The Sound of Resilience: Dispelling the Myths of Crisis

Mark Cushing and Dr. Dani McVety-Leinen wrote recently of "The Quiet Crisis" in veterinary medicine. Respectfully, I disagree with their proposed solution.

In a recent article in Today’s Veterinary Business, lobbyist Mark Cushing and Lap of Love founder Dr. Dani McVety-Leinen, put forth the proposal for the adoption of a model legislation that allows credentialed veterinary technicians to perform in-home euthanasia for pets, under real-time video supervision of a licensed veterinarian, struck a chord with me. At first glance, it may seem like a reasonable solution to the so-called "quiet crisis" of access to in-home end-of-life pet care. But when I dig deeper, I find there's a more nuanced debate here, about professional expertise, ethical obligations, and the influence of economics on our profession.

Geoffrey: Why, you chivalric fool, as if the way one fell down mattered.

Richard: When the fall is all there is, it matters

“The Lion in Winter” by James Goldman

First and foremost, I must address the gravity of the act of taking a life. Euthanasia is a final and irreversible decision. Making the choice to euthanize demands the same professional knowledge as a diagnosis of disease, and even more in the way of ethical and moral considerations. Veterinarians receive extensive training not only in the medical aspects of our work but also in the ethical decisions that come with it, and we receive much more of both than technicians. This training, this expertise, cannot be supplanted by a technician's qualifications even with specialized training regarding euthanasia. I don’t know a veterinarian who hasn’t, at some point, talked an owner out of the choice to euthanize their pet because medicine can provide a better quality of life for the pet. A precise diagnosis can avoid unnecessary euthanasia, and this discernment can only be carried out by a fully qualified veterinarian.

A technician, even one trained to perform euthanasia or supervised through telemedicine, doesn't possess the depth of knowledge, experience, and intuitive understanding a veterinarian earned through our more intensive, extensive education. The relationship between pet owners and veterinarians is built on trust, and the pet owner must be confident that all possible diagnostic routes have been exhausted before euthanasia is considered. This level of trust cannot be replicated with someone with only the limited training of a technician because that level of trust is founded upon a doctor’s much more extensive expertise and training.

Mr. Cushing takes to criticizing decades old practice acts that did not consider the economic expedience of having a less-trained person perform a euthanasia. I wonder if these acts did consider that while it would be cheaper to have a less qualified person perform a task, it is in the public’s best interest limit that activity to a more qualified person. The acts don’t exist to protect the staffing needs of a lobbyist’s supporters, the acts exist to protect the citizens of a state from unqualified and subpar veterinary medical care. It is in this way that Mr. Cushing has worked to erode the quality of veterinary care in the United States by diminishing the standards of the veterinary-client-patient relationship in Arizona and elsewhere. I don’t know Mr. Cushing, but I disagree with many of the changes he seeks to affect in our profession because I believe that the interests of the pets and the pet owners will not be served for the better.

The proposal offered by the authors can, of course, lead to unforeseen consequences. For instance, if an animal reacts unexpectedly during euthanasia, a technician may not possess the necessary skills to intervene effectively. In essence, the technician, despite being supervised remotely, is alone in dealing with any emergency that might arise without the direct supervision and potential aid of a veterinarian. But truly, the technical side of the job’s performance is not my greatest concern. Veterinary technicians are frequently some of the best hands in a practice. It’s the motivations of the proposal’s supporters that give me pause.

So I turn attention to the economic aspect, it is essential to critically examine the motivations behind this proposal. Dr. Dani McVety-Leinen, the founder and CEO of Lap of Love Veterinary Hospice, is a key supporter of this initiative. It's worth considering how this change could benefit companies like hers. Could it be that the so-called "quiet crisis" is, at least in part, a narrative shaped by financial motivations of a CEO’s own interests? I am not so cynical to believe it to be her only concern, but neither I am so naïve as to believe it isn’t a consideration.

The proposal would potentially allow businesses like Lap of Love to replace veterinarians with technicians, thereby decreasing their payroll and increasing their profit margins. Such a practice raises questions about whether the wellbeing of the pets and the wishes of the pet owners are genuinely at the heart of this initiative. Or is it a question of economic demand, rebranded as a “quiet crisis” and moral imperative?

It is understandable that the veterinary profession, like any other, faces pressures due to technological changes, staffing shortages, and rising costs. But these issues should not lead to compromised solutions that potentially endanger the welfare of our beloved pets or undermine the trust of pet owners in our profession.

In the interest of full disclosure, I used to work for Lap of Love. I did not enjoy the work, though the most vicious criticism I can honestly offer against Dr. McVety-Leinen is that I disagree with her proposal of this article. The work done by hospice veterinarians is important and necessary, but it shouldn’t be offloaded to technicians. After I returned to clinical practice, there was a demand in the area to which I’d moved. And for the last several years I’ve worked part-time as an on-call veterinarian for a local pet crematory. The demand and pay is not substantial, but I believe it’s important to serve my community this way. It’s my responsibility to the people and pets of my hometown. Each and every one of the euthanasias I perform scrapes my soul. I hate to have to do them, they always hurt. But it’s vital that they’re done right and done well, and that takes more than a correctly calculated dose and a well-placed catheter. More times than I can count I have talked owners out of euthanasia to address a simple disease process with treatment that offered months or years of quality life and health to a pet. I keep those thank you notes in a different box than the others, because I need to use them to remind myself of the importance of doing this difficult part of the job.

I say all this not to boast, but because before I am a writer, a speaker, a practice owner, or anything else in my professional life, I am a veterinarian. And a veterinarian steps up to do what is right for their patients. I still practice medicine, I still perform surgery, I still perform euthanasia. Not everyone who has an opinion about the profession needs to do these things, and not everyone who has an opinion does, but it’s important to me that I do.

Ultimately, while the affordability and accessibility of in-home euthanasia are important issues, they should not overshadow the necessity for professional judgment, the ethical responsibility towards our pets, and the ethical concerns regarding financial motivations driving such proposals. A thorough and balanced debate is needed to ensure that any reforms truly serve the best interests of pets, their owners, and the veterinary profession as a whole, and that debate should not be shaped by lobbyists and executives alone. Veterinarians must speak up, not only for the good of our profession and its long term health, but also for the clients and patients we serve.