Urban Jungle
This week: ethical dilemmas
My clients present me with many obstacles and challenges. Some are mental challenges, such as when I am presented with an animal with a rare condition that may send even the most experienced vet back to the textbooks. Others are physical challenges, such as when the nurse and I are wrestling with an angry bulldog to obtain a blood sample; or challenges of dexterity, such as suturing a ruptured blood vessel; or a test of patience, such as trying to explain a complicated situation to a child or someone who just doesn't listen.
But I have always found the moral and ethical challenges the hardest to face. These rarely have easy answers and I have found that as I mature and grow in experience, my attitudes have changed, too. For example, when I was younger, I found the question of when to euthanise an animal an easy one. My criteria for such a decision was well defined, or so I thought at the time. I would recommend euthanasia when there was no hope for a cure and the animal was suffering - suffering being defined as a lack of quality of life or severe constant pain. I defined quality of life as being able to carry out the basic necessities of life, such as walking or some other form of mobility, eating and drinking, and the ability to urinate and defecate without the animal soiling itself. These were the core factors I considered before recommending euthanasia, and even now I think they are a pretty sound foundation for the decision.
But experience has taught me there is a broad grey area in which the above simple rules can be dead wrong. It is all a matter of perception. It is the perception of the owner of the animal that counts the most; my perception can only be used as a reasonable guide.
I remember a case a few years back when I was presented with a cocker spaniel. It had a bladder tumour that had caused a urinary obstruction. It was unable to urinate because the tumour had spread down its urethra. All attempts at getting a catheter through to the bladder had failed. The only thing keeping the dog alive was regular draining of the urine with a syringe and needle directly puncturing the abdominal wall and bladder. This problem was compounded by the fact the dog had uncontrolled diabetes, which was causing its blood to become very acidic - also a life-threatening situation.
On top of this, the dog had been unable to get up and walk for six months because of severe arthritis, resulting in the development of pressure sores all over his body. Because of the previously undiagnosed diabetes, these open sores never healed properly. This dog was definitely suffering chronic severe pain, immobility, terminal illness and loss of appetite and was soiling itself constantly. There was pretty much no hope, and euthanasia was a reasonable option.
Surprisingly, the owner declined euthanasia despite all the evidence of suffering. I tried my best to explain the situation, at first in a mild manner, later rather bluntly. I felt the dog was in immense pain and I felt really bad to see it suffering like this. I felt even worse when I had to introduce more pain by sticking a needle into the bladder regularly to drain the urine, even when I used morphine to dull the pain. In my mind, keeping this dog alive was cruel.
The owner's reason for not putting it down was that to do so went against her religious beliefs. This is the only remotely reasonable excuse I can think of. She said she was a devout Buddhist and her interpretation of the strictures of the religion was that taking a life was wrong. This was ironic because I believe, as a devout Buddhist, that euthanasia is okay to prevent suffering.
At the time I was not in a position to deny someone else's religious faith, and hers was very strong. All I could do was provide as effective pain relief as possible and encourage her diplomatically to ask her Sangha (Buddhist spiritual community) for more advice. I don't think she bothered, though. At the time I was angry with the client in private. I displayed as much disapproval at her choice as my professionalism would allow.
Now that I am older and hopefully a little wiser, I have a different opinion of the situation. I have learned to see the situation from the client's point of view; it is her perception of the case that is most important. I still think her decision and the basis on which it was made were wrong, but my own beliefs are irrelevant in the decision-making process. In her mind she is right, and killing is wrong.
Perhaps she just wasn't brave enough to make the decision and her excuse was a diversion. I don't know. But that is my point - I don't know that there is a 100 per cent correct decision. I can't blame anyone for being afraid of making that final, tough decision. So nowadays I am a happier person and never get angry at a client, even in private.
