Even as I said it, I knew it was ridiculous and selfish. “Just promise you’ll make it till my 30th birthday,” I said quietly to Kitty, my tiny ten-year-old cat. We were both underneath my bed, where she’d decamped the minute we returned home from a long day at the vet. Earlier that day, she’d been diagnosed with a terminal heart condition. Nearly two and a half years later, she’d die from it, in a cold and unfamiliar emergency room in the middle of the night.
This was a longer prognosis than any vet predicted, and yet, in the months since her death, I can’t stop wondering whether I did the right thing in delaying the inevitable for so long. The twice-a-day pills, the bimonthly visits to the veterinary cardiologist (which almost always included a chest tap, a risky, invasive procedure that drained fluid from in and around her lungs), not to mention the vast sums of money spent on it all: Were these things really for her, or were they mostly, selfishly, for me? Saying good-bye to a pet has never been easy, but advances in modern veterinary care can make it near-impossible for pet owners to know when to let go. It’s an ethical quandary that’s in some ways unsettlingly similar to aging and end-of-life issues currently plaguing human medicine: Just because we can extend a life, should we?
Once, the biggest moral dilemma veterinarians faced was that pet owners were hasty and thoughtless in their decision to euthanize, requesting the procedure at the first sign of age, illness, or mere inconvenience. Now it’s often the opposite extreme, said Bernard Rollin, a professor of philosophy and animal sciences at Colorado State University, who in 2011 wrote a paper for the journal Veterinary Clinics of North America: Small Practice about the stress this causes veterinarians. “In a major ironic twist of fate, rather than human medicine learning the wisdom of euthanasia for suffering animals from veterinary medicine … veterinary medicine assimilated some of the more pernicious aspects of human medicine,” Rollin wrote. “In particular, as animals became increasingly viewed as members of the family, the reluctance to euthanize began to enter veterinary medicine.”
A pet is not a person, and the end-of-life decisions for each are not the same. As science writer Carl Safina explains the distinction in his forthcoming book Beyond Words: What Animals Think and Feel, “I don’t mean to imply that I value the life of a fish or a bird the same way I value a human life, but their presence in the world has as much validity as does our presence.” It’s not the same, but each life still has value in its own way.
And Rollin is right about the pets-as-family idea. A 2013 survey by the American Veterinary Medical Association found that two thirds of dog owners consider the animal part of their family, up from just over half in a 2006 survey. (The numbers are lower for cats, but they also show an upward trend.) “The human-animal bond has grown — it’s accepted, it’s recognized, I think, at least in part because of the change of social structure in families,” said Jane Shaw, a professor of veterinary medicine at Colorado State University. She’s referring to the rise in cohabitation and childlessness among Americans, or of the increased number of those who are putting marriage off or never getting around to it at all. There are more ways to form families these days, and, as a result, “pets are filling a big role for many people,” Shaw said. “And it means many people are willing to invest the same level of care for their animals as they are for human families.”
Americans spent $56 billion on their pets in 2013, according to the latest figures from the Federal Trade Commission; of that, $7.6 billion went to prescription and over-the-counter drugs for cats and dogs. That’s expected to grow to $10.2 billion annually by 2018. Indeed, many pet owners are willing to shell out substantial amounts of money on veterinary care: In a 2010 survey of more than a thousand pet owners, 42 percent said they’d be somewhat to very likely to spend $5,000 on a single treatment for their pets. Tara Parker-Pope of the New York Times noted that the pet owner’s annual income did not make a difference in their answers — those earning $50,000 per year answered similarly to those earning more.
But the cost of treatment for a slow-acting illness like Kitty’s was deceptively exorbitant. I could never agree to pay $5,000 in one go, but $300 here, $75 there? The smaller costs added up. By the end, I was spending about $150 per month on medication and $300 to $800 every other month on visits to a specialist; once, I paid more than $2,000 for an overnight stay in a hyperbaric oxygen chamber, to help her breathing return to normal. I felt equal parts panicky over the expenses and guilty over my mounting financial anxiety, and I noticed that when discussing treatment, the question never seemed to be what was best in the long run for Kitty (or for me, for that matter).
Not so long ago, even if you’d wanted to drop thousands on a pet’s medical care, it wasn’t an option. Eleven years ago, Cornell developed the first MRI machine designed for pets. Six years ago, some vets began offering stem-cell therapy for dogs, to ease the symptoms of chronic illnesses like arthritis. In many respects, advances like these are a wonderful thing, both for the animals and the people who love them. Initially for Kitty, a chest tap would buy her several solid months of easier breathing, so her vets and I decided the temporary discomfort of the 20-or-so-minute procedure was worth the cost (financial for me, psychic for — well, for both of us). They warned me that a time would come when she’d need them much more frequently, and the risk and distress would outweigh the benefits. But for the moment, they assured, things were okay. I focused on the moment.
If I’m ever in this situation again, though, I’ll look further ahead. As it stands now, Americans have the chance to ensure that their pets get the planned, peaceful exits out of this world that their human loved ones often do not. “In the end, you have to make a judgment, one that we’re socially not in a position where we make it for ourselves or for our relatives,” Rollin said. “But you are forced to make it for the animal. I like to think of death as a closing to a life. … And you don’t want the animal to close on its life in misery.” In hindsight, I can see the point I should’ve shifted course to planning a good death for Kitty rather than stubbornly fighting for her life. Last summer, the chest taps started increasing in frequency — once, she needed three in a month. “These are not benign and have the potential to cause bleeding,” the emergency vet wrote in the medical records after the third one, adding that each tap created inflammation and scar tissue. And yet her vets and I decided to stay the course; even as the taps increased to every other month, the cardiologist (whom I liked very much) and I never spoke of prepping for the end of her life.
But then, even veterinarians struggle with these decisions. Rollin believes he hung on too long to a German shepherd he once had; the dog developed a degenerative spinal disease, and after a while, it couldn’t walk. “I’d come home six, seven times a day and move him, so he didn’t get bedsores,” Rollin said. “I think now: Was that the right thing to do? I think, now, that I waited too long.”
It’s so hard to know, in part because veterinary end-of-life care comes with complications that don’t apply to human medicine. For one, with animals, there is the tiny matter that the patient can’t speak. For another, pets can’t comprehend the trade-off they’re making in enduring the pain and terror of medical treatment now for the promise of more time later. “All they know is, This hurts now,” Rollin told me. “And they look up at you, and they want you to make it stop. And if you’re doing it for eight months to garner another three months — you see what I mean? I don’t think that’s fair to the animal. The animal doesn’t know anything about the last three months. It’s just miserable. And thank God, really, we’re in a position to give them a decent death.” For some pet owners, a decent death means turning to pet hospice, or in-home euthanasia; for others, it’s a conversation with their regular vet about making the decision to euthanize before an emergency situation forces it. In either case, it takes an enormous amount of unselfish courage to recognize when it’s best for the animal to let them go.
In Atul Gawande’s 2014 book Being Mortal, he talks about how to make the final years of life meaningful for the aged and the ill. Before your loved one gets truly incapacitated in sickness, Gawande suggests clarifying what, exactly, makes life worth living for them. One man’s list, memorably recounted in the book, was very short: ice cream and college football. As long as he’s well and alert enough to eat his favorite food and watch his favorite football team, he’s happy. Again: Pets are not people. But the lesson here applies. “When the animal gets very sick, particularly with a terminal disease like cancer,” Rollin said, “you consult that list, and you make sure your own needs, your own guilt, are not prolonging the animal’s suffering.”
I know what Kitty’s would have included: Watching East 73rd Street from the bedroom window, something she did with such intense focus my boyfriend Andrew and I called it Cat TV. Jumping on top of one of us when we went to bed, to sleep perched on one of our backs or sides. Wolfing down the can of Fancy Feast before I barely had the chance to dump it in her bowl. I said earlier that pets can’t speak, but, then — that’s not entirely true, is it? They can’t literally talk, but they can and do communicate. And when they stop doing the things they’ve always loved, they’re telling us they’re getting ready to go.
My 30th came and went, and with it the (unfair and silly, not to mention one-sided) “agreement” I’d made with Kitty. I don’t know if her health truly unraveled in the weeks after that, or if it was that I finally forced myself to look at it squarely. Probably, it was a little of both. One night, she didn’t hop up on the bed with us. Later, I tried and failed to recall the last time I’d seen her unwind with some Cat TV. The weekend before her death, she hardly touched her food, even the fanciest of Fancy Feast varietals. The following Monday, she tried to walk toward me but collapsed on her side halfway there, and I couldn’t deny it any longer. I gently placed her in her carrier and headed with my boyfriend to the emergency vet for the last time.
There, the on-duty vet suggested we place her once again in a hyperbaric oxygen chamber, this time for several days. It wasn’t guaranteed to help, and would bring the charges to at least $3,000. If we took her home, however, she’d almost certainly die, painfully, and within hours. (These were the options laid out for us — even then, no explicit mention of euthanasia.) Andrew and I asked for time to talk it over, and when the vet left us in the examination room, he (inadvertently, I assume) left the screen up that showed Kitty’s medical records, and we saw the alarming frequency at which she’d needed chest taps in recent months. We’d already asked so much of her; the vast financial and emotional cost suddenly seemed too great to justify. We knew what we had to do, though even still I made a last attempt to hang on. (“You can haunt us if you want!” I blurted through my tears, stupidly.)
Before the vet gave her the initial sedative, which preceded the injection to stop her failing heart, Kitty swiveled her head wildly around the exam room, taking in the grim metal surfaces with wide eyes. I hated that her last moments were spent in such a scary and strange environment, but it was too late to plan for a peaceful good-bye. She had been a very good kitty, and we told her so, as we each stroked her fur. Finally, I let her go.