In January 2020, three weeks after I spent $5,000 on an emergency surgery for my dog, my 10-year-old cat Gentleman was hospitalized for eight days because he was unable to urinate. Left untreated, the condition can be fatal, but as long as he was at the hospital with a urinary catheter, his life was never in any medical danger. But as the bills from his visit racked up — $2,000, then $4,000, then the projected cost of follow-ups — I began to worry he wasn’t going to survive.

Not because his condition was fatal, but because my funds were limited.

My mom and I discussed my budget; if Gentleman kept relapsing, getting blocked, or needed surgery to come home, Mom said, How much should you spend before you let him go? I had a high enough credit limit to charge it all, but I’d already done that the month before with my dog, so at what point does the financial burden become too great to continue care?

Then all I could think was: His death would not be medically necessary. Why should he have to die because I won’t spend the money?

For both my pets, the prognosis was the same: with medical intervention, a nearly 100 percent chance of recovery. These weren’t instances of terminal conditions or last-ditch, low-chance-of-success medical procedures. The only thing that stood between my animals and their survival was my credit card.

Surely I am not alone in that grim calculus. How often does it happen that medical decisions for pets — not strays or shelter animals — are based more on money than medicine? How do you make the decision between spending everything you have — and then some — on an animal you love and knowing when to stop?

Veterinary costs in America are expected to top $16 billion this year, according to Pet Life Today.; a 2016 study by the National Bureau of Economic Research found that spending on pet health care outpaces human health care. Pet insurance can help cover the bulk of veterinary costs, however, only one to two percent of cat and dog owners have insurance (some lucky people are able to get pet insurance through their jobs).

“I’m in the ‘would sell an organ to pay their vet bills’ camp,” Alex, 29, a former quality engineer from Liverpool, told me. “I don’t see it as being an option. They’re my babies.” Six years ago, her staffy mix, Billie, required surgery for a dislocated knee at three years old; Alex spent nearly $3,500 to get her well. For Alex, there was “no question” of pursuing treatment “regardless of cost.”

Kimberly, 31, shared Alex’s sentiment. “I would’ve done anything short of selling my own organs on the black market to raise the money. Pets aren’t merely animals to me,” she said, echoing Alex’s words and explaining that her seven-year-old red-nose pit, Nell, was like her child. There was nothing Kimberly wouldn’t do to afford Nell’s heartworm treatment, which totaled $1,500 — a steep price for an English Ph.D candidate in Tennessee, living on a modest graduate stipend and no savings. “I seriously considered selling my furniture,” she said.

Roxanne spent nearly $31,000 on medical bills after Lilly, seven at the time, had an adverse reaction to a rabies vaccination

Fellow pet-owner Alison agreed, emphasizing she’d “do anything to care for Marcus.” Her dog came to her as a foster already sick with urinary crystals, seizures, and heartworm, among other problems; when the rescue withdrew their support, she continued caring for him out of pocket, since his pre-existing conditions made him ineligible for pet insurance. She told me at one point his vet bills topped five figures. To afford this as a freelance writer, she “lives a very simple, frugal life with no frills.” She describes her life as “a lot of scrimping” and “eating ramen noodles.”

Similarly, for Colorado-based writer Roxanne, 52, there was no limit on what she sacrificed for her border collie, Lilly. She spent nearly $31,000 on medical bills after Lilly, seven at the time, had an adverse reaction to a rabies vaccination and went from “perfect to almost dead in about seven days,” which she writes about in her book Heart Dog.

“In that crisis it’s very easy to hand over your credit card and say, ‘Save my dog,’” Roxanne told me. After the immediate emergency, Lilly required extensive medical care for the rest of her life — just shy of two years. Roxanne doesn’t regret her decision, though she added, “It was probably not a very smart thing I did.”

“But she was the dog of my lifetime,” she said.

Despite how beloved pets are to people, the financial reality of them can’t always be met. Kimberly, though she wanted to do anything for Nell, simply didn’t have the money. “I called my mom and cried for hours,” she said. “I remember telling her if I couldn’t raise the money somehow, I would have to put my dog down.”

Vets bear witness to these decisions every day: The pet or the budget? The practice of putting an animal down for monetary reasons is called economic euthanasia. In these cases, euthanasia becomes a financial decision as well as a medical one, when treatment is available but not affordable.

For John, 45, and his cat Hodge, the decision wasn’t immediately obvious. Hodge had cystitis — the same condition my cat developed — and presented with urinary issues “from the start,” John explained, but despite the cost of medicated food and frequent vet visits, he “approached the economy of care as a necessary part of loving [his] cat.”

“That is, I assigned moral and emotional value over monetary value during this stage,” John said. When Hodge was six, that economy of care shifted. He fell ill suddenly and the doctors, not sure why his kidneys weren’t functioning, presented John with two options: put Hodge on a dialysis machine while they continued running tests, or euthanize. He chose the latter.

“In over 30 years I can recall only very few cases whose outcome was determined by financial cost alone”

“Ultimately I decided that this situation no longer was transactional,” John, an English literature lecturer in Tennessee, said. “I hate using such cold language but feel like it was necessary, not only for my financial status but also for my emotional well-being.”

“In over 30 years I can recall only very few cases whose outcome was determined by financial cost alone,” Dr. Eileen Mulcahy, D.V.M., told me. Her colleague, Dr. Karen Fine, agreed, explaining that “while it does happen” that animals are euthanized for financial reasons, “it is more likely to be one of many factors that the owner weighs, including the age of the pet and the likelihood of recovery.”

The truth is, it’s not always reasonable to assume large amounts of debt for an animal. While there are many alternative ways to offset the cost of medical care — pet insurance, credit companies, private loans, crowdfunding, nonprofits — for many people, it remains a matter of practicality, not affordability.

Suzie, 31, an adjunct instructor of composition in Missouri, thinks of it as a financial line in the sand: anything before the line, she’d pay to help her two-year-old cat, Willa. After a certain point, however, she would have to reconsider.

“I would spend a lot of money to save her,” Suzie said. “I love her, she’s my cat. But she’s still a cat.”

Nicole, a 25-year-old teacher from Ohio, also approached the decision practically. Her horse Rally was only six when she opted for economic euthanisia. Between his cleft palate, joint trouble, and mental issues, recovery wasn’t financially feasible; instead of “paying the ungodly amount of money” that he would require to to run diagnostics, she decided to say goodbye.

When I asked if veterinary clinics had options for owners who cannot or will not pay, like surrendering an animal to a rescue organization, Dr. Fine said, “Often the animal may not be adoptable without care and would require a rescue with a large fund.” She noted that veterinarians themselves have very little control over the prices of treatment and that when procedures are done for free or reduced rates, it’s often out of pocket for the clinic.

“It’s the type of thing that can happen occasionally, but not all the time,” Dr. Fine said, “unless you had a rescue with very deep pockets.”

For many pet owners, however, even surrendering their pet was not a solution. Kimberly said sending Nell to a shelter “to be sick and scared by herself” was “never an option.” If it came to that, euthanasia seemed more humane.

Nicole agreed. She was worried if she surrendered her horse, another owner might take advantage of his pain. On her decision to euthanize instead of rehome, she explained, “It was a matter of quality of life. I always said if I didn’t own [Rally] no one would, because I would be so afraid that someone would mistreat him due to all his issues.”

I wonder if people hear these stories and think that those who spent the most love the most. Perhaps for some, the only way to prove devotion is to give everything. People have a responsibility to their pets, after all. As Alex said, “You chose to take on an animal… If you can’t afford to take care of them, you don’t deserve them.” But is financial devastation the only way to express devotion?

It feels gauche to talk about having a price limit on life or love.

Gentleman isn’t “the cat of my lifetime,” though I love him in all the quiet ways love starts to feel like being taken for granted. I love his aggressive headbutts, that he is willing to be held on his back, that sometimes when he sleeps he coos like a pigeon. In the week he was hospitalized, my house was not home without him. But I am troubled by the implication of linking that love to my wallet, as though any hesitation at the thought of taking on crippling debt is proof of callousness.

It feels gauche to talk about having a price limit on life or love. Like love is only love when it is swallowing you whole. It’s customary among humans to prove affection with extremes.

“It’s very hard to know where to stop,” Roxanne said. “Part of me looks at [Lilly’s first] relapse and thinks I probably should have let her go then. I could have made a different decision there.”

Then she added, “But it’s very hard not to feel like if you quit, everything you’ve spent was a waste.” When John said goodbye to Hodge, he had already spent $3,000 on his little companion. Part of him wanted to spend more, but he said that his “attempts to rationalize that emotional and financial economy failed.” He explained that he considered spending the money not only financially irresponsible, but emotionally “selfish.”

“There’s no price high enough to cling to a suffering pet. I miss him every day,” he said. “But I know I made the right decision.”

In the end, I paid for Gentleman’s treatment. He’s home now, though the chance of a repeat blockage is high. If it happens again, I don’t know that I would pay twice. Even Roxanne, who now has three dogs and one foster puppy, said that “faced with a similar situation [she] might make a different decision.”

“You do what you can,” she added. “You forgive yourself and you go on.”