Is cancer treatment for cats ethical?

I am curious about cancer treatment for cats. To me, it seems like chemo treatments are just medicalizing or anthropomorphizing, but I wouldn't want to harshly judge anyone for wanting to do good by their cat. But is it actually a good or moral choice to put an animal through that? I don't know if as a human I would want to go through chemo, but I have agency and can stipulate things legally or just simply refuse. 

—Curious in Colorado

Being in a place to make decisions on behalf of others is a sacred and heavy responsibility. The rapid expansion of advanced veterinary care is making these decisions even more challenging, something I suspect we will be revisiting frequently in this column. Improvements in cancer care—and lifespans, which mean more pets are diagnosed with cancer—can make conversations about treating cancer in companion animals especially tough.

You mention chemotherapy, but as is the case with humans, that’s only a small slice of cancer care, and it’s worth pausing for a moment to discuss the myriad of treatment options available. Some cancers may benefit from surgery or radiation therapy instead of or in addition to chemo. Cancer treatment may also target secondary issues related to the primary cancer, like fluids; anti-inflammatory drugs for pain; or antibiotics for infections caused by a weakened immune system. 

Even chemotherapy runs a spectrum: Some chemotherapy regimens are mild with limited side effects, while others can be more aggressive. More invasive and aggressive treatments may carry more of the moral hazard you’re thinking of than others, which is something to weigh when considering the ethics of cancer care—but also, of course, providing no care at all is not a good moral choice. 

Staging is also an important consideration. There's a big difference between a highly treatable malignancy such as a slow-growing tumor removed at an early stage, allowing an animal to make a complete recovery and enjoy many years of active life, and advanced lymphoma that might be lethal within weeks or months even with aggressive treatment. 

Your cat’s age might also weigh here as well, as the prognosis for cancer care and life expectancy can look very different for a three-year-old cat than a thirteen-year-old cat. Younger animals are usually healthier, and more likely to have successful outcomes, while older animals may have a harder time with side effects and frequent vet visits. 

The purpose of cancer treatment for cats—and companion animals in general—is another issue. In veterinary medicine, often the goal is palliative treatment to improve comfort and quality of life, rather than curative treatment. While this care may extend an animal’s life, depending on the cancer, sometimes it can start to walk the ethical divide between care and torment; for pet guardians who think that the end outcome is a cure, this may be viewed as a necessary cost of getting through treatment, while those who understand it as palliative may make different choices.

Veterinary professionals don’t always communicate well about cancer diagnoses and their implications, which can cause a mismatch when it comes to understanding treatment options. When you’re expecting an outcome that a vet knows is unrealistic, it can be a hard, but necessary, conversation to have. If a vet doesn’t communicate clearly about the situation, or you don’t feel comfortable asking questions to get more information, you can’t make an informed choice. 

Is cancer treatment a good and moral choice? If you identify a small malignancy on your cat that a veterinarian surgically removes with clean margins and your cat lives another 15 years, that feels like the right decision. If you’re at the emergency vet in a crisis after your cat has been struggling with escalating health issues and growing discomfort for six months and the vet finds a large abdominal mass that looks cancerous and is likely metastatic, treatment is still the correct choice, but the form that treatment takes may be more or less moral—from humane euthanasia to alleviate suffering to comfort care to an aggressive last-ditch attempt.

Our cultural beliefs surrounding nonhuman animals are another facet of this discussion. Humans often assume both that nonhuman animals do not really understand the world around them and cannot communicate, but neither of these things are true. They may understand things in different ways, and have distinctive relationships to the world that aren’t like ours, but that doesn’t mean they don’t comprehend. The belief that nonhuman animals can’t communicate is also false—we know that they have rich social communications with members of their own species, and sometimes across species divides—though sometimes humans fail to establish communication with them. 

Cats can certainly communicate when they feel pain or psychological suffering, and, when given the opportunity to do so, can also be participatory decisionmakers in medical care. Digit, a cat on the @pixelandfriends TikTok account, for example, collaborated with his guardian to choose which pills he wanted to take in which order. While she made the overarching treatment decision to give him the medication, providing him with a measure of control was an important part of their relationship. She also empowered Digit to make choices about his end-of-life care.

Our historic understanding and treatment of nonhuman animals deprives them of agency and dignity; delving into critical animal studies is a great place to start shifting your thinking about human and nonhuman animal relationships, and I find it really informative for thinking about ethical questions like this. If you take a liberatory approach to deconstructing the way humans interact with nonhuman animals, it opens up complex and sometimes difficult conversations. While there is an academic journal dedicated to critical animal studies, it’s worth noting that this is a highly interdisciplinary area of work and one that actively rejects the notion that thought and action must flow through academia to be valid. Activists are, in fact, a vital part of critical animal studies.

This is where we land upon another area of contention across veterinary care, not just in cancer treatment: Are we making choices because of their interest, or ours? 

It’s natural to want to apply your own feelings about cancer treatment for you to decisions on behalf of your companion animal, but our values may differ from those of our pets. Treatment we think of as traumatic and upsetting may not be so for companion animals, and vice versa. The question I ask myself when making these decisions, and encourage others to ask too, is whether you are thinking about the best outcome for a pet, or want more time with them, especially if you are experiencing guilt and internal conflict. 

Sometimes our interests and those of our pets are aligned, and sometimes they are not; aggressive chemotherapy, for example, might buy eight weeks more, but those weeks could be stressful, painful, and miserable. If you have established a relationship of mutual respect and communication to get to know a companion animal on their level, you can think about making their interests the focal point of decisionmaking. What makes a pet happy? How does a pet express emotions and interact with their surroundings? You might also want to ask yourself how you want to remember a companion animal’s final days or weeks, speaking to your question of whether it is moral to “put an animal through that.”

As one vet student put it in a 2012 study: 

Sometimes we take cases too far and subject dogs to radiation or chemotherapy to satisfy the client …. A lot of times the animal is in intensive care and it’s just for the people.

Questions about duty of care can be deeply situational, and questions like this are good to ask early in a companion animal’s life, rather than at the end, when you may be faced with escalating treatments and tests to find out what is wrong in urgent situations where you feel like you don’t have time to be informed and weigh your options. If treatment does not cause suffering—or causes minor, manageable side effects on the way to a positive outcome, whether curing or controlling cancer—I’d argue that’s a pretty straightforward moral choice.

When that treatment starts to cause suffering, it’s a more deeply individual question informed by your own relationship with a nonhuman animal, your awareness of how much they are willing to tolerate, and your preparedness to establish communication with them. 

Tell your cat I said…

…it depends.