Let’s say you’re a conscientious, careful vet. You undertake a routine procedure with the best intentions and excellent medical protocols. Despite your best efforts the patient dies. Though you know your feelings can’t possibly compare to the grief your client faces, you’re incredibly saddened and shocked, nonetheless.

As a vet you took an oath to heal and protect the animals in your care. Yet you now know that had you never undertaken this procedure this pet would still be alive. No doubt you’d feel tremendously responsible. But you also know that these things happen a certain percentage of the time—even to the best vets on the planet.

So what then do you do about the bill?

A recent veterinarian-only conversation on VIN (the Veterinary Information Network) highlighted the stresses involved in making decisions on this very issue.

Do vets have a right to charge for their services even when things outside their control go wrong? Or should they extend their heartfelt sympathies by covering all costs?

The opinions expressed on VIN were lopsided in favor of the latter option. For routine procedures (especially when the outcome was really unexpected, as for an adverse anesthetic event in a young pet), it seems most vets demonstrate their compassion (in part) by offering to pay for all services rendered.

That outlook pretty much matches my own. The few times in my career that things have gone WAY wrong in a completely unexpected way, I haven’t have the heart to ask the owners to pay. In fact, as several of the vets in the VIN discussion mentioned, I have also gone one step further and paid for a necropsy (post-mortem exam) in some cases.

Yes, I know that 1) I performed these services to the best of my ability, 2) the outcomes were in no way my fault, and 3) lawyers advise that covering the cost of services rendered in these cases might give the clients the wrong impression about where the blame lies.

But if my experience is any guide, your average vet is typically so shocked, dismayed and sorry when things go wrong that asking clients to pay seems like twisting the blade after you’ve stabbed them with a knife.

Yet when it comes to emergency and specialty care the take is quite different. The risks are clear and the outcome less unexpected:  “We did everything possible to save/treat your pet and we could not. You owe us for the services we provided.”

In most emergency and specialty cases you’ve already paid up front, anyhow. And it’s a lot easier to explain why your policy is to have your services paid for (despite the loss) than it is to be asking for cash on the back end of a bad situation.

Underlying the dichotomy between how different groups handle this situation is the issue of expectations. When routine procedures are undertaken the shock of a poor outcome is an overriding factor. Clients just don’t expect to lose a pet during a root canal or spay.

But with a sick or debilitated pet, as with a long surgical procedure to fix a broken bone, for example, a seemingly inconceivable complication really isn’t so inconceivable. In fact, it’s a distinct possibility that’s usually discussed in advance.

It’s inevitable that specialists and ER docs would be looked upon as mercenary in these situations. But the reality is the same as for regular vets: We didn’t plan on losing the patient. We feel horrible about it. Most of us will be honest and tell you so. Do we really deserve not to be compensated for our time, expertise, use of supplies and facilities?