‘It’s not about the money’ and the cost of saying goodbye
By Gina Spadafori
February 3, 2008
Whenever someone says, “it’s not about the money,” I always figure it probably is about the money. And I bet nobody hears those words more often than a veterinarian, now that nearly every option in human medicine is available in veterinary medicine. How far do you go? And what factors into your decision to choose euthanasia before all medical options have been explored?
What got me thinking about this was an essay in the Washington Post this morning by Jonathan Yardley, the Post’s book editor. He writes about his decision to say goodbye to his dog instead of going forward with more veterinary care:
The staff at the cardiology center and the cardiologist herself were uniformly wonderful, but the price was steep: A single five-minute sonogram ran a cool $340, and an overnight visit four days later came to $1,012. We paid all this readily, just as we paid the grand total of $2,341.56 that Reggie’s treatments and medicines ultimately cost. Indeed, we paid with gratitude for the availability of expert counsel and state-of-the-art equipment, but the whole experience served to impress upon us that veterinary treatment now approaches human medicine in the opportunities and expenses it entails.
(Actually, it’s not even close to comparable costs for the same procedures in human medicine, but specialty veterinary care is still a budgetary blow. Back to Mr. Yardley:)
One of those opportunities is, of course, endless (and endlessly expensive) treatment undertaken simply because it is there. Whether exploratory surgery would have prolonged Reggie’s life is another question I cannot answer, but now that highly advanced procedures and equipment are available for such emergencies, as well as highly skilled practitioners to make use of them, pet owners must confront emotional dilemmas, and perhaps moral choices, that rarely presented themselves in the past. I am as certain as I can be that I made the right choice for Reggie, and I know that our veterinarian agrees, but there will always be, in the back of my mind, that lingering, nagging doubt: Did I really do the right thing, or could the expenditure of a few thousand dollars more have brought him back from the abyss?
Money had nothing to do with my decision, but as veterinary medicine becomes ever more state of the art and ever more costly, inevitably it will be part of many people’s decisions. The questions people must ask themselves as they start playing God do not lend themselves to easy answers: How much is a pet worth? How much value can we assign to a creature who is both a dumb animal and a cherished friend and companion, a family member whose importance in one’s life is incalculable?
I do believe Mr. Yardley: It wasn’t all about the money. But it was at least in part about the money, which is no doubt why he went into the prices in such detail, and mentioned “expense” or “expensive” so many times. $2,341.56? People who don’t care about the money at all don’t write it down to the penny.
Honestly, I don’t see people writing such hand-wringing “did I do the right thing” pieces about the cost of fixing a car transmission, or the high cost of fence-repair with the price of concrete and lumber climbing. We accept with little more than a grumble that costs for other things have gone up, but not a day goes by when I don’t get an e-mail or two bashing veterinarians for “price-gouging” or even castigating them for not giving a break to rescue volunteers (as this breed-rescue worker did in a piece in the Sacramento Bee last week).
I know people who have spent thousands to save their pets and thousands to lose them — I’ve been in both classes at least once, over the years, and have also chosen what was essentially economic euthanasia once, when a pet had cancer and when I was well and truly broke — and in the end the only regret was whether or not the quality of life for the pet was worth it. I think that’s pretty much where I am on the issue: Everything for quality of life, nothing for simply prolonging it to keep a beloved pet around longer on my account. Which is why I’ve also chosen euthanasia a couple of time without choosing to go forward with more medical options that were available.
Problem is: Few decisions regarding a pet’s end-of-life are black-and-white, and we don’t always know how big a role our emotions are playing until the final curtain comes down. Or how much we’re subsconciously worrying about the money.
No decisions is right or wrong, and honestly, I’m not advocating losing your house chasing the last few shreds of hope a medical procedure can offer. But I do think we need to be honest with ourselves, and set clear and compassionate guidelines for end of life care we can feel good about when it’s all over. (This must be said: I rely on my veterinarian to help me through these times, because of the trust and respect we’ve developed over the years. But the final decisions are mine alone.)
Anyway, go read. And I like to hear how you make these decisions for your pets. Be honest about it, at least to yourself.
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Good stuff, elsewhere: Pet Connection BFF Dr. Patty Khuly writes on the veterinarian’s dilemma when a puppy ordered from an Internet site puppy-miller (for thousands of dollars!) arrives loaded with parasites, life-threatening illness and serious congenital defects. Honestly, it makes you want to slap some sense into anyone who’d buy a dog that way (which is more or less her conclusion, stated in a kinder way).
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I know Christie will be watching the Puppy Bowl if she watches TV at all. I can guarantee you that she may not even be aware that there is a big football game on today, and I doubt she can name the quarterbacks. (But she knows all about Project Runway, I assure you.) I’ll be TiVoing the Super Bowl so if it’s a Super Bore (as it often is) I don’t waste my time. I don’t have a favorite, but my dad informed me at breakfast (La Familia meets every other Sunday) that the smart money takes the Giants and the points.
I not only can’t name the quarterbacks, I can’t name the teams nor where the Super Bowl is being played. I only know it’s this weekend because someone mentioned it to me on Friday.
I’m very happy here under my rock!
Comment by Christie Keith — February 3, 2008 @ 12:24 pm
My decisions for my pets are the same I have for me. I have watched people with cancer spend not only their last dime but their last minute suffering through some horrendous treatment in an effort to get that last minute and maybe more. I would like to think that if I was told I had cancer, that the first questions I would ask are How long without treatment? How long with treatment? And how long will the treatment last and how disabling. Time is more valuable than money and if you are going to take a treatment that will destroy your life for three months to gain three months - it isn’t worth it. Take the time you have and enjoy it. The same for my pets - if a treatment is only going to salve my conscience and gain my pet a lot of pain, suffering and fear so I can have a little more time - it isn’t worth it. Pets have no fear of the future - they do have fears in the present. My dog expects me to do right by him, I expect to live up to that.
Comment by Cheryl — February 3, 2008 @ 12:29 pm
It’s taken a long time to finally understand, but I now tend to let my beloved companions choose when it is their time to go. Then I do my best to “listen to” and respect their wishes as they attempt to depart.
My beloved kitty Cali taught me the real meaning of this last summer. After 25 years together she decided it was her time to go. As an indoor cat all her life who didn’t much like to go outside, one morning she began begging at the door.
I found this quite peculiar but she was so insistent I honored her request and let her out. Concerned for her safety, I secretly watched on as, with obvious intent, she inspected every inch of the yard. After about 15 minutes, she settled beneath the Jasmine vine and gently dozed into a sweet slumber.
The phone rang and since she was asleep I felt it safe to leave her alone. When I returned five minutes later, Cali was gone! Frantically I searched everywhere and finally found her in the barn. She lay quietly with her head on the hoof of my horses back leg.
As you can imagine, I was shocked and feared that she had already been stepped on. If the horse moved just one inch he would crush her aged and fragile scull. I spoke quietly to Skipper asking him to be very still as I moved toward what I thought to be the old girl’s dead corpse.
Just then I heard a big “Cali” meow! Elated, I quickly scooped her from beneath the 1000lb. animal who turned to looked at me as if to say, “I knew she was there all along.” He didn’t want anything to do with helping Miss Cali’s off the planet and returned to eating his morning bucket.
The whole experience made me realize that it was in fact Cali’s desire to go. She had been gradually sleeping more and more and eating less and less and although she had no real health issues, I somehow knew in my heart she was tired and ready to go. The “suicide attempt” was just the final sign.
I made an appointment with my vet for the next afternoon and Cali and I spent the remaining hours cuddling and watching movies and saying goodbye. Oddly enough, all the other kitties were exceptionally loving toward her that night as well…. each taking their turn sleeping near and cleaning her old, worn out fur.
When the time arrived, the doctor blessed Miss Cali and sent her gently over the Rainbow Bridge. It was the most beautiful and peaceful death I have ever experienced. I dream of a day when all animals can return to living such long, healthy lives and leave when they decide it is time. I wish too that it were so easy and Divine for those who love them so dearly to be able to assist them on their way.
Comment by Shelly — February 3, 2008 @ 12:41 pm
I think, for the average person, money has to come into the equation at some level. Whether it’s a question of how much to spend, where to loan it from, how to pay it back, it’s there. That’s just how it is.
I don’t know where my lines are. There are so many variables- what the chance of a good outcome is, impact on quality of life in the meantime, etc. But I don’t have endless amounts of money, and that has to come into question, too, as much as I hate that it does.
Comment by katie — February 3, 2008 @ 12:44 pm
HI Gina, Sure seemed like money was an issue to me…
Two summers ago I racked up nearly $7,ooo in vet bills after a car accident when no one could figure out what was wrong with my dog. If I had been told it would cost 7,000 up front, instead of the initial 2,000 for the ER……don’t know… At the time I was facing huge legal fees for a divorce and we are barley making the house payments. I love the dogs, but my 3 kids do come first. Also if I had been truthfully told how much PAIN she would been in before we fixed her and that the chances she would suffer from painful pancreatitis for her entire life time (she hasn’t!) were like 85 %….. I would have added all that info up and most likely had her put to sleep. I find it impossible for dogs who live with kids to have strict diets 100 % of the time, and we would have made her sick,had that been true. On top of that, Charlee is a tweaked dog who would be hard to place. As it turned out, we didn’t hear the “future” predications until well visits after the fact.
Just goes to show that sometimes, (rarely) not knowing is better than knowing. Had I weighed all things equally, and factored in pain and quality of life in there, my awesome dog would most likely not be sleeping at my feet right now.
Comment by Nancy Freedman-Smith — February 3, 2008 @ 1:20 pm
Gina, you’re so right. All that ought to matter is quality of life. I don’t think you can really draw a hard-and-fast line, because every case is unique.
And so much depends on the vet you have helping you make the decision. You have to realize that your vet’s job is to keep your pet alive and to find out what’s making him/her sick. Just like human doctors, actually. And like in human medicine, it’s often the patient’s family’s job to help define quality of life. Good vets will help you do this.
I learned a hard lesson the first time I ever had to make the decision to euthanize. My dog Brie was a walking vet bill, but I loved her dearly. She was diabetic, had a recurring malignant cancer, blind, deaf, and arthritic, and I spent a lot of money over the years - all worth it - to keep her going to the age of 17. But the final thousand was the worst money I ever spent, because she wanted to die (kidney failure) and I wasn’t ready to let her. I also didn’t have the advantage of a vet who could help me differentiate between what could be done for her and what ought to be done.
A little time, experience, and a good vet made a huge difference last year when I lost my best-ever boy cat, Max, to kidney failure at 13. Again, I willingly spent a lot of money to help keep him going as long as he was happy. This time, though, I had a great vet who was proactive about talking about treatment goals upfront. We agreed early on that we would keep him around as long as he was happy to be here, but that we wouldn’t make him undergo tests or surgeries unless there was a good chance they would change either his prognosis or his treatment. She also helped me make a list of five things that defined quality of life for him. When he stopped doing most or all of them for days on end, it would be time. That helped SO much.
With subQ fluids (daily by the end) and meds, he had about two extra years. - a huge gift to me. Still, when he took a turn for the worse, I started to buckle, asking my vet about more exotic (and expensive) treatment options. She gave me all the information I wanted, but she also gently reminded me about our goals at the onset.
Anyway, that’s my longwinded way of saying that yes, it’s about quality of life, but even *that* can be hard to measure objectively when you’re facing the loss of an old friend - and just because you *can* pay for more expensive stuff doesn’t always mean you should. A good support system is essential, but in some cases, a good vet is just as important.
Comment by LauraL — February 3, 2008 @ 1:54 pm
Our vet, who we have had for over 15 years, will only do euthanasia for selected clients. If she gets even whiff of human convenience as a motivation, forget it. She’s also good at explaining options and keeping everyone grounded in reality and what is in the animal’s best interests.
She has put down two cats for us, one with lung cancer and one with kidney failure. They died at home, with us, in my arms. No heroic measures. They were clearly ready and we helped them on their way and ended any suffering. It wasn’t about us and our needs (thinking of Eilonwy makes me cry six years later and probably always will), but what was truly best for them.
I feel no guilt or ambivalence about compassionately ending their lives. When we take responsibility for a companion animal’s life, the odds are that we are taking responsibility for their death also.
It honestly seems to me that many Americans are so hung up on death that they subconsciously see the choice as death or no-death, not when-death or compassionate-death. Maybe that is sometimes part of the motivation for the “spare no expense if it gives Fluffy one more month”, choice. That said, I can see how even if you accept a fatal prognosis, the exact point at which to choose euthanasia could be agonizing.
Lastly, I showed dogs to an older couple, probably in their early 70’s and a little frail, at our shelter last year. They were looking at puppies, which seemed inappropriate and ridiculous. I gently extolled the virtues of older, adult dogs- known size and temperment, calmer, etc. The woman smiled sweetly at me and said, totally seriously, that they wanted a puppy so it would outlive them. How nice for them. They avoid the messy inconvenience of dealing with the end of life of their beloved pet by ensuring that it would go through the shock and stress of having to be re-homed. No polite riposte was possible, but fortunately, we had no puppies at the time, so they went away empty-handed. Thank goodness.
Comment by Susan Fox — February 3, 2008 @ 3:38 pm
I’m very sorry about Mr. Yardley’s loss. The focus on cost was unnecessary, and his total bill was actually pretty trivial. The one and only time I was faced with a decision about vet treatment that was going to be extremely hard for me to afford was in the mid-70s, a young cat with a head injury. I managed to come up with the money, she recovered and lived to be 20, and never cost me more than her annual checkup after that. I think Tweezer’s total bill was $1,200 – the equivalent of about $5 K today. The next year sucked financially, and the whole thing scared me so much I’ve had an emergency bank account ever since. I’ve been able to make decisions based on prognosis and quality of life, and my vet is wonderful helping me to evaluate those.
So I’m not at all impressed with Mr. Yardley’s $2,341.56. There is probably an amount that would make me stop and think, but fortunately it hasn’t happened to me since Tweezer. I know the amount is a lot higher than the cost of a new plasma HDTV to watch the Stupid Bowl. Rather have the dog or the cat than the TV, thanks anyway.
Comment by Carol PW — February 3, 2008 @ 3:54 pm
Heck, an external fixator to set a broken leg can easily surpass Mr Yardley’s paltry sum, as a friend of mine has endured trying to fix a broken leg on her show prospect puppy that did not heal right the first time. I suspect there were 1000s of people who spent at least that much trying to diagnose and save their pets from melamine/ cyaneuric acid poisoning last year. In today’s inflated world, $2400 is insignificant.
There are too many variables for me to make a guess at this point what I would do when faced with a life threatening illness in one of my dogs. Suffice it to say, I will do whatever it takes to insure quality of life for Elf, Meggie, Starrie, Rocky, Sirius and Dragon. Quality is not the same as quantity. I value my dogs much too much to keep them going just because I have an emotional problem facing their death. It’s not about ME really, is it? It’s about THEM! I won’t know what I will do until I am faced with the ‘whatever’, but I do know the cost will not be part of the equation!
Comment by deb — February 4, 2008 @ 5:38 am
“Still, when he took a turn for the worse, I started to buckle, asking my vet about more exotic (and expensive) treatment options. She gave me all the information I wanted, but she also gently reminded me about our goals at the onset.”
Laura, I think this is a great idea, having those goals in mind. Some of the geriatric illnesses are so gradual that they really do sneak up on you bit by bit. I know with my last two geriatric cats, I was periodically adding a medication or supplement to the routine as they slowly declined, and none of it seemed like “too much” at the time. Yet last month, when I stumbled across the year-old chart I had drawn up of Rhett’s medications with the 4 times a day he should be given the various pills, I was kind of taken aback at how extreme the routine got to care for him toward the end.
Still, it’s about quality of life. Last February 9, I decided it was time for Rhett because his breathing was getting labored and his lungs were filling with fluid, and medication wasn’t staving it off any more. I would have spent whatever I had to help him feel better, but ultimately, “helping him” meant letting him not suffer any more.
I still sometimes wake in the night expecting to feel his little chin propped up on my head, as he slept to help his breathing. But I know we did the right thing, saying goodbye before he helplessly choked alone on useless lungs one day while we were at work. That’s part of my stewardship and love for them, too. Being willing to spend the money, and knowing giving them the best life I can with it.
Comment by Feline — February 4, 2008 @ 6:07 am
Cats will let you know. They’ll hide and try to starve themselves if they’re sick enough. They don’t really understand their options, either. You can’t sit a cat down and say, “Okay, this is going to make you feel sick, but you’ll feel better in the long run.” That’s the part that always gets me: they understand that you’re trying to help, but if the treatment is unpleasant they don’t understand “in the long run.”
No, extra time is for us. If they’re happy and not suffering that’s fine, but I don’t want my cat to suffer because I’m not ready to face her leaving.
I want my cat to have as much life as she wants. No more, no less.
And I’ve done this far more times than I wanted to recently.
Comment by Katherine — February 4, 2008 @ 9:32 am
I’ve never been a big believer in extraordinary measures to save pets. Of course, some circumstances demand it. However, when faced with the choice of chemo/radiation for a cat with cancer who clearly wanted to die in peace at home, there was no wavering on my part. It all depends on the creature and the situation. Money is always a factor; but hopefully, not the only one.
Comment by Carol — February 4, 2008 @ 10:07 am
If you have a vet that you trust, I don’t think its inappropriate to ask her “what would you do in these circumstances.” That may the best way to determine if you should do more.
A really good vet isn’t going to recommend treatment if she believes that the animal is suffering.
Comment by 2CatMom — February 4, 2008 @ 10:33 am
I think money IS always an issue. It’s silly to pretend otherwise. It’s an issue in human health care too.
There always will be something more you could do. How about a kidney transplant for your CRF cat? It’s about 10K. If you don’t live near the cities where they’re done, well you just need to add a few grand for transportation and your accomodation while you take kitty there & back. I know they’ve been done but I haven’t actually met anyone who has gone that route; as a CRF cat owner, all I know are people who do the ‘common’ treatments of restricted diets, phosphorus binders, sub q fluids and their cats gradually got worse and either died or were euthanized. Nobody yet says “gee, you should have gone to such and such a place and got her a kidney transplant. Did you even look into it?” But soon, I imagine that is exactly what will be said. Where will it end? Are we making pet ownership so expensive that only millionaires will be able to afford to have pets?
I think this obsession about our pets receiving the ‘best’ medical care is a symptom of the growing anthropomorphization in our culture. I believe in providing good preventative care, good nutrition and a healthy lifestyle. I do not believe in high cost interventions & I do not like how so many people guilt other pet owners for not pursuing expensive treatments. It’s become a status symbol now to brag about the size of our vet bills and how willingly we pay them.
IMO, the more mature the animal, and the more serious the disease, the less costly interventions should be employed and the focus should be on palliative care.
I see huge problems ahead if vets continue on the path of becoming increasingly snotty about euthanizing seriously ill pets because the owners do not want to incur extreme costs.
And surely, there are some huge ethical dilemmas in considering spending large amounts of money on one very ill pet, when thousands of healthy ones are euthanized in shelters.
Comment by hornblower — February 4, 2008 @ 10:34 am
“And surely, there are some huge ethical dilemmas in considering spending large amounts of money on one very ill pet, when thousands of healthy ones are euthanized in shelters.”
There are some huge ethical decisions any time you spend money on anything. And anthropomorphization has nothing to to do with how I care for my animals, and the decisions I make on their behalf. I know they’re animals, thank you.
Comment by Gina Spadafori — February 4, 2008 @ 11:08 am
Indeed, hornblower. You had me nodding along until the idea that one’s pet is interchangeable with every other animal in need. Yes, money is a factor, quality of life is a factor, but these are decisions based on our relationship with the animal. Otherwise we end up right back at ‘why help animals at all when their are people in need?’
Comment by emily — February 4, 2008 @ 12:05 pm
I just have to chime in here on Mr. Yardley’s comment “How much value can we assign to a creature who is both a dumb animal and a cherished friend . . .”. Of course he also went on to call the dumb animal a member of the family, etc. I just think “dumb animal” is a rather out-dated term. I don’t consider my pets “stupid”, even if they don’t have the same level of (or kind of) intelligence as I have. And if we take the definition of “dumb” as the inability to speak, let us not forget that our pets DO communicate with us, even if they don’t usually use human language.
The very fact that he used this term, and raised the question as to “value” (presumably monetary value in this context) of a “member of the family” creeps me out a bit. We all have to make hard decisions sometimes, and if we just don’t have the money, we just don’t have the money. But to suggest that those decisions should be based on some kind of financial analysis? ewwwwwwwww.
Comment by mountain kimmie — February 4, 2008 @ 1:51 pm
Kimmie … it’s very naive to think these decisions aren’t made economically, at all levels, for animals AND humans. That’s what acutaries are for, an entire profession to assess risk and plan for it.
A few years ago, my (then-37-year-old) brother contracted Guillain-Barré Syndrome. He spent weeks in the hospital near death and months in rehab learning to balance and walk again. His medical bill was close to three-quarters of a million dollars. (And it continues to add up, since he’s on expensive meds for life as a result, on top of being a Type I diabetic.)
He used to joke — hey, if you don’t laugh, you’d cry — about the insurance company sending a hit man after him to save them money. In his “joke” version, he’d open the door and there’d by a guy with a silencer on his gun.
“Sorry, pal, but I’m from your health insurance company,” would say the hit man. “Nothing personal, ya know?”
And ya know, if the insurance companies could get away with it, I think they might send hit men out after all.
As for “dumb,” I’d bet you $100 that Mr. Yardley meant “unable to speak.” But yes, it IS an archaic term, which is why the Denver Dumb Friends League — foundedin 1910 — once explored changing its name. They realized their name recognition in Denver was very, very high, though, so they left their name alone.
Comment by Gina Spadafori — February 4, 2008 @ 2:49 pm
And surely, there are some huge ethical dilemmas in considering spending large amounts of money on one very ill pet, when thousands of healthy ones are euthanized in shelters.
I don’t have a personal relationship with, or personal obligations to, those other animals. I donate and do what I can, but I have a different level of obligation to my own pets, who share my home and fill my life. I agree with most of the rest of what you said, but the animals in shelters because others couldn’t, or simply didn’t, keep them, is not a factor in how far it’s appropriate for me to go for my pets. Just like the starving children in Africa are not reasons for sister to keep my niece on short rations or dress her from Goodwill rather than buying her nice, age-appropriate clothes that fit properly.
Comment by Lis — February 4, 2008 @ 3:45 pm
Well said, Lis.
My responsibility is solely to the other species I have chosen for whatever reason my animal species made the deciding factor in bringing them into my home. They are my first consideration.
And I am bloody sick of this differentiation between Homo sapiens and other mammalian species. Folks, I hate to be the one to tell you, but we are animals! We are not one whit superior to any other life form on this planet, in spite of what our religious teachings lead us to believe or our communication and technological skills convince us to the contrary.
Comment by deb — February 4, 2008 @ 9:46 pm
We like to think we are superior to other mammalian species so that we can have the advantage over other species.
Long time ago, it seems to me, some people did not know that animals have reasoning power, do not communicate with other animals, have not too many emotions, and lack a lot of memory power.
That was so we could either boss them around or eat them without too much guilt. After all, weren’t animals put on this earth for man’s convenience?
Hard to believe now—but that is how I remember it.
Comment by Colorado Transplant — February 5, 2008 @ 6:22 am