To Treat or Not to Treat: The Real-Life Ethics of Managing Diabetes in Cats

Feline diabetes isn’t just a medical diagnosis, it’s a series of deeply human decisions layered with emotion, finances, logistics, and ethics. A new qualitative study published in PLOS One offers a rare look inside how veterinarians actually navigate those moments, revealing the complex balancing act behind every treatment plan, adjustment, and difficult conversation.

The research, led by Ninni Rothlin-Zachrisson and colleagues, explored the lived experiences of 10 Swedish veterinarians who regularly manage cats with diabetes mellitus. Through in-depth interviews, one theme rose above all others: veterinarians consistently center their decisions around the cat’s wellbeing, while simultaneously negotiating the realities of the owner’s situation and their own professional responsibilities.

Together, these forces create the moral landscape of chronic disease care in veterinary medicine.

The cat comes first — but never alone

At the heart of the study was a core truth most clinicians already feel: the patient’s quality of life drives decision-making. Veterinarians described seeing themselves as advocates for the cat, responsible for protecting health, preventing suffering, and preserving both longevity and comfort.

But feline diabetes management doesn’t happen in a vacuum. Successful care depends heavily on the owner’s ability to give insulin, monitor blood glucose, adjust diet, and stay committed long-term. That means every clinical recommendation is filtered through what’s realistically possible at home.

In other words, the cat, the owner, and the veterinarian form a triad — and every decision sits at the intersection of those relationships.

The owner is the gatekeeper to success

One of the strongest themes to emerge was the central role of the owner. Veterinarians recognized that no matter how solid the medical plan is, treatment only works if the owner can carry it out.

Participants described investing heavily in communication: explaining the disease, setting expectations, and reassuring overwhelmed pet parents. Many talked about “de-dramatising” the diagnosis by sharing success stories and emphasizing that diabetes can be manageable.

Others focused on empowering owners with information so they could make informed decisions about whether they were ready to take on the responsibility.

This relationship-building wasn’t viewed as a distraction from patient care — it was seen as essential to it. Without trust and buy-in, adherence drops and outcomes suffer.

Between gold standard and real life

The study also highlighted how often clinicians adapt treatment plans to meet owners where they are. While ideal protocols might include strict insulin schedules, frequent monitoring, and immediate dietary changes, reality doesn’t always allow for perfection.

Instead, many veterinarians described using incremental approaches: starting with diet changes, simplifying monitoring, or easing owners into routines to build confidence. These compromises weren’t viewed as lowering standards, but as practical strategies to give the cat “a chance to live” when the alternative might be euthanasia at diagnosis.

Financial limitations were among the most difficult constraints. Participants spoke about trying to find a “bronze standard” option when gold standard care wasn’t possible — not out of resignation, but out of determination to help the cat within the boundaries that existed.

When euthanasia becomes part of the conversation

Perhaps the most emotionally charged theme was how veterinarians think about euthanasia in diabetes cases.

For many, it was not framed as failure but as a compassionate, ethically grounded decision when quality of life could not be maintained or when treatment wasn’t feasible. In some situations, the choice was driven by the cat’s suffering. In others, it reflected insurmountable barriers faced by the owner, such as illness, fear of injections, or inability to manage daily care.

Even when veterinarians understood the circumstances, they described the emotional weight of these moments — especially when the disease was treatable and the cat might have lived well under different conditions.

These situations can create moral stress, particularly when clinicians feel caught between advocating for the patient and respecting the owner’s limits.

The emotional labor behind everyday medicine

Beyond clinical decision-making, the study sheds light on the psychological toll of chronic disease management. Participants described walking a fine line between empathy and emotional self-protection. Some spoke about maintaining professional distance as a coping strategy, while recognizing that constant exposure to ethical conflicts can be draining.

The findings echo broader conversations happening across the profession about moral stress, compassion fatigue, and the emotional complexity of practicing in a system where ideal care isn’t always achievable.

Why this matters for practice

While previous research has focused heavily on owner perspectives, this study offers something different: a window into how veterinarians interpret responsibility, navigate constraints, and make meaning out of difficult decisions.

The takeaway isn’t about choosing the “right” path for every diabetic cat. It’s about recognizing that each case is a negotiation between medical ideals, practical realities, and compassion — and that communication sits at the center of it all.

For clinicians, the findings reinforce what many already know from experience: success in managing feline diabetes isn’t just about insulin and diet. It’s about relationships, expectations, adaptability, and the shared goal of protecting a cat’s quality of life in the real world.

Read full article here: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0341762