I never cease to be amazed at how veterinary medicine has changed since I adopted my first cat at the age of 13. Back then, people rarely brought their cat to the vet unless he was sick, and unless the problem was easy to fix — say, an abscess or a low-grade infection — the treatment of choice more often than not was euthanasia.

Thirty years later, life expectancy has increased. Cats can get chemotherapy, radiation therapy, an assortment of advanced and high-tech surgeries, dialysis, blood transfusions, and even kidney transplants.

Diagnostic testing has advanced exponentially, too. Vet clinics used to have very few options for figuring out what was wrong with your cat. Now, your vet has tools at her disposal ranging from the standard X-rays and fecal tests all the way to in-house blood tests, ultrasounds, and EKGs. Specialty clinics have access to CT and MRI scanners, too.

In large part, these advances are driven by a change in attitudes about pets. When we believe our cats are full-fledged family members who deserve the best possible care we can give them, we’re going to expect our vets to provide that. And they do.

But here’s the thing: Even if we can afford to do everything possible to fight for our cat’s life, should we? It’s a question of ethics worth asking.

I’m not talking about being callous and saying, “Screw it, my cat’s really sick, so just put her down.” I’m talking about using the incredible array of veterinary treatment options to extend your cat’s life long past the point where it has any quality.

This is an ethical question I’ve faced more times than I’d like, and I’ve had plenty of time to think about this subject. Here are the questions I ask myself to determine whether and how long to treat.

1. What’s the prognosis?

Even if your cat is very old, sometimes costly treatment is justified as long as your cat’s quality of life is otherwise good. When I chose to get radioactive iodine therapy to treat my 17-year-old cat’s hyperthyroidism, I did so after getting a reality check about Siouxsie’s quality of life from my vet and from my best friend, who’s not afraid to tell me things I may not want to hear.

2. Is my cat suffering now, and is that likely to change if I choose treatment?

When my beloved Dahlia developed cancer, I chose to treat palliatively until I got a diagnosis. I did my best to keep the suffering to a minimum by giving her medications and having fluid drained out of her chest to make her breathing as easy as possible. But when the biopsy came back, my vet told me that the prognosis was bleak. I could do chemotherapy if I wanted, she told me, but it might not get Dahlia more than a month and she would be suffering the entire time. I chose euthanasia.

3. Am I able to manage treatment at home, even if it gets ugly?

Some diseases require treatment that can be difficult, either because we’re squeamish or because the cat is extremely resistant to treatment. If your cat has kidney disease, you can save money by learning how to give subcutaneous fluids at home — but are you able to overcome your instinctive cringe reaction about poking needles into your furry friend? Can you restrain your cat safely in order to give him medication? Can you deal with changing dressings on gruesome wounds?

4. Am I making this decision for my cat or for me?

I’ve seen people treat their cats for longer than is kind or humane because of their own fears and issues around death. But as painful as this time can be, it can be an amazing experience, too. If you’re willing to do your emotional work and examine your own hang-ups about death and dying, you’ll not only be able to help your cat with a clearer head and heart, you’ll be more prepared to deal with future losses.

What questions do you ask yourself when thinking about whether and how long to treat a sick cat? Have you been faced with this decision, and how do you feel about the choice you made? Did people try to convince you to do something different? Let’s talk in the comments.

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About JaneA Kelley: Punk-rock cat mom, science nerd, animal shelter volunteer and all-around geek with a passion for bad puns, intelligent conversation, and role-play adventure games. She gratefully and gracefully accepts her status as chief cat slave for her family of feline bloggers, who have been writing their award-winning cat advice blog, Paws and Effect, since 2003.