Ethical dilemma: Discussing rabies testing after euthanasia

Fritz was a 16 year-old-cat who had been Dr. Gleason's patient since he was a kitten. At age 14 Fritz developed diabetes, and his chronic feline gingivitis worsened. In addition to providing appropriate treatments, Dr. Gleason exempted Fritz from his mandated rabies vaccination. He felt that Fritz's diabetic status and immune-mediated disease might have been further compromised by vaccinating him. In addition, his house cat status and advanced age made him a low-risk rabies candidate.

Late one evening, while Fritz was sitting in the window of his suburban house, he became disoriented and fell. The owner found Fritz in the back yard one hour later. Fritz was distressed and unable to walk. The owner felt that Fritz had suffered enough with his multiple diseases and senile deterioration, so he presented him to Dr. Gleason for euthanasia. The veterinary team took the cat to the treatment area for placement of an IV catheter before he was brought back to the exam room for the euthanasia procedure in the presence of the owner. During the catheter placement, restraint distress caused Fritz to bite a technician on the arm. The technician promptly tended to her wound, and then she went to the local walk-in emergency clinic. Fritz was then euthanized in the presence of the owner, who requested a private cremation.

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State regulations compelled Dr. Gleason to have Fritz's brain checked for rabies—an unvaccinated cat had bitten a human. Observation for a necessary 10-day quarantine was out of the question. And while this was a provoked bite by a house cat, Dr. Gleason did not think it was his place to violate state requirements. In addition, his technician wanted to be absolutely sure this was a rabies-free animal.

After he completed the euthanasia, Dr. Gleason consulted with the owner. In a gentle and compassionate fashion, he told the owner that Fritz had unintentionally bitten a staff member. When this happened in their state, the doctor had to ensure that Fritz's remains were tested for rabies. The veterinarian mentioned that the state would bear the lab costs involved but that a small preparation fee was required. The pet owner was distressed, but he granted permission for the testing and felt bad that a staff member had been injured.

Five days later, the rabies test came back negative. The pet owner called Dr. Gleason and was clearly distraught. He had read on the Internet that the only way to test his cat for rabies was to remove the head and access the brain. He was upset that his cat had to be disfigured and felt that Dr. Gleason had been dishonest with him about the details. Dr. Gleason replied that state law mandated the procedure. Dr. Gleason also believed that discussing graphic details at the time of euthanasia would have created undue trauma to the pet owner. The owner chastised Dr. Gleason for his deception and accused him of sullying the memory of his beloved cat.

Do you think that Dr. Gleason acted in an unprofessional manner?

Dr. Rosenberg's response

The need to remove the head of a beloved pet for rabies testing is aesthetically repulsive. States wouldn't mandate it if the consequences of rabies were not so potentially devastating to human bite wound victims. Dr. Gleason's hesitancy to forthrightly discuss this with the pet owner also involved the circumstances of the bite. This provoked bite occurred while he was preparing the pet for humane euthanasia. He may have been feeling guilty about exempting Fritz from vaccine requirements due to his advanced age and disease. He also may have felt that he was partially responsible for the bite wound occurring.

In this case, Dr. Gleason's heart overruled his professional judgment. A clinician's obligation is to be honest and professional when discussing a patient's needs with the owner. There is a fine line between massaging the truth and deception. In this case, Dr. Gleason was deceptive. He should have told the owner that the head had to be removed and that this would be done with as much dignity to Fritz as possible. Dr. Gleason acted in an unprofessional manner.

What are your thoughts?

How would you have handled this ethical dilemma? Dr. Rosenberg and DVM Newsmagazine would like to know. E-mail us at dvmnews@advanstar.com or post your thoughts at dvm360.com/community.

Dr. Rosenberg is director of the Voorhees Veterinary Center in Voorhees, N.J. He is a member of the New Jersey Board of Veterinary Medical Examiners.