One of the most common things I hear from veterinary clients is: “What would you do if it were your pet?” I sometimes reply that of course I would do exactly the same thing to my pet. Or to my parents’ pet. Or to my neighbor’s pet. To be honest, I didn’t come up with these various lines. I borrowed them from the surgeons who trained me during my residency. Sometimes, because emotions might interfere with my judgment if it were truly my pet, I reasoned, I’ve always thought that it was not a fair question, which I’ve told many clients. Other times, it feels like a silly question. Hopefully, my pet would not have been walked off leash and therefore would not have been hit by a car. Hopefully, I would not have allowed my pet to grow a tumor bigger than his head. Hopefully, I would not allow my great Dane or German shepherd to go through life without a prophylactic gastropexy. In other words, many avoidable situations would hopefully be avoided. But in other cases, I realize that “What would you do if it were your pet?” is a very fair question. After all, these clients want to learn from our experience with similar patients. Of course, there is no question that I would perform a total ear canal ablation, do a tibial plateau leveling osteotomy or remove a foreign body. These are easy decisions. I am referring to the really tough or borderline ethical situations. Would you recommend a “half-facectomy” in your own 14-year-old beagle with a nasty tumor involving part of the cheek, the base of the ear and one eye? On a dog with a heart murmur? Would you recommend intestinal resection and anastomosis in your own 16-year-old cat in which you suspect focal cancer? Would you recommend a hemi-pelvectomy in your own 12-year-old Lab mix with an invasive myxosarcoma of the caudal ilium (see photo)? We have the technology to perform these surgeries. In fact, I have done these very surgeries (on client-owned pets). Other surgeons have. We have all kinds of analgesic modalities to make these pets surprisingly comfortable. Still, I didn’t sleep very well those nights. Is it fair to those pets? Would I do it to my own pet? Sometimes I’m not so sure. Which is why in extreme, difficult or ethical situations, I always have a long heart-to-heart with the clients to make sure they understand the whole concept they’re getting into, complications and all. Communication is always paramount, and it’s especially true in these tough cases. A few times, I have actually refused to perform surgery when I thought that it was not in a pet’s best interest. Primum non nocere. One case comes to mind: a young, childless couple presented with a 16ish-year-old cat with a large, aggressive mass involving the rostral mandible. It was likely squamous cell carcinoma. They were in complete, utter denial. To them, euthanasia was not an option. The cat was pitifully cachectic. Would you have done surgery? They begged me to remove the mass. Oh sure, technically, it was possible. A quick mandibulectomy, a quick feeding tube, and voila, I’d cure their cat! Right? When I refused, they offered more money. When I refused still, they said I just didn’t care about animals. (Usually angry clients say we’re in it for the money — you just can’t win!) Thankfully, most pet owners and I are on the same page. Even though some decisions are truly difficult, we hopefully make the right one for the vast majority of clients and patients.
