September 27, 2006
Death is part of every life
I came away from my PBL class (post below) feeling like there was an answer (maybe many) to be had, but that I just couldn't see it. I gave lots of thought to the matter, plumbing my feelings about what my responsibility as a vet will be. People look up to veterinarians not just for their clinical knowledge, but for their [supposed universal] compassion and insight. With this in mind, I asked myself what I would consider when presented with the task of helping my clients prioritize their decisions. Boiled down, I found lots of ethics and opinions of my own. Obviously, I should not allow these personal beliefs and conclusions cloud my consultation. So what insight can I offer? Again, after much consideration, I realized that this is what I can offer:
We in the west (as Mick has so poignantly pointed out in a comment below, and as Mom has reminded me this morning) are generally not okay with death. This leads to occasional circumstances (more common than one might realize) where inordinate amounts of energy, time, thought, emotion, and resources are poured into a situation than is necessary, or even significantly effective. That is, one can eat right and exercise as much as possible, and the person will still die. Similarly, we can ultrasound, blood transfuse, treat with antibiotics, and monitor an old cat with chronic renal disease, but the cat will still die (and probably sooner than an old cat without chronic renal disease). So, then, is it worth all the energy to try to keep it alive? Well, the worth is something that each person will have to decide for themselves. However, one point that we can always remind them (and ourselves) of, is that "death" in and of itself is a neutral essence. It doesn't matter if something is alive or dead. It really does not matter. That isn't to say that we won't miss a person or animal (or plant) if it dies, especially if it had a positive influence in our own lives (we will also miss them in a negative sense if they had a negative effect on our lives)--but note that we place that importance on the life; it is not inherent. Similarly, my life seems important to me while I'm alive, but if I'm not alive, then it doesn't matter at all. As long as I am able to contribute to the world, and enjoy the world myself, my life is worthwhile to me.
This brings us to the second point to remind our clients (and ourselves) of; suffering is something that is uneccessary, and it can be dealt with. Some suffering may be worth the sacrifice to get through to see the other side (vet school for instance). This sort of suffering may increase the contribution and enjoyment of self and others in the world. But other sorts of suffering are simply unneccessary. As doctors, we can attempt to alleviate suffering through treatment and care. This runs the gamut from prevention, to antibiotics or surgery, to euthanasia. As we consider what treatment or care to use, it is important not to keep euthanasia as a last resort, but as a method of alleviating suffering equal in viability as anything else. With this in mind, and truly accepted (DEATH IS NOT BAD), the options can be considered more clearly. Euthanasia is often not so much a question of "artificially ending" a life, but of determining when to cease artificially extending (via medicine) that life.
Worth can be measured in the ability of something (person, animal, etc) to contribute to the world around them, and (in the case of living beings) the ability to appeciate the world around them. As an owner, part of the measure of your own worth to the world around you is by how you distribute your resources. Resources may be allotted to your pet, or may be to your family, or your job, or charities, and so forth. Therefore, when presented with a situation in which euthanasia is a viable treatment alongside an expensive or time/labor-intensive treatment, it is not necessarily "selfish" to weigh the considerations of cost as a reason to opt for euthanasia. If your resources are better put to use in other realms and the ability of the animal to contribute to or enjoy life is compromised, then euthanasia may be appropriate. Not good, not bad, but appropriate.