End-of-life care and euthanasia.
These are trying issues for all of us. Every day, veterinarians like me are asked medical, moral and ethical questions by caring people about the last weeks or months of their pet’s life, such as:
- Is it time?
- What else can we do?
- Should we do the surgery?
- Is this fair to him?
- Am I continuing for him or for me?
- Is there anything else we can do?
- If he was yours, what would you do?
There are no right or wrong answers to many of these questions. Often, answers are truly unknown or must be arrived at with careful communication with the vet.
What Is Hospice Care?
I’ll start by telling you what it is not.
Hospice doesn’t mean sending your pet home with a few medications and asking you to call me “when it’s time.” It’s about caring for a pet when we are probably not curing anything anymore.
We are in the dying process, and hospice is about supporting the pet with palliative medicine and supporting you with information and guidance as well as tailoring a program that makes this process humane and ethical.
Human Hospice Model
Hospice-trained vets have borrowed heavily from human hospice practices and made guidelines to help animals approach the end of life with dignity.
The guidelines state that animal hospice is a program of care that addresses the physical, emotional and social needs of animals in the advanced stages of progressive, life-limiting illnesses or disabilities. The patient receives it at the time of terminal diagnosis through to the animal’s death, inclusive of death by euthanasia or hospice-assisted or supported natural death.
It addresses human mental health — the psychological, emotional, social and spiritual needs of the caregivers — in preparation for their pet’s death and their subsequent grief. It is provided by a multidisciplinary health care team under the supervision of a licensed vet.
An Option for Some
People who have pets nearing the end of their life suffer a difficult time between diagnosis, the intense failing of their pet’s health and death. What to do in this period is a highly personal and individual decision.
In the past, people had 2 options:
- Euthanize the pet.
- Support the pet with medications at home or in the hospital until death.
Hospice provides another answer.
Here’s how it works: You have an animal hospice team, a vet and trained veterinary nurses who make home visits. Many people may not be able to give certain medications, keep up with hydration via fluid therapy or offer nutritional support — or keep a debilitated animal clean. The hospice team can do this.
But more important, the hospice team has professional and trained eyes on the patient — which can help you more than anything else.
When you are living with a debilitated pet day in and day out, you can lose objectivity. This is natural. Your hospice team helps you with tangible issues such as weight loss or gain, nutritional guidance and medical support. But they can also gauge quality of life, animal suffering and subtle changes in the pet that may have gone unnoticed. Then they tailor the hospice plan accordingly.
Does Hospice Prolong Suffering?
Many people believe that because vets can euthanize a pet, why would anyone choose to prolong a pet’s life with hospice? After all, isn’t the pet suffering?
It’s not as cut-and-dried as that — every end-of-life case is different.
I’ve seen 20-year-old cats in multiple organ failure who just want to go on a bit longer, enjoying nice parts of their day on the windowsill, purring and being responsive. Or the young dog with an incurable bone tumor still enjoying a good percentage of life as long as pain is managed.
If vets and nurses dedicated to this difficult task of aiding people and pets at the end of life with dignity and in comfort, this is a great option for some.
Both my mom and my dad lived in my home under hospice care. Also, my mother-in-law has just discontinued hospice care because she is doing so well.
This reprieve can sometimes happen with pets, too. The cat with kidney failure may perk up and rally. A tumor may go into remission. All things are possible.
A good veterinary hospice team helps you at home and guides you through the most difficult end-of-life process. This is an invaluable service and the right choice for some families.
- Home Care and End of Life Issues. Scherk, M. Conference Proceedings, 2015.
- VIN/VSPN Rounds: Dispelling Myths About Veterinary Hospice. Hendrix, L., & Shanan, A. 2016.