The Methodology of Treatment Decisions

I’ve found decisions over treatment options, and even a decision on whether to treat at all, are perhaps the most difficult options I’ve ever considered in my life. Potentially life or death choices resting in the palm of my hand and concerning a living being that I loved so deeply. I was desperate to make the “right” decision, and terrified about how to go about this. So I examined the problem and began to dissect the methodology of arriving at decisions.

Boomer’s bone cancer was getting worse. I would either have to amputate his hind leg or euthanize him in the near future. I was concerned about making matters worse for my alpha male, The Big Dog, and at the same time, I didn’t want to say goodbye too early. How could I resolve this dilemma?

Early on, I had choices over treatment; chemotherapy, radiation, just to name a couple. These were rather objective points where I had a specific goal in mind. I just had to choose the best option to reach that goal. I called these “Results Driven Decisions.”

I also thought about the more difficult decisions. Perhaps the issue wasn’t so objectively clear or the specific goal a bit less clear. This was the dangerous territory for me because of my habit for retrospective judgment. Stated otherwise, and if the selected treatment didn’t work, I’d look back in time and chastise myself for such a stupid decision. This called being a “Monday Morning Quarterback.”

So I pondered if, and then how, I might remove all judgment from this set of decisions. Fortunately, this proved easier than I thought.

In Boomer’s case, he was down to mere hours of life. Absent amputation, he’d have to join his brother. The steadily increasing pain of bone cancer made that fact rather clear. To me, the decision became one of promoting health and life. There wasn’t any guarantee or clear goal in mind (i.e., a results driven decision), just a result I could live with later on, no matter what the result. I called this a “Process Driven Decision.”

The process driven decision then insulated me from guilt later on. Since I acknowledged the lack of a clearly defined goal, prior to the decision, I couldn’t beat myself up later on. What I did need to do was sit down with my dog and have a long talk about our life together. The decision became one more of personal philosophy than veterinary medicine. I was simply making a decision that I could live with many years down the road.

I decided that Boomer’s offending leg would have to be amputated. I’ll always be a bit uncertain as to whether I honored Boomer or disobeyed a direct order. However, I am certain I made the best possible decision under the circumstances and remain comfortable in this choice several years afterwards.

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