I think, again (I know I sometimes harp on this type of point

) there can be middle ground between two extremes. It's true our shelters are horribly overcrowded and millions of unwanted animals die needlessly in them every year. It also is true that pets should get medical care. (I know it varies by state, but her in MA it's required that all animals receive food, shelter and medical care; not sure about other states but when we've discussed this before, I recall there being some states where it's not required.) Vaccinations in MA are a minimum requirement. Spay and neuter are NOT required (anywhere that I am aware of, because laws like that would "trample" on the rights of people to breed them, which is probably material for another thread). Sometimes issues are pretty clear - with cancer, say. It's ok to choose not to do a surgery and euthanize, but it's not ok to leave the animal to languish in pain and suffering, with things like gangrene and what not. If it gets extreme, one can be prosecuted (here).
Less clear are "optional" medical treatments.
Let's take the twisted bowel mentioned above. Without a vet's diagnosis, one might not know what the problem is. Animals can't tell us what they're feeling so owners need to be in cue to notice subtle signs that something's wrong, and let's face it, some owners aren't in cue at all, and others may be in cue but don't recognize the problem is as serious as it is - animals seem to sometimes tolerate more pain than humans do. Death, also, may come relatively quickly in that situation so there may not be a lot of languishing going on. But then we have the people who recognize something is wrong, but don't care, and choose not to do anything about it. So circumstances can differ. And as we've seen on this thread, everyone sees it differently. I am not sure about the idea of people taking pets that can't care for them properly just to empty out the shelters. I think a better approach might be education, and perhaps legislation, on conditions for adopting a pet (which there seem to be in many places. ETA Soldier's Sweetie's case highlights how rigid some of these shelter have become, which, again, is probably for another thread).
I guess the bottom line is that reasonable approaches to care for animals fall into a broad category, and as long as basics are met, then that should be fine for most animals. It is extremely sad to see, though, some of the things that are happening with pets who aren't cared for properly. Love and kindness can't be legislated. And I'll just leave it at that.