controversies, dogs, ethics, healthcare

The surprising judgment that comes with seeking advanced veterinary care…

The featured photo is of Arran and Bill, just a few days ago… As you can see, they love each other very much. Arran is glad to be here with his favorite person. I’m glad we can afford to treat his cancer and keep him comfortable for a little while longer. And I’m grateful that living in Germany allows this outcome for us.

A month ago, I wrote a post about our decision to treat our dog, Arran, for B-cell lymphoma. I was inspired to write that post after reading an article in the Washington Post about the cost of treating major diseases in pets. The article in the WaPo was written by Kim Kavin, whose dog, Blue, was diagnosed with cancer. She decided to pull out all the stops to treat Blue, and it cost a lot of money. Blue initially responded to the treatment, but then suffered a relapse when the cancer came roaring back with a vengeance. Kavin’s piece ran in the paper, and lots of people had negative opinions about it. I felt badly that she was getting so many brutal comments, so I wrote my own post about our decision to treat Arran.

At this writing, Arran has had six chemo treatments. If we hadn’t done these treatments, I feel pretty sure he would have died by now. When we started the chemotherapy on October 13th, he was starting to get sick. He wasn’t eating much, and looked very sad. He spent a lot of time sleeping, and could barely manage a short walk around the block. Now, he eats, sleeps, takes walks, jumps on the furniture, and tears things up. The chemotherapy hasn’t made him feel sick. The only thing I’ve noticed is that he sleeps a bit after he gets Vincristine and/or Endoxan. But he doesn’t have diarrhea or issues with vomiting. He hasn’t lost his fur. He doesn’t even have to take medication every day. And you’d never know he has cancer.

What has his treatment cost us so far? So far, we’ve paid for six weeks of treatment, which consists of weekly IV pushes of Vinistrine, a chemo drug. He takes two Endoxan pills per week– on Thursdays and Saturdays. Every other day, he takes three 5 milligram tablets of Prednisolone. This regime will continue for another two weeks, and then it will change to one that is less extreme. Total cost here in Germany? Still less than 1000 euros. And he feels much better with a great quality of life, while we’ve been able to enjoy his company for a little bit longer. I think he’ll make it to his tenth anniversary with us. That’s all we could have ever hoped for.

This was Arran’s first chemo bill. It covers two treatments. As you can see, it’s very reasonable. The following week, we were billed another 445 euros for four more treatments.

A couple of days ago, The Atlantic ran a story titled “How Much Would You Pay to Save Your Cat’s Life?”, by Sarah Zhang. The story was about the veterinary hospitals in the United States that give cats kidney transplants to save their lives. Their owners shell out $15,000 for the surgery, which involves using a donor cat’s kidney, implanting it in an often elderly cat. Many times, the owners end up adopting the donor cats, too, as they are typically young and healthy and in need of a home. As it is for most humans, cats can get by just fine with one kidney. In one case, the prospective donor got adopted anyway, when the cat that needed a kidney passed from heart failure before the surgery could be done.

It was noted in the article that kidney transplants are the only transplant surgeries available to cats. The donors are not killed. Apparently, transplants are not yet available for dogs, because “the canine immune system is unusually reactive, leading to kidney rejection.”

Zhang wrote about a 16 year old cat named Strawberry who got a new kidney. Strawberry’s owner did not want to be identified, as she feared backlash from people about the cost. The surgery alone costs $15,000, but with travel, follow-up care, and other costs, it can end up being twice as expensive. And Strawberry’s owner didn’t want to deal with a bunch of negativity about her choice to spend that money. Zhang writes that she interviewed a dozen cat owners who had opted for the surgery and also wanted to remain anonymous. One person quipped, “I wouldn’t think of saying to somebody, ‘Wow, that’s an expensive car,’  But people seem pretty free to say, ‘Wow, you spent a lot of money on a cat.’ ”

I remember the very negative and judgmental comments on Kavin’s article in the Washington Post. I expected to see similar comments on The Atlantic’s article. Much to my surprise and delight, The Atlantic’s readers seem to be a lot more open-minded. Or, at least they aren’t as full of judgmental bile about what people will spend their money on, as well as the mistaken belief that cancer treatment is always unpleasant and leads to sickness, as it often does in humans. And one person wrote a very astute comment, which I think really highlights why people tend to have strong reactions to other people’s choices to treat illnesses like cancer in their pets. Facebook user Isaac Suárez wrote:

The issue is not “is a cat’s life worth saving.” A cat is a companion, to be loved and cared for. There is no shame in wanting to preserve this bond and prevent unnecessary suffering.

Rather, the judgement comes from the fact that some have $15k to burn on pet care while the vast majority of people don’t. I know many people who’d happily pay the price to help a friend; I know very few who have the money to do so.

Sadly, a cat with kidney failure is just one of innumerable occasions where the stark class divide of our country manifests. Instead of talking about “are cats worth the price” we should be asking “why is the price so high” and “why do some people have the freedom to make this choice when the vast majority don’t?” As with many topics covered by Atlantic, the question is misframed and a valuable opportunity to address a visceral and important issue is sidestepped.

Another Facebook user liked Isaac’s comment, and responded thusly:

Brilliant and eloquent response! Its heartbreaking that so many must choose to have their beloved pet euthanized because the treatment cannot be afforded or people take on a hideous amount if debt in order to save their pet. Either way, there is a great deal of needless pain.

I also really related to Isaac’s comment, especially as an American who lives in a country where healthcare and veterinary treatments are much more reasonably priced than they are in the United States. If Bill and I were living in the United States, Arran’s treatment would no doubt cost a whole lot more. It would probably be undertaken at a high speed referral center, rather than at our local vet’s office. And we would be paying much more for his medications, as well as every single thing that would be done for him. We love Arran very much, but we’re practical people. He’s already an old guy. I can’t see us spending many thousands of dollars to keep him going. But in Germany, we can easily afford the treatment, and it makes him feel better. So he gets this comfort care at the end of his life, which will allow him more time with us, and give the vet more valuable experience treating lymphoma. It’s a win-win.

Arran and Noyzi welcome us home two weeks ago. You’d never know Arran has cancer, thanks to canine chemo. Isn’t this a result worth paying for? Especially when it’s pretty reasonably priced?

Many Americans resent how some people can afford to provide such advanced care for a pet, while human beings are going without care because they can’t afford it. And yet, so many people continue to vote for the same leaders, who do nothing about this problem. The United States is among the richest countries in the world, yet so many Americans lack the ability to pay for their own healthcare, let alone that of their pet’s. But a lot of us would never bat an eye at buying the latest iPad or tennis shoes. We don’t roll our eyes when a neighbor takes a trip to Hawaii or buys a Tesla. A pet can give a family intangible things that an iPad or a Tesla never can. Why should anyone be ashamed to spend money on their best friends? And why should anyone feel the need to judge someone negatively for making that choice? It’s not as if that person who can afford the advanced veterinary treatment for their dog or cat is going to be paying for their neighbor’s treatment.

I am probably not one of those people who would opt for a kitty kidney transplant, especially on a cat who is 16 years old. But now that I’ve experienced giving a dog chemo, I might opt to do it again for another dog… if I think the dog is well enough to be treated and wants to fight. I would probably pay a fair amount for that option, even if I’m living in the United States, where it will undoubtedly cost a lot more. Here in Germany, it’s a no brainer to give chemo a chance, although not all dogs respond the way Arran has. The response depends a lot on the animal and the type of disease. In Arran’s case, he is resilient, and he has a type of lymphoma that responds to treatment. We have the money. Why not treat it? What makes it any different than treating him for heartworms or diabetes or any other disease that people don’t think twice about treating in their pets? And if someone else has the ability and the desire to pay for advanced treatment for their cat, who am I to judge them? I’m not involved in the aftermath of that decision, and it’s really none of my business.

Anyway… I found Sarah Zhang’s article thought provoking on many levels, especially since we’re dealing with a pet who has cancer now. Arran is our fourth dog to get cancer, but he’s the first one we’ve been able to do anything for… and it really does feel good to do something. I can see, every day, that Arran is glad to be here. No, it’s not fun for him to get intravenous medications every week, but that’s only for about a half an hour. In a couple of weeks, he’ll be getting the IV meds less frequently. We’ll see how long he can make it before it’s time to let him go. I’m just glad we have the luxury of being able to prepare for the end, and enjoying every minute with our beloved Arran. If we weren’t in Germany, I’m not sure we’d have that. This shouldn’t be something that other people judge us negatively for doing, simply because our healthcare system is so fucked up and prices for humans and animals needing medical care are so ridiculously high. It seems to me that Americans ought to be demanding lower healthcare costs. I know that’s the way I’m going to be voting from now on.

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healthcare, law, LDS

Utah’s new “pregnancy and pre-natal child support” law…

Last night, as I watched Liam Neeson kicking ass in his Taken series, I was scanning the news for interesting headlines. Sure enough, The New York Times delivered with a story about a new law set to go into effect in Utah next month. The headline read, “Utah Will Require Fathers to Help With Pregnancy Bills”. It was inspired by a law signed by Utah Governor Spencer J. Cox on March 16th, which amends Utah’s Child Support Act by “requiring any father whose paternity has been established to pay half of the mother’s insurance premiums while she is pregnant, and any related medical costs, including the birth.” The new law is set to take effect on May 5th of this year.

Utah’s new law comes from HB113, which was sponsored State Representative Brady Brammer and State Senator Daniel McCay, both of whom are Republicans. The men said they came up with this law as a way of addressing the very contentious abortion debates that have come up in recent years, as “pro-life” people try to convince the Supreme Court to overturn Roe v. Wade. Mr. Brammer confirmed that he hoped this bill would be sort of a “pro-life” measure, although he didn’t intend it to be about abortion, per se. It’s more that he recognizes that pregnant people are in a “really tough spot, making a really tough decision.” In other words, he acknowledges that many women decide to terminate their pregnancies because of the high cost of being pregnant and giving birth. Personally, I don’t think it’s a bad thing that Mr. Brammer acknowledges that simple fact. It’s true– fathers’ names aren’t the ones on the medical bills when it comes to pregnancy, and since they are responsible for making women pregnant, theoretically, they should be paying.

On the surface, this new law, which may be the nation’s first stand-alone law to mandate prenatal child support, sounds like a good thing. In fact, given the culture of Utah, I can see why prenatal child support has now been made a state law. Utah is a state full of Latter-day Saints (Mormons), and Mormons are famously pro-marriage and family– as long as the marriage and family involves a man and a woman… or women, as they case may be. Utah is historically not so tough on polygamist families. However, once I started thinking about the law, I realized that it could cause some problems. And then I looked at the comment section, and sure enough, I saw how this new law could end up complicating matters for a lot of women. The first point made in the story, in fact, illustrates that the new law doesn’t directly assist pregnant women and could tie them to abusive partners.

In Utah, a person who is considering having an abortion must wait 72 hours and receive “counseling”. The counseling includes information that is designed to discourage abortion, rather than allowing pregnant people to simply hear the facts about the procedure and determine the right course of action for themselves. Supposedly, if the woman also has some help paying the bills, that might also convince her to have the baby instead of terminating the pregnancy. That is probably true in some cases, although it doesn’t address the fact that some women just plain don’t want to be pregnant or go through childbirth, particularly if the baby is the product of a tryst with someone she doesn’t know or care about. While adoption is still an option for people who don’t wish to parent their offspring, a lot of pregnant people decide not to choose adoption. They have some good reasons for not choosing that path, too. Frankly, if I were pregnant and didn’t want a baby, I would probably not choose adoption over abortion. But I have always wanted to have kids and didn’t get the chance.

Looking at the comment section, I saw many men opining that thanks to this law, men might FINALLY have a say in forcing women to birth babies when they don’t wish to be pregnant. After all, if he’s paying his fair share, shouldn’t he be able to dictate that the woman stay pregnant? Personally, I don’t think so. It’s still her body that is being used as a vessel. It’s still her health on the line. It’s her kidneys and bladder being danced upon in the middle of the night, and her nether regions that will be ripped apart as the baby passes through the birth canal… and it’s her blood pressure that might rise to unhealthy levels that could lead to a stroke and permanent disability or even death. Financial support from fathers is a very good and necessary thing for pregnant people, but it’s still not an equalizer of the situation at hand when it comes to making babies.

The bill would also require the paternity to be confirmed. There are situations in which the paternity can’t be confirmed, or perhaps the pregnant person does not wish to identify the father. In those situations, the mother would presumably still be paying her own bills. Although I know that there are initiatives that exist that encourage mothers to identify the fathers of their babies– mainly so that the government can go after deadbeat fathers. I was once interviewed for a job that would have had me encouraging new mothers to name the fathers of their babies if they hadn’t already. It wasn’t about involving dads, though. It was mainly about money, and preventing mothers from using welfare or other social safety nets.

If you’ve followed my story, you know that I’m very much in favor of father’s rights, once the babies are born. Even if the mother thinks the father is a total shithead, I think the father should have rights. After all, in most situations, the women chose the fathers of their children when they consented to having sex with them. And before anyone jumps my shit, let me reiterate that I also know that there are exceptions. In fact, the exceptions are one reason why I strongly believe in a person’s right to have an abortion. However, if the baby is born, and there is a father, and he wants to be in the baby’s life, I think it should be allowed and encouraged. If fathers had stronger rights when Bill’s kids were young and Bill could have feasibly gotten custody of his daughters, maybe they wouldn’t have gone through all they did. And I write that knowing that Bill also chose a poor mother for his daughters.

However, I don’t think the time leading up to parenthood is the same for males and females. Men do their part at the time of conception. So many of them do choose to walk away from their responsibilities, and it seems that a lot of them either never think twice about it or don’t ever know the difference because they’re never told about the pregnancy. Either way, once they’ve fertilized the egg, their path to parenthood involves waiting and, if they’re a decent sort or the relationship is amicable, supporting the woman through the pregnancy. Women, on the other hand, have to deal with the physical, emotional, mental, and hormonal effects of being pregnant. Some of it, I’ve heard, is pretty amazing and interesting. A lot of it is unpleasant or even dangerous. All of it is potentially very expensive.

Anyway… it wouldn’t be one of my blog posts without a few reactions from the peanut gallery. Here are some of the unedited comments that made me laugh, scratch my head, or feel genuine concern for the people of Utah who will be testing this new law. As you can see, reactions ran the gamut. Some people, whose comments I didn’t include, were aghast because they live in countries where this isn’t an issue because healthcare is a fundamental right, rather than an overpriced privilege.

Agreed, however this is more about Mormons and polygamy than it is about a cultural problem with men taking paternal responsibility for creating children. It’s Utah. (probably)

When I was pregnant in the 80’s I was told that the most dangerous time in a women’s life was when she was pregnant. This just makes it more dangerous to be a woman. (this could be true, too… there will be some men that won’t pay and will think murder is a better solution)

That’s a start. The impregnator should also pay all the funeral expenses, if the pregnant woman dies from complications caused by the pregnancy. The impregnator should also be assessed a portion of the funds necessary to care for any underage children the pregnant woman might have as a result of other impregnators, since she’s no longer alive to contribute her share of support for those children.

Story cut out on me but that’s what I’m talking about. And don’t stop with pregnancy bills. Get some hard and fast bills on the floor to make sure these fathers are paying child support. Real child support; not 5.25/wk you (I, anyway) see these moms receiving. Of course, women are more susceptible to being murdered by an alleged love one during pregnancy than any other time. Maybe we need to rethink that whole mandatory vasectomy thing. Do it at age 15 – when they’re mature enough, and wish to start a family, reverse it. After all, a male can impregnate multiple women a day if he were so inclined whereas a woman if going to produce 1 child in 40 weeks. (side note– not all vasectomies are reversible. I know this from Bill’s experience. I would NEVER support mandatory vasectomies, for the same reason I support a woman’s right to have an abortion. No one should have a say over another person’s bodily autonomy.)

Utah is creative in its efforts to allow men to control women’s reproduction.

I have a strong feeling were going to be seeing a lot of fathers move out of Utah and make it a strictly women only state.

They should make this retroactive. It would bankrupt the LDS Church.

Great, as long as the putative father has the right to demand an abortion. (make up your minds, guys…)

But they don’t get any say about abortion.

So are they having a voice on abortion or not ? (Why is this so important?)

Good….now it paves the way for father’s to have a say in abortion too.

Nice. Can fathers block abortions now? Accountability is a two way street. (not in cases of rape or incest, you cave dwelling twit.)

Great, but also should have concent before his baby is murdered as well.

They should be able to veto abortion decisions then. Their money their choice. (This comment got a shitload of replies. Why do so many people seem to think that an investment of money trumps everything? This guy seems to think that paying money for pregnancy and pre-natal support is akin to paying a prostitute.)

So the father has to pay half the medical bills (I agree because he helped make that baby) but the father has no say if the mother wants to commit murder and have an abortion? (ABORTION ISN’T MURDER!)

If guys have no say in preventing an abortion, then they shouldn’t be forced to pay pre baby costs. (They DO have a say. Don’t have sex with a woman with whom you don’t wish to make babies.)

And just like that – the words “it doesn’t feel as good with a condom” were never said in Utah ever again… (bwahahaahaa!)

This is what happens when you let men set the “birthing” agenda. Next thing you know, we’ll be requiring DNA testing of every fetus to determine the father. How long is that gonna take, who’s gonna pay for it and what if a woman refuses to name the father, or the man she names refuses to provide a sample? Too ridiculous. (I think she’s right.)

First, how do you establish paternity before birth? Second, does this give the presumed father the right to monitor the woman’s pregnancy and behavior? Will he have a say in the birth plan? Is he allowed to attend medical appointments? Will he be there for the birth? Or does he just get to foot the bill with the mother? What if the mother doesn’t desire or need his assistance? This could go south really quickly. (Yep… this was my thought, too.)

As long as the mother and fetus can be on my family insurance during the pregnancy then I don’t have a problem with it. The problem is that if I’m not married to the woman, how can she be on my insurance? (this guy is clearly NOT a mental giant… dude, maybe you shouldn’t be having sex with people to whom you aren’t married, if her not being on your “family insurance” is a concern? In fairness to him, he did come back and clarify, showing that he’s not really as dumb as that comment seems… Besides, the law indicates that the man must pay half of the woman’s health insurance premium, not put her on his insurance. And with a pregnancy rider, that’s probably gonna be pricey.)

And one guy, whose comment I can no longer find, said he was fine with the new law as long as a woman didn’t “trap” him into being a father. Now– I know for a fact that men CAN be raped, but the odds of a male rape leading to pregnancy are pretty small. I think the bigger issue is convincing men to use condoms and/or not have sex so freely with women they don’t wish to make babies with. I doubt being trapped in fatherhood is a real thing for the vast majority of men, if the man is being responsible.

There were many more comments, but I don’t have all day to share them. Bill was up very late last night, working in the office. We got a late start this morning and I want to practice guitar and do some reading. Anyway, after March’s visit from Aunt Flow, which was a bit irregular, I realize that this is an issue that really won’t affect me at all for much longer… and probably doesn’t affect me now, if I’m honest. It’ll be interesting to see what Utah does with this new legislation and how it changes things in the Beehive State. I’ll be watching for the headlines.

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