Euthanasia: Hard times call for hard decisions

National Report — "I think every family and every individual has a limit in their mind — not only cost, but stress to the pet — that they will reach before they stop treatment," says Jennifer Hicks, a small-animal veterinarian at Brookville Road Animal Hospital in Indianapolis.

Easing the burden: "We see a number of people who have lost their jobs," says Dr. Jennifer Hicks of Indianapolis. To accommodate them, her hospital looks for cost-saving ways to help them afford to treat their pets.

As the recession widens, the decision to treat or euthanize is coming earlier, DVMs say.

On average, veterinarians report most of their clients will refuse or stop treatment for their pets at $1,407, according to an exclusive DVM Newsmagazine survey (see story on p.18 for past comparison, other findings).

But that amount varies widely from region to region — from $100 to $1,700-plus.

In the Midwest, arguably the hardest hit economically, veterinarians report clients stop treatment on average at $1,175. In the Southeast, the number is $1,383. In the Southwest, it's about $1,460, while veterinarians in the Northeast report the highest stop-treatment point, about $1,747.

Gary Holfinger, of the East Suburban Animal Clinic in Northwood, Ohio (near the state's northwest corner), says his clinic definitely sees the effects of the brutal economy.

Not only are veterinarians seeing an earlier stop-treatment amount, but also fewer clients willing to go through the expense of testing to rule out or confirm various illnesses and disease.

Basic medicine: While Dr. Jennifer Hicks would like to send in every tumor for a biopsy, she knows that's not an option in her Indianapolis practice.

"Unemployment is high in our area of Ohio, Michigan and Indiana," he says. "Whether people have the cash flow now or not, they are trying to hold on to what they have because they think things are going to worsen."

While Holfinger sees the stop-treatment point at $700 to $800 at his clinic, it's been consistent, despite the economy.

What has taken a more drastic hit is diagnostic procedures.

"We're not doing as many work-ups, and more empirical treatment is becoming the norm."

Hicks reports her clinic's stop-treatment point is about the same as Holfinger's, but in some cases less.

Quality vs. cost: Owners want to do what is best for their pets, but they can't always pay for it.

"We see such a variety of lifestyles and incomes here," Hicks says. "We do have clients, especially right now in this economy, who stop sooner. And we have clients who say do anything necessary."

Adjusting to clients' needs

Hicks' practice, slammed by the recession, altered its strategy for clients.

"We see a number of people now who have lost their jobs. They want to do these treatments, but we may need to adjust the length of the hospital stay or do the procedures as out-patient in order for them to afford them." Still, owner-initiated euthanasia continues to be done mainly due to poor prognosis, Hicks says.

"Without any form of other treatment, it's uncommon," she says. "I wouldn't call it rare, but uncommon. We usually can find an alternative. It may not be the best treatment, but it is a form of treatment or option, whether that's finding medication or a behavioral class."

The stop-treatment point had been steadily climbing until this year.

In 1997, it was $576, but jumped to $795 in 2000. By 2003, the number was estimated at $961, according to past DVM Newsmagazine surveys.

This year, only 28 percent of clients didn't base their decisions soley on cost, which is down markedly from 41 percent in 2006.

For those who said cost was a factor, 33 percent still agreed to recommended treatment, which is consistent with the previous few years.

Despite the overall decline, 72 percent of veterinarians believe that their clients' decisions to opt for euthanasia for sick animals is about right.

Educating owners

"For me, it's education," Hicks says. "If the owner understands what is happening with his or her pet and how to change the possible outcome, they are more likely to proceed, or they will find the means to do what is necessary. If you stand there and tell them you will do this, they don't understand and they won't proceed."

Discussing euthanasia as an option remains important for owners, and it's something that is not done enough. Waiting until a pet is completely debilitated only prolongs its suffering and that of the owners, Hicks says.

But euthanasia does happen too often with behavior and dermatology issues, unfortunately, Hicks says.

Overall, Hicks says she is seeing an increase in strays and microchips, but not in euthanizing healthy pets.

Holfinger has not seen an increase in requests for euthanizing otherwise healthy animals, although adoption requests seem to be on the rise.

Owners still want what is best for their animals, however.

In some cases, owners may opt to treat symptoms, as opposed to searching for a greater threat, he says. In many instances, the animal will respond.

It's when the pet doesn't respond and the owner decides not to pursue further testing that the economic impact can be seen.

"We try to give them a pattern we would like to pursue," Holfinger says. "We help pace out their diagnostics, not to drag a problem out but to give them some understanding of the order of dominance and help spread out payments.

"It just takes empathy."

Understanding that the owner is financially burdened is a step in the right direction, Holfinger says.

But skimping on veterinary care doesn't pay, Hicks says.

"One client who wouldn't spend $300 here ended up spending 10 times that much in an emergency hospital," she says.

Spending based on means

In the end, how much an owner is willing to spend depends on their finances, according to C. Earnest Wyatt of the Northwest Animal Hospital in Oklahoma City.

He has clients who are willing to spend as much as $1,000 on their pet and as little as $100.

"I had one guy who came in yesterday and said, 'I have $50," Wyatt said. "The type of person who only has $50 in their pocket is not going to do anything for the dog. What would have helped the dog was trimming its nails, but he wouldn't even trim the nails. The other part of the problem was arthritic, but he wasn't going to treat that, either."

On the other hand, Wyatt says the amount that veterinarians charge to keep an animal alive has gotten out of hand.

After suggesting one client take her dog to a specialist, Wyatt called to get a quote for her.

The estimate was $1,200 for tests and $3,000 if the dog needed surgery.

"Four-thousand or $5,000 for a dog," he questions. "It's just a mixed-breed dog and these people didn't have the money. People are upset because of the charges vets are charging. It's just too expensive."

And it's not just the sick dogs who are expensive.

"It's not necessary to do blood work on every dog that walks in the door," Wyatt says. "That's the vet's job, to look at an animal and do a differential diagnosis."

While Wyatt hasn't noticed an increase in patient-requested euthanasia, he does say that the lengths some clients will go to keeping an animal alive have gotten out of control.

"I'm not in favor of treating a dog that is dying unless they want to treat it," he says. Even then, Wyatt does not believe chemotherapy or radiation treatments are in the best interest of the animal.

The economy hasn't had much of an impact on veterinary services in the South yet, Wyatt says.

"I'm sure it's going to," he believes.

Hicks says the Indianapolis area already sees the effects of the economy. "We get into cases with owners who are willing go beyond a couple hundred dollars," Hicks continues. "I don't see $1,400 here. We're at the edge of a big city. We see both pets and work animals and there is a difference in what owners are willing spend. The work animals that are not pets, we see much less spent on them, hunting dogs, for example. They spend their life in a kennel. They have a job to do. When they can no longer perform that job, they're no longer useful. We still have farmers who want us to see their animal in their truck."

"Every tumor I take out, I'd like to send in," Hicks says. "But that extra $75 might be a hardship for the client. I wish quality of care were available for every client — not just those who can afford it."

On the Web

Euthanasia is considered a gift to end suffering. At what point, financially, do your clients choose that option?

We want to hear from you. Is an average stop-treatment point of $1,400 about right for your area? Is it too much? Not enough?

Let's talk about it.

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