Medical futility is commonly encountered in small animal clinical practice

Abstract

OBJECTIVE To document veterinarians’ perceptions and understanding of medical futility and determine the frequency with which medical futility occurs in small animal practice. SAMPLE 477 veterinarians in small animal general and specialty veterinary practice. PROCEDURES A cross-sectional study was performed with a 25-question, web-based, confidential, anonymous survey distributed through various professional veterinary specialty associations. RESULTS Nearly all respondents (469/474 [99.0%]) believed that futile care occurs in veterinary medicine, and 42.4% (201/474) felt it occurred commonly (> 6 times/y). A similar percentage (471/475 [99.2%]) reported encountering futile care within their careers, and 85.0% (402/476) reported encountering it within the past year. A majority (293/477 [61.4%]) reported witnessing futile care occurring in both inpatient and outpatient settings. Most respondents disagreed or strongly disagreed (320/463 [69.1%]) with a statement that providing futile care is always wrong, and only 38 (8.2%) agreed or strongly agreed. Over 70% (329/464 [70.9%]) of respondents agreed that there are situations in which provision of futile care is appropriate. CLINICAL RELEVANCE The importance of reaching a consensus definition for medical futility in veterinary medicine is evident given the frequency with which such care is being provided. Most small animal specialist veterinarians will encounter futile care, and the establishment of an ethical framework to navigate questions surrounding medical futility may help reduce moral distress.

End-of-life decisions: A focus group study with German health professionals from human and veterinary medicine

“…From the perspective of animal hospice, a palliated natural death, if requested by the animal patient's owner, is acceptable as long as the animal is comfortable and not in pain ( 23 ). There have been only a few attempts made at approaching veterinarians' perspectives concerning animal hospice and care perceived as medically futile or non-beneficial, for example ( 31 , 32 ). Small animal practitioners in the US commonly encounter requests for what veterinarians deem as futile care but also agree that there are situations where its provision is appropriate ( 31 ).…”

“…There have been only a few attempts made at approaching veterinarians' perspectives concerning animal hospice and care perceived as medically futile or non-beneficial, for example ( 31 , 32 ). Small animal practitioners in the US commonly encounter requests for what veterinarians deem as futile care but also agree that there are situations where its provision is appropriate ( 31 ). However, veterinarians disagree on whether palliative sedation is appropriate EOL care ( 32 ).…”

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“…1 Of the veterinarians who participated in a 2022 cross-sectional study, 30% disagreed that 'all treatment options should be presented to owners'. 19 Which options are introduced by veterinarians to clients and how information is presented influence the direction of the consultation. 14 The emergence of communication as a key influencer in the consultation room…”

Balint in the Animal World: Balint Groups for Veterinary Professionals

“…1 The authors identified the need for similar interventions in veterinary medicine, where futility of care and moral stressors are commonly encountered in the course of practice. 2,3 Indeed, a recent review of literature examining veterinary well-being found a high prevalence of psychological stressors and increased risk of burnout, anxiety and depressive disorder in veterinarians compared to other occupational groups. 4 Significant psychological distress was found among the veterinary workforce by the Merck Veterinary Wellbeing Study III, 5 with 9.4% of veterinarians experiencing serious psychological distress, a steady increase from prior reports in 2017 and 2019.…”