My editor at Dogster drew my attention to an article by David Grimm published on Slate: “How Far Should We Go to Save Our Pets?” It has an interesting subheading: “Veterinarians with wondrous new treatments face an ethical dilemma.”
The article briefly covers the history of veterinary medicine and accurately describes the evolution of the role of veterinarians in society over time. In the olden days, vets were akin to auto mechanics who used crude methods to fix beasts of burden. Now we are more like pediatricians to four-legged family members. Throughout my career my sole interest has been companion animals, and I think Grimm’s assessment is spot on.
The article then goes on to discuss money. Alas, veterinarians have always had a really rocky relationship with money. We don’t make anywhere near as much of it as many professionals, such as doctors or lawyers, with comparable educations.
Over the years I occasionally have heard people disparage veterinarians by claiming that they are “in it for the money.” That is hogwash. Any vet who wanted money would have been a doctor, lawyer, or hedge fund manager. Every vet among us went into the profession fully knowing that it doesn’t pay as well as it should. Vets are a class of people that have effectively shunned money. And many among us also don’t think they deserve money. The social norm among veterinarians is to take pride in loving animals, and to think about money as little as possible.
Here is where the problem lies: Vets assume that everyone is like them. Vets don’t value the services they provide, and they worry that nobody else does, either. They assume that people don’t value veterinary services, and that people don’t want to spend money on those services.
That assumption has increasingly been clashing with reality in recent years. As Grimm points out, “A recent poll found that nearly two-thirds of people would pay up to $1,000 to save their animals, with another quarter ready to fork over $3,000 or more.”
This dissonance between what vets think about what their clients think, and how their clients actually think, is a recipe for danger. It may needlessly be placing pets’ lives at risk. From the article:
All of this might seem like good news for vets, but they’re struggling with the issue. “It’s wonderful that people are willing to spend $10,000 or $20,000 to deal with their sick pet, but ethically it puts us in quicksand,” says Douglas Aspros, the former president of the American Veterinary Medical Association and the manager of a veterinary clinic in White Plains, New York. “If a client wants me to do a $20,000 surgery on a cat, the practicality has to go beyond, ‘There’s someone willing to pay for it.’ As a society, should we be promoting that?”
Dr. Aspros, I disagree. Vets are not in fact in an ethical quicksand. And I believe that your comments are emblematic of an dangerous paternalism that is epidemic among veterinarians.
First, to be clear: I know that $20,000 is a lot of money. Would I be willing to spend that much money to save my pal Buster’s life? In truth, I can’t say. It is a lot of money for a guy who chose a relatively poorly paying career. But I do know one thing for sure: How I spend my money is none of Doug Aspros’ damned business, or anybody else’s for that matter. If I want to spend my hard earned cash on my dog, Dr. Aspros, where do you or anyone get off telling me not to?
Consider as well that for some people, $20,000 is not a lot of money. Remember the doctors, lawyers, and hedge fund managers from earlier in this post? How about venture capitalists and Silicon Valley executives? Is it not their right to spend their considerable wealth in the manner that they chose?
Here is what gets my goat about Dr. Aspros’ statements: In my opinion they include an implicit assumption that veterinarians know better than their clients how money should be spent. It implies that we must somehow protect clients from themselves.
When I practice medicine, I treat my clients like the responsible adults that they are. I believe they deserve to be treated with dignity and respect for their free will. It is not my job to tell them how to spend their money. How my clients spend their money is nobody’s business but theirs. It most definitely is not mine.
When I am involved in cases, I face no ethical dilemmas of the type described by Dr. Aspros. I simply explain what the treatment options are. I describe the advantages, disadvantages, and likely expense of each option. I am careful to explain the likelihood of success or failure with each option. I make every effort to help my clients make informed decisions. And then, crucially, the decision is theirs to make. I have no business making it for them.
Also crucial to the process is respecting the decision that the clients make. I do not judge. If clients cannot afford the best treatment, I do not judge them because their finances are none of my business. If a client chooses to spend thousands of dollars on a treatment that has a low chance of success, again that is none of my business. (Although it is my business to ensure that the treatment is humane, and that the clients are aware of the low chance of success.)
I worry that veterinarians who think in the manner outlined by Dr. Aspros may take the step of not mentioning expensive treatments to clients. Such behavior, in my opinion, is outright paternalism. Even if a client can’t afford a $20,000 course of chemotherapy, that client is entitled to know of the treatment’s existence. And how can a vet know what a client can or cannot afford, anyway? Clients also have the right to know when a less expensive treatment option may be as effective as a more expensive counterpart.
In fact, I don’t merely worry that such paternalism occurs. I know it does. I saw it when I treated a Chihuahua for kidney failure. The dog had been sick for days, and had seen another veterinarian who did not even offer to run tests that might have caught the condition before it was too late. I saw it when I treated a dog in heart failure whose former vet had recommended euthanasia because heart failure treatment was “really expensive.” I have seen it in many more cases than I care to recount.
Over the years many of my clients have declined expensive treatments that they could not afford. Others have elected eye-wateringly expensive procedures. I take pride in having made my clients aware of their choices, and I take even more pride in having respected their choices.
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