I'd speak up, maybe couching it in the second opinion terms but definitely to suggest that she consider that option. As perceptive as you are, I have a lot of confidence in your opinion of this vet and suspect she would respect your thoughts (assuming she knows you better than we do)
When doctor's offices of any sort give bad feelings, heed that warning. There's no reason for a vet to be callous and the fact that his staff turns over so often tells you a lot.
I'd say, be honest with your friend. I think she'll be thankful. Katc p.s. a friend has a senior cat who was sent home to die with cancer about six years ago. He's survived two moves and now runs the household in the new house and marriage.

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