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• W2202172152 abstract "Dear Editor,We read the August 2012 ethical question of the month (Can Vet J 2012;53:823) and the subsequent comment in the November 2012 issue (Can Vet J 2012;53:1154–1155), and frankly, were disappointed by the scenario presented by Dr. Rollin. The proposed treatment plan was, in our opinion, unrealistic. Most, if not all, veterinary oncologists would not have recommended the aggressive treatment options offered in this case. Thus, this ethical question to the family veterinarian does not represent an ethical dilemma for oncologists, as the advice we would give would not have allowed this situation to occur in the first place. This was our main reason for not responding in August. However, we felt compelled to respond following certain comments published in the November issue of The CVJ.We would like to address a few points in response to Dr. Goeree’s comments. Firstly, we believe that the decision about your patient’s care has everything to do with you, the family veterinarian. As a freethinking individual, you are allowed to formulate your own opinion that can be shared with your client and the open-minded specialist. Communication is a key component between the professionals involved in the patient’s health care needs and, obviously, the client. Why would you just “defer, nod, and bob”? The family veterinarian is a critical player in this scenario — your client is looking to you for your trusted opinion as they know you best and value your insight.Dr. Goeree made the following statement: “The only players are the oncologists who believe in clinical care heedless of (all aspects of) cost and the owners, who are in denial of death and reality.” A considerable amount of time is taken with every client during an oncology consultation, and a crucial point discussed with all clients is the fundamental importance of quality of life — the primary goal when treating cancer-bearing pets. It is typically the oncologist who educates the owner about the reality of the situation by providing evidence-based information, and not providing false hope. Appropriately educating the owners helps them make clear, conscious, and informed decisions and, in fact, helps avoid denial of death and reality. Cost always remains an important factor, and suggesting that oncologists pursue treatment “heedless of cost” is both unfair and inaccurate.We do not have the tendency to “pat ourselves on the back for our Godly interventions and self-ascribed compassion.” If Dr. Goeree is against treating cancer-bearing pets, even in situations where the patient could potentially be cured, then he should state so. It seems like everything we do in veterinary medicine could be considered a “Godly intervention,” including the administration of insulin to the diabetic cat or furosemide to the dog with congestive heart failure. Even surgeries such as spay, castration, and fracture repairs are imposed on animals. None of our patients sign their own informed consent forms.We agree with most of Dr. Rollin’s interpretation of this scenario with the exception of a few details. In some cases, short-term discomfort may be considered worthwhile if it means cure or long-term control of the tumor with excellent quality of life ensuing. Chemotherapy in cancer-bearing pets generally is not “extremely unpleasant” as it sometimes is in humans — if it were, we would not recommend it. In this case scenario, however, the dog was presented with pulmonary metastases and the proposed plan that included thoracotomy and splenectomy was simply unreasonable. We can only agree that pursuing these options is not a way to demonstrate love to your companion and we would not recommend it if that situation arose in our practices.We considered it important to write this letter because some practitioners might erroneously conclude that the proposed scenario reflects how certain oncologists think. Fortunately, the reality differs." @default.
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• W2202172152 date "2013-01-01" @default.
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• W2202172152 title "The ethical question on prolonging the life of a cancer patient -- a comment." @default.
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