A Holistic Decision-Making Tool for Canine Chronic Kidney Disease: Navigating Palliative Care and Euthanasia

Ethical decision-making in veterinary medicine often suffers from subjective bias, particularly in the management of terminal conditions like chronic kidney disease (CKD). This paper presents a structured algorithm that translates clinical scores into actionable ethical tiers. We redefine palliative care as an active medical commitment—focusing on the mitigation of uremic gastrointestinal distress and the prevention of metabolic crises—rather than a passive withdrawal of care. This framework provides a transparent roadmap for clinicians, ensuring that every intervention, from proactive palliation to compassionate euthanasia, is grounded in the principle of non-maleficence and the preservation of the animal’s dignity.