How much is a pet’s life worth?

  WASHINGTON - In Maura Hall's suburban kitchen a cat - a stray turned queen of the household - perched on the table. At the counter, Hall drew drops of the immunosuppressant drug cyclosporine out of a tiny bottle with a hypodermic needle and injected it into a capsule. She added an antibiotic for a fungal infection, the steroid prednisolone, and insulin for diabetes.
  Lily, a longhaired, gray Maine coon-type, received her new kidney last year, and the medicine is part of her post-transplant regimen. She takes it every 12 hours and will need it on that precise schedule for the rest of her life.
  Lily is a good patient. She swallowed her medicines, licked her paw and, with a look of fastidious forbearance, jumped off the table.
  "I'll be doing this for the rest of my life, or hers," Hall said cheerfully, The divorced mother of a teenage daughter, Hall has spent more than $25,000 for kidney-transplant surgery and follow-up care at the University of Pennsylvania's veterinary hospital. The transplant itself cost about $8,000. Complications, weekly blood tests at $200 each, and medicines have driven the cost up from there.
  But Hall says she has no regrets.
  "It's not for everybody," she said. "But to see this cat now - she's fat, she's happy, she's jumping on top of the couches. To me, it doesn't matter whether it's a human life or an animal life."
  Still, "you ask yourself: Is this the right thing? Am I interfering with the natural progression of things?"
  The decision can be a lightning rod. Hall received hate mail after news of Li-ly's transplant appeared in local newspa-pers. For some Americans, the idea of spending tens of thousands of dollars on a cat when so many humans don’t get even basic care is, if not incendiary, at, least highly objectionable.
  Hall also encounters resentment and guilt from pet owners who had to forgo transplant treatment for financial reasons. "I can understand it," she said.
  The question of access is "the driving ethical question in veterinary medicine today," said Arthur Caplan, chairman of Penn's department of medical ethics.
  "I can assure you that if your cat or dog is hit by a car in a poor neighborhood, you're going to have the choice of euthanasia or hoping that the animal will come around," he said. "In a rich neighborhood, you're going to get a whole recipe of things you might consider doing: orthopedics, the possibility of dialysis, lots of things that would be similar to what happens with human trauma.
  "I think that sometimes the economic forces, on the part of the vet, and family guilt, line up to promote treatments with only a remote possibility of success."
  Katherine Karamolengos agrees. Her cat, Leo, lived three and a half years after surgery in Penn's feline kidney-transplant program, but much of that time was spent battling complications including diabetes, anemia, and liver cancer. The transplant's original estimated cost, $4,000, ballooned to seven times that.
  "Faced with similar circumstances, I wouldn't do it again. Absolutely not," Karamolengos said. I think the public should be educated and know what they're getting into when they consider high-tech and experimental procedures," she said. "Because everything is very expensive, and you don't get a break."

 

Euthanizing an animal in the face of difficult or expensive veterinary care no longer is mainstream for American pet owners. Many are willing to go far and dig deep to save their four-legged friends' lives.

WASHINGTON The blood-pressure reading was fine, and now the veterinary anesthesiologist picked up an electric hair clipper to clear a patch of fur from my dog's foreleg. This was too much. Stoic through patient intake and the tightening of the blood-pressure cuff, he now turned his head toward the whirr and chick of the blades and began to quaver in a way I'd never seen.
  "He's probably just picking up on your anxiety," the vet tech said. I nodded and tried harder to act like a $1,400 veterinary brain scan was no big deal.
  But the dog knew better, and so did I. My most recent experience with major veterinary care had been way back in the 1970s, when 10 was old for many dog breeds, and visits to the vet with the family dog never involved anything more complicated than a rabies shot or a worming pill.
  Now, we were uneasy pilgrims in a strange new world, where we never seemed to get out of the clinic for less than $250 and our first real sick visit cost $900, more than I'd ever spent on one doctor visit for myself.
  Bear was a 14-year-old mutt who looked a lot like a black Labrador, until you stood him next to one. His symptoms were mysterious; the diagnosis was elusive. He was sluggish; he had fevers and loss of sensation in his paws. The regular vet diagnosed a thyroid condition, but beyond that, he was stumped. He sent us to a veterinary neurologist, who, suspecting a brain tumor, had sent us to the Washington area's only commercial veterinary MRI facility - the Iams-Pet Imaging Center in suburban Vienna, Va.
  It was hard to get appointments here specialists such as veterinary neurologists were in such demand that veterinary schools were having trouble keeping enough on hand to teach.
  "An MRI for a dog?" said an acquaintance. "You're kidding, right?" She shook her head. "The old-fashioned kind of vet," she said firmly. "That's what you want."
  What did that mean, anyway'? In a cavernous examining hall at the Leesburg campus of the Virginia-Maryland Regional College of Veterinary Medicine, a student stood in the shadow of an enormous draft horse.
  Headier Craven, 32, was shaving a small patch on its neck, preparation for a catheter through which a large sack of blood would be drawn.
  In addition to the traditional course work - about 60 percent of it in small-animal medicine (i.e., dogs and cats) Craven's $200,000, four-year veterinary education included instruction on the human-animal bond and the importance of good vet-client communication.
  "Even horses have gone from being farm workers to people's companions," Craven said. "That course did a good job of making it clear that the relationship has changed, that people are willing to spend the money on their animals. And they want to spend the money."

Pets' social status rises
  That sea change began in the late 1980s, driven by technological innovation and the rising social status of the American house pet.
  At leading veterinary teaching hospitals, surgeons now routinely perform procedures unavailable to the average pet 10 years ago: kidney transplants, cancer chemotherapy, back surgery for herniated disks, titanium hip-joint replacements, radiation treatments for goldfish, MRIs for hawks.
  Until the 1940s, veterinary medicine was devoted to helping agriculture manage its food animals, with a creed of helping society by helping animals (as opposed to helping animals themselves). Until the '60s, most vet students were men with a background in farming or animal science. During the suburbanization of the '50s, practices began to proliferate, but cats and dogs still spent much of their time outside. As recently as the late '80s, most owners treated their pets as second-class citizens.
  Veterinary practices reflected this lowly status. Even now most veterinarians carry little or no malpractice insurance, because until very recently it was impossible for a pet owner suing over loss of a pet to recover anything more, than its replacement value. The bigger part of the vet's week was spent administering vaccines and fixing the broken bones that were common before leash laws. When the problems became difficult or expensive to fix, the animal was euthanized.
  One of the most discouraging parts of my practice in the early days was having a dog come in with a simple broken leg and having the owner say, 'Well, it costs money and it's just a dog, so put him to sleep,"' said Jack Walther, president of the American Veterinary Medical Association (AVMA).
  In the late'80s, however, pets began to fill the emotional and physical void created by rising divorce rates and growing numbers of single-person and childless households. And from 1987 to 2000, the life spans of the average dog and cat increased by more than one-third, thanks to better commercial pet foods and widespread vaccination, according to the AVMA.
  But that longevity meant a jump in the incidence of the diseases of old age: cancers, organ failure, crippling arthritis. With the family pet now ensconced on the bed instead of in the yard, medical problems were easier to spot and harder to ignore.
  Today, many people think of their pets as family members, and they want them to have access to the same medical technology they do, vets say. And this is possible, thanks to the same biomedical revolution that transformed human medicine in the '50s and '60s.

Pressure on clinics
  According to the FDA, which regulates drugs for the veterinary market, the pharmaceutical industry has begun shifting its energies away from the agricultural market and toward companion animals. The number of new drugs approved for veterinary use has increased dramatically in the past decade, with special interest in drugs for behavior modification and pain relief
  All of this has put new pressure on the ordinary clinic. Vets, who 30 years ago needed little more than a stethoscope and an Army surplus field X-ray machine to set up a practice, now equip their clinics with an array of expensive diagnostic equipment, from blood-analysis machines to ultrasound scanners. Setting up a small practice costs upward of $500,000.
  The average veterinary bill, which has tripled in the past 10 years, reflects this. It's the direct result of a half-million-dollar study commissioned by the leading veterinary professional organizations in 1998 to figure out why veterinarians' salaries were lagging.
  The study cited federal statistics showing that veterinary-practice incomes had declined during the 1990s, when many other professional incomes rose, and the profession set up a national commission to encourage vets to concentrate harder on the bottom line.
  These days, veterinary-school graduates enter a profession more focused on management economics than ever before, and one in which ethical questions are beginning to surface. Veterinary-malpractice cases, once rare, are on the rise. State courts have begun awarding aggrieved pet owners sums as high as $30,000 for pain and emotional suffering.
  "Twenty years ago, if your dog had congenital heart failure or an arrhythmia, you might just be told, 'There's not much we can do,' and that was upsetting, no doubt," said Nancy Kerns, editor of the influential Whole Dog Journal, a national magazine. "But it's also quite upsetting to learn there are things that can be done and it's going to cost you $10,000 or $15,000 to do them. At that point, you're making serious financial decisions, and that's a lot of pressure for some people."

Pinpointing the problem
  When Bear began stumbling regularly, sometimes hopping across the yard as if it were covered in hot coals, the vet sent us to a veterinary neurologist at a sophisticated specialty practice, where you needed a referral to get in the door and the vets had done postgraduate study in everything from cardiology to ophthalmology
  The neurologist suspected a brain tumor, he said. An MRI, about $1,400, would be the only way to know for sure. If it was cancer, radiation therapy (price tag $1,500 to $4,000, depending on how many years of remission I was hoping to buy) was one option. Or we could just treat the symptoms with steroids, in which case the cancer would advance.
  After the brain scan was determined to be negative, we went through a variety of treatments but got no definitive diagnosis. Eventually, Bear ran a high fever and couldn’t walk. X-rays to check for signs of cancer and other tests were inconclusive.
  A nonsteroidal anti-inflammatory, ad-ministered by pill, caused severe gastric problems. After a couple of days, I called the clinic. How do you know when it's time to go to the emergency room? I asked. "Use your judgment," the vet tech said.
  I spent that night next to Bear, spooning water into his mouth. On Tuesday the vet, on an emergency house call, recommended his spleen be checked with ultrasound. The spleen was fine, as it turned out, but the ultrasound revealed something much worse.
  There was a hole in Bear's intestine, and the leak had caused a massive infection of the abdominal cavity. The hole had probably opened only a few days earlier. There were two options: operate immediately to close the hole and try to clean up the infection. Or, the doctor said, "I'm afraid we have to put him down."
  Bear lay panting on the examining table between us. The doctor outlined the risks and costs. If Bear survived, he Would need at least two days in intensive care , followed by two weeks of convalescence and massive antibiotics. The cost would be roughly $3,200.
  I looked at Bear. Though he was clearly in pain, his head was up and he was alert. It didn't seem possible to give up on him. I stroked his head one last time and gave the go-ahead.
  But Bear died on the operating table that night, before a single incision. He was weak from infection, and his heart did not tolerate the anesthesia, the vets said.
  I asked to see him. In a small examining room, he lay with a blue surgical blanket covering his body up to his neck. His upside ear was cocked, as if he was listening. The top of his head was still warm. I thought about the golden retriever I'd seen earlier in the evening, a successful amputee dancing out of the clinic with his elated owner. Why couldn't that have been us?

The human side
  It occurred to me that what I'd wanted all along from veterinary medicine was the best of both worlds: the commitment, skepticism and horse sense of an old-fashioned vet, and the compassion, diagnostic smarts and philosophical approach of the new breed, vets informed by the belief that animals, in effect, were people, too.
  A few days later, flowers arrived. They were from the veterinary clinic.
  "With sympathy for the loss of Bear," the card said. "He will be missed."