A moral dilemma

Vets, perhaps even more than doctors, face frequent ethical challenges in their work. Having to make decisions for your patients via a third party (the owner/client) means that we have to make judgements and decisions not purely based on what is best for the patient, but on what is practical, expedient, compassionate and affordable. A less common conundrum is whether to deny an effective treatment to your patient when it may not be legally obtained.

Feline infectious peritonitis (FIP) is a virally-induced immune-mediated disease which results in the production and deposition of immune complexes leading to granulomatous or pyogranulomatous vasculitis. It occurs in two forms, wet (or effusive) FIP and dry (non-effusive) FIP. The disease is caused by a coronavirus. FIP is normally seen in cats under 2 years old.

Normally, the prognosis is hopeless. There is no recognised or licenced therapy. Attempts to discover a vaccine have been disappointing as the vaccine tends to make the FIP signs worse (a worry when we are hoping that vaccination is the escape route from the COVID-19 pandemic). Almost inevitably, a diagnosis of FIP can only lead to death or euthanasia. Various drugs have been used in an attempt to treat FIP — at best these may have achieved remission in a small proportion of cases. Because the diagnosis of FIP relies on immunohistopathology, pre-mortem diagnosis is difficult, and a combination of clinical signs, pathology and serology are used to gain a ‘best guess’. This difficulty in confirming diagnosis may account for apparent recovery of sporadic cases in general practice, which is actually a different syndrome.