Pets and Ethics : Veterinarians Rethink Euthanasia and Other Common Practices

It is a veterinarian’s nightmare. A Los Angeles family appears at the vet’s clinic with a healthy, well-behaved, 2-year-old German shepherd.

The husband has been transferred to New York City. The family will be moving from a Southern California suburban home with a yard to a cramped one-bedroom Manhattan apartment to which, they believe, the dog will be unable to adapt.

Will the veterinarian, the man and woman ask, get them out of this dilemma by putting the dog to sleep?

A Moral Conundrum

Although a hypothetical example, the couple’s plight and their intended solution represent a moral conundrum veterinarians see with some regularity in their practices. And, although most are reluctant to discuss their personal experiences with what is known as “euthanasia for convenience,” most agree there is steadily increasing attention to the ethical considerations of euthanasia, as well as discussion of the moral defensibility of such commonly accepted practices as ear trimming, tail docking and the declawing of cats.

To Jerrold Tannenbaum, a lawyer who teaches biomedical ethics at the Tufts University School of Veterinary Medicine in Boston, that the dilemma posed by this hypothetical example is even being widely and publicly discussed among veterinarians represents an important trend.

Fifteen or 20 years ago, said Dr. Walter Martin Jr., the Nashville-based president of the American Veterinary Medical Assn., chances were good that the German shepherd in question would not have lived out the day.

But today, Tannenbaum and Martin said, a new focus on bioethics--which has preoccupied human medicine for a generation--is transforming the way veterinarians are trained and the way they think.

As a result, Martin said, the family with the German shepherd could probably still find a veterinarian who would kill the dog. But in most urban areas, he said, their choices would be limited and the search prolonged. They might resort to leaving the dog at a pound, where it would likely be killed, if it was not adopted, simply because of the oversupply of pets in need of good homes.

Bonds Between Humans, Animals

Tannenbaum, who is married to a veterinarian and who has conducted research on the bond between humans and animals, has just taken a quiet, if prominently symbolic step, in ethical consciousness-raising: He has published a textbook on veterinary ethics that is widely viewed as the first work of its kind.

Many point out that this ethical ferment is occurring as the profession--influenced by such divergent factors as the animal rights movement and studies affirming the psychological importance of contact with animals--is reconsidering the traditional attitude that pets are property that humans own. “I see more people in the field admitting their feelings for animals and being sensitive to the fact that the animals may have some rights that didn’t seem to exist before,” said Dr. Victoria Voith, of the University of Pennsylvania veterinary school and an expert on animal behavior problems.

“The more we have studied animals and realized that they have what are apparently emotions and social groups and the ability to solve problems, we have realized that perhaps they’re not as different from us as we were led to believe,” Voith added.

Even basic veterinary nomenclature is being altered. Because the word “pet” implies the status of owned goods, the drift, in veterinary literature at least, is toward replacing the word with the term “companion animal.” And today, said Dr. Jacob Antelyes, a New York veterinarian who has written a series of columns on the human element in veterinary practice in the Journal of the AVMA, veterinarians routinely refer to animal owners as their “clients” and to animals as their “patients” to emphasize the patient’s rights, even though the human is paying the bill.

Tannenbaum, for one, was explaining the need for veterinarians “to have a deliberative process,” when he interrupted the telephone interview to put down the receiver and assist the elderly, blind dog that lives with him and his wife as it tried to climb onto the couch.

Very Difficult Issues

“These are very difficult issues,” Tannenbaum continued from his Boston home. “My general principle would be for the veterinarian to think about life, instead of death, and in all possible cases to try to save the life of every animal.

“If the dog is a puppy, it may be easier to place it in another home. But I am not comfortable about putting even an elderly dog down. The ethical obligation may even be stronger in the cases of older animals that have been with the family for a number of years. It would be like putting down a grandmother.”

Tannenbaum contends that in many cases of requests for convenience euthanasia, “the client really wants to hear an objection.”

“I advise veterinarians not to be bashful about expressing their concern for pets,” he said. “If the veterinarian says, ‘Do you really want to do this?’ there is often a sigh of relief.

“There are, for instance, many apartments in Manhattan that do permit animals,” he added. “There are many misconceptions about large dogs. Some of them, such as great Danes, do very well in small places. A number of people in Manhattan have German shepherds.”

Martin and Antelyes agreed that thinking about a veterinarian’s proper role also raises ethical questions about how they market their services. In fact, said Martin, the AVMA is currently rewriting large sections of its ethics code to address concerns about marketing. Antelyes, for example, would like to see controls on the entrepreneurial urges that have produced such suggestions as the possibility of dying the graying muzzles of aging dogs.

“One guy (a veterinarian),” Antelyes said, “even asked me about opening a liposuction clinic for dogs.”

Tannenbaum’s book, “Veterinary Ethics” (Williams & Wilkins)--intended as a basic text for bioethics courses now offered at most veterinary schools--covers a wide range of ethical situations and offers counsel on services that traditionally have been reliable sources of income for vets but are currently the object of ethical rethinking.

Cropping Tails, Trimming Ears

Three such practices are cropping dogs’ tails and trimming their ears--supposedly to enhance appearance--and declawing cats to minimize damage to furniture. Martin said there is a clear trend away from ear cropping, but the practice continues because breeding groups insist on uniformity of appearance. Shortening of tails--”tail docking” in veterinary jargon--is much more controversial, Martin said, since many ethical veterinarians believe it may enhance a dog’s hygiene.

Tannenbaum noted that declawing cats is a crucial controversy since it leaves a cat that somehow gets out of its residence without an important defensive weapon. Too often, Tannenbaum said, routine declawing of cats when there is no evidence that the owners have tried training the animal away from its bad habits, is an example of choosing an easy solution. Tannenbaum contends that veterinarians must resist such choices, even if it means a fee will be lost or a client may take a cat out of the practice.

Tannenbaum and Dr. Jim Wilson, a veterinary bioethics expert who teaches at both the UC Davis and University of Pennsylvania veterinary schools, agreed the animal rights movement has intensified the trend toward attention to veterinary ethics.

But the two experts said many other factors are involved. Among them:

* The growing dilemma--paralleling that in human medicine--as more and more technologically sophisticated treatments make it possible to treat more and more patients, but at vastly increased cost. For the veterinarian functioning in a system where prepaid insurance plans are still rare, a moral dilemma presents itself when a vet can beneficially treat a patient, but the client simply can’t afford the fee--which can range between $500 and $4,000.

This will only worsen, Wilson said, as technology advances. For the veterinarian, the situation can be wrenching. “ . . . a client’s inability to pay results in the vet being forced to help the client justify a decision for euthanasia,” Wilson said, “when, in reality, it is directly opposite to the veterinarian’s view that he knows he could help this animal.”

* A parallel problem in which the veterinarian must make increasingly fine distinctions about when the point has arrived that a terminal illness or injury necessitates euthanasia--since the animal has no realistic chance of recovering or is in a continuing state of suffering.

“Veterinarians are going to have to get more involved in the area of ethnics of making a decision on euthanasia for an older animal or severely ill one,” Voith said. “At what point do you really start encouraging the owner to make that decision, as opposed to continuing to treat an animal? As we get many older animals in the pet population (with their lives extended by better treatment technology) this may become more of a dilemma. Obviously, the veterinarian can’t kill the animal without the owner’s permission.”

* The changing perception of the role of animals. “There have always been people who treated their animals as members of the family,” said Tannenbaum, but more people are treating them this way and they are less embarrassed about it.

“One theory is that, as our society is increasingly urbanized and increasingly cut off from the natural world, we take companion animals in part to re-establish this connection with the natural world. Another is the increasing evidence that animals are good for people in terms of their health. People live better and longer with animals.”

* The changing nature and composition of the veterinary medical profession itself. “Today’s students are so different,” Wilson said. “When I graduated in 1968, euthanasia for convenience was an accepted standard with which veterinarians simply complied. Of my classmates, 90% of us grew up on farms and we were all men. We looked at our animal patients as economic entities. Today, 70% of our students are women and 90% of our students grew up in the city.

“Today’s young graduate basically will deny requests for euthanasia for convenience, whereas the next generation older (Wilson’s own generation) will maybe go along, and the next generation, which graduated in the 1950s, many of them are still in the mode of simply responding to the client’s wishes.”

Ironically, Tannenbaum said, this ethical evolution in veterinary medicine may well influence human medicine as it comes to grips with euthanasia issues. “In human medicine,” he said, “this is a new idea. Veterinary medicine has been dealing with euthanasia for generations. I think human medicine has a great deal to learn from veterinary medicine. If you had said this to a physician 10 or 15 years ago, he would have laughed.”