It has always bothered me when doctors and nurses blandly tell dying human patients that they will be “OK.” I am also bothered when I hear veterinarians and their support staff tell pet owners that their pet is going to be “all right” despite a poor prognosis looming overhead.
We may feel guilty if we take away a person’s hope, but should we lie about reality? Deception is all too common a habit in the human health care field, but should veterinarians also support the false hopes of their clients? Should frank lies come straight from health care professionals who encourage terminal patients to thrash in the gears of the “mindless machinery” of medicine? Is there harm in giving clients the truth about their pet’s actual condition and probable prognosis, at least as a reality check?
If veterinarians follow the pediatrician model, we need to inform the “parents” about their pet’s condition. Are physicians and veterinarians too blunt when they inform us with the statistical prognosis? Is there a more compassionate way to say, “You have six months to live”? How can this difficult information be gently delivered to the family without ripping their hearts out and stomping on their hope?
Deception is commonplace in the human and pet food and supplements industry. We know that 38 percent of the labels in the supplement and nutraceutical industry are not what they claim to be.
In a 2008 University of Chicago medical ethics survey of human oncologists, 73 percent said prognosis communication education was either absent or inadequate during their training; 96 percent believed it should be part of cancer care training. How much prognosis disclosure and communication training did you receive in veterinary school? Have you attended communication sessions to increase your skill in prognosis communication? Is this fixable?
You can communicate a poor prognosis by giving your time and using some compassionate gestures such as sitting beside the person or putting your hand on their shoulder or taking their hand in your hand. Kindly tell the family members that the overall prognosis for 100 other pets in this situation would be less than six months (or whatever you perceive it to be). Draw a bell curve or a median curve and show how a small group of patients pass on sooner than the majority and a small group will survive much longer, against the odds. With a sensitive tone of voice, you can say, “Most pets in Bella’s situation will die during the time that the bell curve rises, but we will do what we can to help her be in the group that survives.” Teach the family to monitor the basic quality-of-life criteria and have the “attitude of gratitude” for every good day that is left, viewing it as a gift. Refer the family for an expert opinion and a pet-loss hot line, or better yet, a pet-loss group that meets regularly.
“This support can be of tremendous help,” according to Ana Figueroa of Hermosa Beach, Calif., who was devastated when her beloved 13-year-old Doberman Pincher, Sheena, was dying of liver failure, three years after beating a twice-recurrent metastatic mammary adenocarcinoma. When recurrence appeared after Sheena’s second surgery at suture removal, Ana’s doctor told her that, “This is a vicious cancer.” Ana asked her doctor, “If Sheena was your dog, what would you do? Her veterinarian answered with a matter of fact, “She is an older dog at 10-plus and the treatment would make her ill, so let nature take its course.” Ana said she “had to insist on a referral.” Her doctor gave Ana a referral despite his bias. Together, Ana and Sheena and yours truly fought the breast cancer and won back Sheena’s precious life for three more years!
Deception also may drift into self-deception. Some physicians and veterinarians have a bias against treatment or palliation of cancer patients, especially older patients with multiple comorbidities and advanced disease. Many times we talk ourselves out of the possibilities and omit the concept of end-of-life Pawspice care. Then we influence our clients to follow our thinking for early euthanasia.
Some professionals may be reluctant to refer or are unaware of state-of-the-art options available for treatment of a complex, resistant or terminal condition. They might tell their clients, “There is nothing else that we can do” or “It is inoperable,” when that is not the case in another facility with more equipment and staffing. Ana says she would not have had the extra three years with Sheena if she had not seen our sign, Animal Cancer Clinic, on the highway or read our slogan, “What If Your Best Friend Had Cancer?” Today’s clients search the Internet for in-depth information and options for state-of-the-art care. Wouldn’t it be best if they learned about these options from you?
Deception is commonplace in the human and pet food and supplements industry. We know that 38 percent of the labels in the supplement and nutraceutical industry are not what they claim to be. We also know that the labels on dog and cat food can be deceptive with claims to be balanced and nutritious when, in fact, they are not. Unfortunately, we have a growing population of sick and obese humans, horses, dogs and cats in the U.S. and worldwide due to deception of a vulnerable public driven by the media to seek convenience and instant gratification. Pet owners are well-meaning but tend to overfeed and underexercise their pets as they do themselves on the road to an obese and sedentary lifestyle.
The public has been deceived about nutrition for themselves and their children. The arterial walls of overweight and obese children are looking more like 45-year-olds, the American Heart Assn.’s 2008 convention reported. The Physicians Committee for Responsible Medicine has pushed the reauthorization of the Child Nutrition and National School Lunch Acts. These acts hope to curb the incredible and devastating childhood obesity and diabetes epidemics in American children. Unfortunately, one in three children born since 2000 is predicted to develop diabetes in his lifetime. Why does a person who has gained 15 or 20 pounds ask their spouse or family members to deceive them when asking the question, “Does this outfit make me look fat?”
So why is deception so common? Was the public fooled by politicians and swiftboaters who used weapons of mass deception? Why have “promise” creams, fillers, plastic and bariatric surgery failed so many while filling the coffers of the merchants of self-interest? Why did so many collateralized subprime mortgages get sold worldwide with a triple A rating? Along with greed, deception was one of the primary forces that fueled the fiasco that plunked many nations toward recession.
Do health professionals feel that deception is the easy way out? Does it make the patient feel better to be successfully maintained on deceptive hope? Does hope, even vague euphemistic false hope, have therapeutic benefits for the stricken? Would patients feel deceived by their families and doctors without the privilege of knowing their own expected destiny so they can prepare?
If our ethics and social consciousness obliges us to serve society's best interest, we must gain deeper philosophical and psychological courage and communication skills to minimize deception and deliver truth with sensitivity.
Alice Villalobos, DVM, offers insights into timely issues affecting the human-animal bond, animal welfare and the relationships among pets, owners and veterinary practitioners. She is a member of the American Assn. of Human-Animal Bond Veterinarians and is on the editorial review board of the Society for Veterinary Medical Ethics.