shifted toward euthanasia being the kinder option, and initially it was a pretty close call. I had to keep a very careful eye on how the new medication regimen was impacting the cat’s trust in me and relationship with me. He also had several significant ups and downs, including a couple that were big enough crashes that I thought that was likely it, before we got his meds and other care stabilized (including the not spitting the meds out on the sly later part). (It also turns out it doesn’t take much for dehydration to set in in a small animal, especially an unwell one; and unlike a lot of less treatable serious health issues, the negative impacts are rapid and obvious. It almost feels miraculous when the cat perks up again an hour after getting a subcutaneous fluid treatment. But I also learned how to syringe-feed him through short bouts of med- or dehydration-induced nausea and inappetite.)

Once the cat started feeling better, he started taking his meds in pill pockets most days. He also quickly started looking forward to the treat paste and brushing session he’d get after being pilled even before that, and started meowing at me to remind me if I seemed a bit distracted or late with pill times even before we got past the stage of the actual pilling procedure being quite stressful in the moment. And he was happy the rest of the time, and never lost his trust in me. Now it’s a year and a half later and he’s been stable and doing great for over a year, and seems likely to continue.

One of the local vets compared the head of the kitty cardiology department at the vet college to St. Francis, and they definitely worked some (scientifically based) miracles. But all of that would not have worked or been feasible with most other cats, probably, let alone a good balance of care. This cat’s temperament even during his hospital visits was fairly calm - that was noted in particular on his discharge papers, so I joked that he had been officially diagnosed as a total sweatheart. Mentioned this when I was back there for a check-up at one point and they were like, “Yeah? Yeah, that’s accurate. You can keep telling people that.” I also joke with my vet that the cat has a giant heart both literally and figuratively and that the figurative part is part of what has kept him alive. But the kernel of truth in that is that the initial period would not have been worthwhile (and he quite possibly simply would not have pulled through) if he hadn’t had an unusual degree of trust in me and bond with me. And I had vet insurance this time around and a higher salary, so the co-pay on the hospital expenses and the ongoing meds and special kidney diet food expenses are within budget for me (and still cost less than raising a kid, though a lot more than many people are able to spend on their pets). So that’s a very, very particular set of circumstances that would not apply to a large number of pets.

(The other cat in the household, for example, would be super stressed out by the car ride to just the local vet if she were as unwell as he was, let alone the trip to the hospital at the vet college. And I can’t imagine trying to pill her - she scarfs down any and all food, so we could probably hide some medicine in her food if it was just a small pill or something, or she might go for pill pockets. But if I had to pill her by hand or syringe feed her the way I’ve done at times with the other cat, the negative impact on her quality of life would be huge, in a way that hasn’t been the case for the other cat.)
posted by eviemath at 2:58 AM on November 30, 2022 [4 favorites]

I love my big old fluff ball. But I am also on the poor side of the ledger. If any big (i.e. expensive) emergency comes up, I'm afraid it's Big Sleep time.

So I do as much preventative care as I can for him – good food (including dental care dry food), keep his weight down, monthly worm/flea/tick treatment, annual shots and check-up, keep his claws trim, brush him every day, lots of cuddles, etc.

He just had his 12th birthday (been with me for 5 years). So far, so good. About as healthy and active as cats can be at that age. Though he is noticeably slowing down, and getting that just-couldn't-be-arsed-anymore look on his face as he begins the journey into old age. Something we have in common.

(And, jeebus, hasn't the price of good cat food gone up lately. And monthly treatments. Eek.)
posted by Pouteria at 3:36 AM on November 30, 2022 [6 favorites]

Both of our very old (one was 20.5, the other 18+) cats passed away earlier this year. The oldest died fairly suddenly in the middle of a snowstorm that would have made it difficult if not impossible to get her to a vet (my wife and I had decided to have her put down the night before because she had suffered a stroke or something and was unconscious). The other we had to have put down, which was incredibly sad but her quality of life had declined to pretty much nil, was not going to improve at her age, and she was clearly depressed. At their age we wouldn't have spent a lot of money on medical procedures, but as others have pointed out if there had been problems when they were younger it would have necessitated some calculations based on cost/probable quality of life moving forward.

One of my earliest lessons in household budgeting was my parents just straight-up telling my siblings and I that they *could not afford* an operation required by one by one of our childhood cats. We were all sad, but I at least was old enough to have an inkling of how much money was a lot of money in my family's context and I understood.
posted by The Card Cheat at 5:07 AM on November 30, 2022 [2 favorites]

My family historically has spent themselves into substantial debt for our creatures--surgeries and chemo for a young, otherwise happy dog with aggressive stomach cancer. Amputation, chemo, radiation for a hale and hearty middle aged dog with a leg tumor. (And somehow one dog who lived to be 21 with maybe 3 vet visits her whole life?? What the heck was her secret?) Hospitalization and IV meds for a kitten with a mystery infection. Etc., etc.

So when I got my own cat, just me, on my own, first thing I did was I bought some fuckin' pet insurance. A lot of folks I talk to seem to think pet insurance is a scam, because human insurance is a scam. But, at least in my experience, it is not. My cat was better covered for better care than I will ever be in this life, and I never had to consider the cost factor for her,* only the quality of life factor. Of course it turned out that no amount of money could give her that, and the pet insurance paid instead for one single hail mary of chemo, and then euthanasia.

When I finally remembered/had the fortitude to call the insurance company and cancel her plan, some months later, the guy on the phone literally started crying with me. They refunded her premiums for the months I hadn't canceled since she died.

This has been a PSA for pet insurance.

*I mean, sure, the cost factor of the 20 or 25 bucks a month for her insurance, which yes, I was fortunate enough to afford, but being able to pay 20 or 25 bucks a month doesn't necessarily add up to being able to pay outright for a 10K treatment.
posted by We put our faith in Blast Hardcheese at 7:00 AM on November 30, 2022 [7 favorites]

I always try to keep in mind that pets aren't living for things. They're not hoping to see their kids get married or write their last novel or whatever goals senior humans have in mind when they choose to undertake chemo or dialysis. If they're in pain, they're not thinking, "At least I can still do these five other things that are precious to me." They're living for their quality of life in the moment, and if they're not enjoying that, there's not much for them. And they don't fear death the way we humans tend to do--they fear suffering, which so many aggressive interventions entail.

All of which means...yeah...it's a complex calculus, but it has to be focused on whether the pet can still take, or is likely to be restored to, pleasure in its daily activities.

(And a dog I loved very dearly just died this month, so I'm going to go cry for a little now.)
posted by praemunire at 9:50 AM on November 30, 2022 [7 favorites]

And, yeah, pet insurance doesn't always cover everything you'd hope, but it's saved me hundreds just this year on my little guy, whose worst physical problem has been a nasty persistent ear infection.
posted by praemunire at 9:50 AM on November 30, 2022 [1 favorite]

This cat’s temperament even during his hospital visits was fairly calm - that was noted in particular on his discharge papers, so I joked that he had been officially diagnosed as a total sweatheart.

Years ago, we took a four-year-old Rottweiler mix through chemotherapy for cancer. She was such a sweet, steady girl that she was really happy to go to the cancer center at the university vet school even after she'd been through the discomfort of chemo. We've definitely had dogs who wouldn't have been able to handle it so well, and our decision might well have been different for them.
posted by Well I never at 5:31 PM on November 30, 2022 [2 favorites]