The Effect of Pet Insurance on Presurgical Euthanasia of Dogs With Gastric Dilatation-Volvulus: A Novel Approach to Quantifying Economic Euthanasia in Veterinary Emergency Medicine

Abstract

Euthanasia of companion animals in veterinary emergency medicine is a common cause of death. Euthanasia is economic when it is the consequence of the pet owner's inability to afford essential treatment while a viable medical alternative to euthanasia exists. Gastric dilatation-volvulus (GDV) is an acute life-threatening emergency condition of dogs; if left untreated, rapid death is highly likely. Surgical treatment leads to survival of around 80-90% of dogs; however, such treatment is costly. Therefore, pre-surgical euthanasia may be largely economically motivated. Having pet insurance, a financial instrument to reduce the burden of unforeseen veterinary medical costs on pet owners, would be expected to abolish the risk for pre-surgical economic euthanasia. We therefore aimed to determine whether pet insurance attenuates the risk of pre-surgical economic euthanasia in dogs with GDV. Non-referred dogs (n = 260) with GDV and known insurance status seen at 24 emergency clinics over a 2-year period were included. Relevant data (e.g., insurance status, age, comorbidities, outcome) were retrospectively extracted from a pet insurer's claim records (insured animals) or from electronic medical records of participating hospitals (non-insured animals). Forty-one percent of dogs (106 of 260 dogs) did not survive to hospital discharge; 82 (77%) of non-survivors died before surgery, all through euthanasia. The pre-surgical euthanasia rate was 10% in insured and 37% in non-insured dogs (p < 0.001). When adjusted for the effect of age, deposit size, comorbidities, and blood lactate concentration, the absence of insurance increased the odds of pre-surgical euthanasia by a factor of 7.4 (95% CI 2.0 to 37; p = 0.002). Of dogs undergoing surgery, 86% survived to hospital discharge. Overall, 80% of insured animals and 53% of non-insured animals survived to hospital discharge (p < 0.001). Thus, insurance was associated with a marked decrease in risk of pre-surgical euthanasia indicating that the cause of pre-surgical euthanasia of dogs with GDV is predominantly economic in nature. The rate of pre-surgical euthanasia in dogs with GDV may emerge as a suitable marker to quantify economic decision making of pet owners and to measure the impact of financial interventions aimed at mitigating economic duress associated with cost of veterinary emergency care.

Risk Factors Associated With Increased Ethically Challenging Situations Encountered by Veterinary Team Members During the COVID-19 Pandemic

“…While pet insurance may protect against economic euthanasia ( 30 , 31 ), many veterinary patients are uninsured. It is possible that in times of economic hardship, clients who have pet insurance may not be able to afford to pay for continued cover.…”

Animal Welfare Considerations and Ethical Dilemmas Inherent in the Euthanasia of Blind Canine Patients

“…In the case in which the owner is unable to afford treatment, it may be suitable “to make known the options and eligibility for charitable assistance or referral for charitable treatment”, as stated by the RCVS (Royal College of Veterinary Surgeons) Code of Professional Conduct for Veterinary Surgeons [ 65 ]. Another financial instrument to reduce the burden of veterinary medical costs on the owner could be pet health insurance that would consequently reduce or abolish the risk for euthanasia [ 66 ]. In our opinion, animal welfare should be the veterinarian’s primary concern.…”

Ethical Challenges Posed by Advanced Veterinary Care in Companion Animal Veterinary Practice

“…Pet humanists were also the most likely owners to insure their pets. Pet insurance may reduce “economic euthanasia” [ 66 , 67 , 68 ], benefitting animals, their clients and veterinary team members who may otherwise experience moral distress. However, pet insurance premiums may not be affordable for many pet owners.…”