CAETA Euthanasia Case: Francisco the itchy cat

The Companion Animal Euthanasia Training Academy (CAETA) invites you to consider the following fictional euthanasia case and reflect on how to proceed. After reviewing the case, read the questions and consider your answers before continuing on to CAETA’s suggestions. This case is designed to test your knowledge of companion animal euthanasia and be a conversation starter among your veterinary team. Case outcomes are enhanced when following CAETA’s 14 Essential Components of Good Euthanasia.

Euthanasia Case: Francisco the itchy cat

Francisco, a 16-year-old, MC, 4kg, Domestic Short Hair, lives at home with his owner, a young woman who bought a new house and is working two jobs to make ends meet. There is another cat named Pounce who lives in the home, and all three have been together for the past 8 years. Pounce is deaf and relies on Francisco for companionship and a better understanding of his surroundings. The owner has contacted her regular veterinarian to report that around 6 months ago, Francisco developed severe itchiness, started losing fur in places, and appears to have crusty lesions on his head. Her regular veterinarian is unavailable so an associate veterinarian takes the case. Upon exam, the veterinarian suspects an autoimmune disease known as pemphigus foliaceus. Before the veterinarian can share his thoughts, the client declares that she feels that, because Francisco is old and money is tight right now, she would like to euthanize today. The owner breaks down and starts to cry, leaving the veterinarian unsure how to proceed. The veterinarian is worried that without treatment, Francisco would continue to have a poor quality of life. After sitting with the client for a few minutes, the veterinarian, seeing the woman’s emotional struggle, decides it is ok to euthanize. There is no discussion about treatment options and they proceed with euthanasia.

Discussion Questions

1. The veterinarian and owner, who have never met before, have just formed a veterinarian-client-patient-relationship (VCPR). What does this mean?
2. The veterinarian, seeing the owner’s emotional breakdown and knowing that treatment could be lengthy and costly, decides not to share that the condition can be managed. What are the ethical and legal implications of this?
3. It can be difficult for veterinarians to advocate for patient care when owners will struggle to provide recommended treatments. What could this veterinarian have done differently?

CAETA Euthanasia Case Suggestions

1. The VCPR is the cornerstone of veterinary medicine. According to the American Animal Hospital Association (AAHA), it is critical to providing quality veterinary care and vital to animal welfare. AAHA defines VCPR to require all of the following: 

• The veterinarian has assumed responsibility for making medical judgments regarding the health of the patient and the need for medical treatment, and the client (owner or caretaker) has agreed to comply with the veterinarian’s instructions. 
• The veterinarian has sufficient knowledge of the patient to initiate at least a general or preliminary diagnosis of its medical condition. 
• The veterinarian is available for ongoing care of the patient or has arranged for emergency coverage or continuing care and treatment of the animal by an appropriate veterinary professional. 
• The veterinarian maintains complete and legible medical records.

2. The veterinarian chose not to tell their client about the suspected diagnosis, nor did they discuss possible treatment options. This was done to protect the client from greater emotional hardship upon learning that the condition is treatable, but that it would take time and money they don’t appear to have. Perhaps the veterinarian also felt that at 16 years of age, other diseases were likely to occur soon and that remaining life might be short anyway. Since the client originally hired the veterinarian to determine the cause of the problem, the appropriate VCPR step would be to inform the client of the suspected diagnosis and to decide together on the best course of action. In this case, the veterinarian decided to withhold their suspicion rather than share the information, which would have allowed the client to make an informed decision. The veterinarian is also making a guess as to the cause of the symptoms; however, it might be something more easily treatable for less money. By withholding information, the veterinarian has placed themselves not only in an ethical predicament but also in a legal one. If the client were to discover that Francisco was suspected of having a treatable condition but not told, a malpractice claim could be filed against the veterinarian since the veterinarian did not follow the standard of care. Francisco’s regular veterinarian may also be upset that treatment options were not discussed and that euthanasia was carried out without further input from them.
   
3. In this case, the veterinarian could have started by offering empathy to the client over the situation. After establishing a common understanding of the client’s situation, the veterinarian could then disclose their suspicion of the disease and explain that, with diagnostics, the findings may lead to something very treatable. Perhaps not, but together, the client and veterinarian decide what to do. Once the client knew the situation, they could discuss payment options and seek to avoid economic euthanasia. Since Francisco was not in a critical condition, the veterinarian could also have suggested that the client take a few days to consider the situation and discuss it with their regular veterinarian when they were able. Lastly, the veterinarian could have given more consideration to the importance of Francisco in the home, especially for Pounce’s well-being, and the fact that more time with Francisco could have been beneficial to this family unit. 

This case highlights the importance of following ethical reasoning during companion animal euthanasia conversations. Consider what else might be done to ease the client’s emotional burden yet allow the veterinarian to provide information and perhaps medical support for a treatable condition. This case is a good example of how using a euthanasia training manual to outline expectations around the VCPR and euthanasia decision-making standards may improve outcomes, reducing premature or unethical euthanasia events. You are encouraged to discuss this case with your team. The Companion Animal Euthanasia Training Academy is here to elevate your euthanasia expertise related to communication, technique, and business.