I couldn’t tell you when I first heard somebody say “quality of life” because it’s so ingrained in every aspect of animal care. It sounds like a no-brainer — of course you would want to maintain an animal’s quality of life, why is it even worth discussing? However, when you think about it more, it’s a concept that is exquisitely unique to veterinary medicine. In human medicine, although doctors work to alleviate the pain and suffering of their patients, for the most part the primary goal is to keep the person alive no matter what. Terminally ill patients are kept alive even if it means that they’re bedridden and hooked up to machines — assisted suicide is currently only legal in three states in the United States and a handful of European countries. But in veterinary medicine, veterinarians and owners have complete control over when they want to end the suffering of their animals.
So the question becomes, how do you draw that line between treatable and in too much pain to help? For the purposes of this discussion, let’s eliminate money from the equation. I know this is unrealistic and more often than not the decision to euthanize an animal boils down to how much treatment its owner can afford (which is a whole other issue), but let’s pretend that we’re dealing with an owner who has unlimited funds at his disposal. We’ll call him George. Say that George has a two-year-old golden retriever named Turk, and Turk has been hit by a car. You’re the vet, and George tells you to do whatever you can to save Turk. Although Turk’s injuries are severe, fortunately you’re able to save him after several hours in surgery followed by weeks of recovery. What if Turk was 13-years-old (very old for a golden)? Do you tell George that the stress of surgery and the painful recovery will be too much for Turk, and that he should consider euthanizing him so that he doesn’t have to suffer?
Let’s try another scenario that’s even more complicated. Turk has arthritis that you’ve been managing with anti-inflammatory medication. However, arthritis is a chronic, progressive disease and the medication only treats the symptoms. How do you know when Turk’s pain is no longer being managed well enough and is affecting his quality of life?
You could argue that it’s all up to the owners — they know the animals best and they’ll just know when it’s time. There are two problems with this, though. One is that it’s often hard for people to make accurate judgments when it comes to pets that they love. They think that just because the animal is sleeping and eating everything is fine, even if it can barely walk to relieve itself. I know that even I am guilty of being slightly psychotic and unreasonable when it comes to my animals, though technically I should know better. So I know that often it takes an outside eye to point out facts that the owner is missing.
The other problem is that as humans, we tend to anthropomorphize animals a little too much. We assume that they want to be treated just like we would want to be treated ourselves, even if it means prolonging their lives when they’re clearly suffering. On the flip side of this, even “clearly suffering” is hard to judge — even though the basic neurological pathways are the same as in humans, we can’t really know if their conscious acknowledgement of pain means the same thing for them as it does for us. Which brings us to the crux of the issue — when we talk about quality of life, how do we know what that means for the animal?
One thing that I’ve come to realize about animals is that disease is much less of a psychological process for them than it is for us. For example, my horse had some type of infection last year and he had a high fever. When his temperature was up, he wouldn’t eat or drink and just stood listlessly in a corner of his stall. Within half an hour of being medicated to bring his temperature down, he would turn around and start eating and drinking again. He didn’t know that the tube of gross paste that I had squirted into his mouth had anything to do with it; he just knew that he felt better. When a person is sick like that though, and their fever goes down enough for them to physiologically feel well enough to eat, their minds often still say “No, I’m sick, I don’t feel like acting normal.”
So it really comes down to understanding what’s normal. Veterinarians have an advantage with this because after a while they see enough normal cases that they can form a baseline quality of care assessment based off of personal experience. People with this kind of experience have created pain scales to try and quantify the suffering of animals, with signs ranging from pacing to hiding to vocalizing. I think that, as students, we just take these scales at face value because we know that they’re made by people significantly more knowledgeable than we are, but knowing that and understanding it are two different things. In the end, the quality of care assessment is based on a combination of the owner’s perception of what is normal for the individual animal and the vet’s objectivity and knowledge of what is normal for the species in general. The two parties can work together to come up with the best possible outcome for the animal.
Nikhita Parandekar graduated from Cornell in 2011 and is a second-year veterinary student in the Cornell College of Veterinary Medicine. She may be reached at firstname.lastname@example.org. Hoof in Mouth appears alternate Fridays this semester.