When they encounter a terminal illness in their pets, some owners will do anything to prolong their lives.
More than 99% of 474 veterinarians surveyed said they have encountered useless or unhelpful veterinary care in their career, according to a new Cornell-led study documenting the prevalence of pointless care for the first time.
The authors use a working definition of futile care as ongoing treatment when relevant goals cannot be reached.
“Before Cornell, I had a private practice in Los Angeles for 11 years. Dr. Nathan Peterson, associate clinical professor of emergency and critical care and lead author ofMedical tampering is commonly encountered in small animal clinical practiceIt was published May 18 in the Journal of the American Veterinary Medical Association.
“But I also had an obligation to the owner,” Peterson said. “I couldn’t do what I thought was right. It’s really sad for the vet and for the technicians and nurses who have to do the care.”
The study, which was co-authored by researchers at Harvard Medical School’s Center for Bioethics, found that 89% of vets said they provided care that was useless, and 42% said it occurred more frequently, more than six times a year.
Veterinarians’ sense of obligation to pet owners was reflected in the data, with 60% of respondents agreeing that every treatment option should be offered to owners, 76.3% agreeing that careless care benefits owners in some way, and 56.6% empathizing with pet owners. Feelings and desires of the owners.
Ironically, an owner-centered approach, the authors wrote, can exacerbate ethical distress for veterinarians and care teams. Previous research by co-authors showed that futile veterinary care was responsible for frequent and severe moral distress in the veterinary community, which they said occurs when a physician believes he knows the right thing to do but is prevented from doing it.
“We’re in the midst of a mental health crisis in our profession, and we’re very interested in whether futile care is contributing to that, which I suspect it does,” Peterson said. “We felt the first step was documenting this happening. I hope the research opens up conversations about futile care, and I hope that professional organizations can take a leadership role and try to provide some guidance on how to resolve these conflicts.”
Factors that influenced veterinarians’ decisions to provide futile care included allowing owners access to be present for euthanasia, meeting an owner’s request by exhausting all treatment options, and responding to owners’ failure to understand the seriousness of the pet’s condition.
These dilemmas have become more prevalent in recent years, Peterson said, as medical advances used for humans have become available in veterinary care. “Now that we have dialysis, mechanical ventilation, a lot of technologies to keep patients alive — that really broadens the line around what kind of restrictions we’re going to put in around what’s in the best interest of the patient,” Peterson said.
To illustrate these gray areas, the authors suggest a definition of useless care in the profession—responders were not in complete consensus about what pointless care means—as well as guidance on how care decisions should be made. A shared decision-making model, where all stakeholders can agree on treatment goals and whether or not they can be reached, as well as a transparent and structured approach to assessing the owner’s ability to discuss and understand the diagnosis can help. Guidance and discussions about positive autonomy – the right to seek treatment – are also needed.
“I think as a profession we’ve been focused for a long time on alleviating suffering by continuing treatment and making animals healthier,” Peterson said. “And we are not prepared to aggressively advocate for euthanasia, to have those conversations, even when we think this is the best way to alleviate the suffering.”
In future research, Peterson hopes to investigate the impact of pointless care on support staff. “This sense of powerlessness for a vet is certainly amplified for technicians who are often not involved in decisions and are directly responsible for providing care,” he said. “It really motivates me to look at the toll this is taking on them.”