A few months ago, my mom went to the hospital for a proactive total knee replacement. When she had a seizure in recovery, an MRI revealed a significant brain mass. Three weeks later, I was sitting in a surgical recovery waiting room, clutching my phone, waiting to hear from the neurosurgeon, who was going to reveal the results of her intraoperative brain biopsy. It never arrived.
Instead, after 7½ hours, I received a text saying my mom was in recovery and that her aggressive brain tumor had been removed. That night, a caller informed me that the tumor was a Grade 4 butterfly glioblastoma. More tests were pending, but the prognosis was poor.
The worst part was that the mom I had dropped off at 5:30 that morning was not the same woman after her craniotomy. She had lost all her short-term memory, vision in one eye, spatial awareness, and the ability to tell time and do math. She was left with the cognitive level of a young child.
The experience made me reflect on how we guide clients, their autonomy to choose, and these two questions:
- If we can treat a medical condition, how do we decide whether we should actually do it?
- How do we discuss the situation with pet owners in a way that preserves their trust and the human-animal bond, protects animal welfare, supports our teams, and still sustains a practice financially and operationally?
For many veterinarians, the biggest challenge isn’t complex medical cases but communicating clinical empathy without judgment. As a profession, we struggle to say, “We have reached a point where further treatment is unlikely to help and may cause harm.” The result is the perfect storm: moral distress, increased burnout, frustrated clients, and outcomes that might not reflect our values.
All this has brought me to examine why we fear such conversations and how we can do better in such moments.
Gaps in Our Training
While caring for my mom, I’ve met with nearly 100 human medicine residents, all at different stages of training and many striving to reach a world-class level of microspecialty. Their common thread is the drive to cure.
Veterinarians are cut from the same cloth. Veterinary school emphasizes intervention over limitations. The curriculum excels at teaching problem-solving skills. We learn to identify disease processes, develop diagnostics, and pursue treatments with precision. The process of examination, diagnostics, and treatment is embedded in our identity.
What we rarely learn is:
- How to decide when additional treatments offer diminishing benefits.
- How to communicate a disease’s prognosis more clearly instead of with hopeful ambiguity.
- Most importantly, how to present not treating as a feasible and compassionate medical choice.
Without that foundation, new graduates start practicing to save lives but are unprepared for conversations about end-of-life care or when stopping is the humane and medically appropriate choice. As those new graduates become seasoned veterinarians, the gap isn’t in their competence but in their communication, ethics, and emotional confidence.
A Profession Based on Relationships
I’m angry at my mom’s surgical team. We weren’t given the choice whether to proceed with the aggressive tumor removal. We were never informed of all the potential complications or the severity of her disease. And, it turns out, we had different goals.
Yet, because building a deep, trusting relationship is almost impossible in such brief moments, we must accept what is given. I understand that is often the reality in human health care, and I don’t blame those limited by such a system.
On the other hand, we’re different. Veterinarians develop long-term relationships with clients — relationships that often span decades, life stages, and multiple pets. The connection is one of our profession’s greatest strengths, but it also creates significant pressure during emotional discussions.
When a client says, “Please, do everything,” we often hear: “You are the person I trust most. Don’t let me down.” That makes saying, “This treatment is no longer in your pet’s best interest,” feel destructive to the client bond. We worry about being perceived as uncompassionate, insufficiently skilled, cost-driven, or a clinician who has “given up” on the pet.
The emotional burden we bear is often unspoken, yet it significantly impacts clinical decisions and the sustainability of veterinary practice. Inconsistent boundaries lead to inconsistent care, which causes client frustration, ethical distress, and confusion within the team.
Smoldering Moral Distress
At one appointment with my mom’s neuro-oncology team, I asked, “What happens if we do nothing?” The room fell silent, all eyes turned to me, and I was asked, “Why would you do that?” My family was working with one of the top brain institutes in the United States, where many cutting-edge clinical trials are conducted, but still, what if we did nothing more?
Veterinarians find themselves in situations in which a treatment’s side effects may outweigh the benefits of therapy. Yet we sometimes treat when we believe we should not.
Moral distress occurs when a clinician knows the ethically appropriate action is to recommend palliative care or humane euthanasia but feels unable to act. Many factors influence this, including:
- Pet owner pressure
- Team member pressure
- A fear of negative online reviews
- The lack of leadership support
- Unclear medical boundaries
Repetitive moral distress leads to compassion fatigue and, ultimately, to turnover. Many of us, including myself, have struggled with it, and some have left our profession because of it. Recruiting and retaining veterinarians is already difficult. Losing them due to a lack of systems supporting ethically aligned care is entirely preventable.
Client Expectations Complicate the Conversation
As you can imagine, during every conversation with my mom’s medical teams, I was armed with research papers, clinical trial networks, treatment protocols, and anything else
I could find out of desperation. At most appointments, I received responses ranging from tolerance to annoyance to defensiveness. In those moments, I felt extremely frustrated.
Upon reflection, I realize how many times I’ve been on the other side of the table.
Today’s pet owners are generally more informed, emotionally invested, and financially diverse than ever before. They enter our exam rooms influenced by Google searches, social media, medical analogies, chat-room stories, and everything in between. However, the true challenge arises when pet owners confuse possibility with obligation. They think that if a treatment exists, you must offer it, and that refusing treatment means they don’t care enough.
Veterinarians need to navigate these three challenges:
- The pressure to recommend advanced treatment even when the prognosis is grave
- Time-intensive conversations that disrupt the workflow
- Potential negative consequences if pet owners think you talked them out of treatment
We Underutilize Palliative Care
One of the few bright spots in my journey as my mom’s medical advocate was the consult I requested with the palliative care team. The conversation felt familiar to me because these moments are becoming more common in veterinary medicine. While human medicine made significant progress when palliative care became a formal discipline, our profession is starting to follow, but not fast enough.
Most veterinary practices today lack integrated, standardized tools for quality-of-life assessment, palliative care protocols, and communication training to deliver difficult news collaboratively and without shame. Because those structures don’t exist, we often have to improvise. Some colleagues prefer to continue treatment, while others favor early comfort care.
Even now, a stigma seems to persist around palliative care. Colleagues pass judgment, and many who try the palliative care approach might find it jarring at first because it conflicts with much of their traditional education.
Our profession needs more mentorship and champions to normalize palliative care as an acceptable choice, not just a last resort.
How We Move Forward
As I write this, I realize the peace I’ve reached with my family’s choice of palliative care for my mom. And while I’m glad we arrived here, the journey was anything but peaceful, and there remains a smoldering resentment of why palliative care was never proactively mentioned at the beginning.
As a clinician, I’ve learned that saying, “Just because we can, doesn’t mean we should,” is not about giving up.
Having courageous conversations with pet owners shows our vulnerability, humanity, and empathy. We should always lean on a core quality of our profession — compassion — when it comes to our patients, our pet owners, and our teams.
5 STRATEGIC STEPS EVERY HOSPITAL CAN TAKE
- Develop guidelines for medically appropriate care: It’s a critical exercise and a valuable use of time to define, as a team, how your practice approaches end-stage disease, patients with grave prognoses, and quality-of-life assessments. This step empowers veterinarians with a framework that supports ethically consistent recommendations.
- Teach communication skills: Most hospitals emphasize continuing education around clinical topics that historically drive revenue. However, workshops on prognostic communication, empathic transparency, quality-of-life discussions, and the grieving process should be equally essential.
- Normalize palliative care: Make comfort care a routine option rather than an afterthought. Hospitals can integrate quality-of-life scoring into rechecks and follow-ups and provide associated education.
- Reduce the emotional burden on the clinical team: Debrief during and after emotionally challenging cases. Promote team discussion. Foster a team culture where clinicians feel empowered and supported when making tough decisions.
- Clarify your hospital’s approach to financial communication: Decide how to present options. Focus on transparency and clarity.
STORY ARCHIVES
This isn’t the first time Dr. Natalie Marks had a less-than-ideal health care experience. Read her story, “It’s Not What You Say, It’s How You Say It.”