Photo by Dr. Teri Ann Oursler
It was another hot summer afternoon, and I found myself with my friend and her family in their back yard preparing to euthanize Daizy, their middle-aged, oversized Beagle. The family was assembled around Daizy, who had finally reached the end after a two-week battle with her kidneys that were no longer doing the job they were hired to do.
As we sat there, I thought about the last couple of weeks spent with Daizy and her family.
Daizy had become ill just two weeks before. She was vomiting, urinating in the house (unusual for her) and not eating. She also had really bad breath. Bloodwork revealed that Daizy’s kidneys had failed. She was treated for several days at my clinic, but although she was no longer vomiting, her kidneys were not improving. My friend and her family decided to take her home to spend her last days in a familiar environment. As long as she was comfortable and enjoying life, they did not want to euthanize her. And until that particular afternoon, Daizy spent time in the yard with her family, interacted with the puppy (as much as she ever did, anyway), and generally enjoyed life. It was a peaceful ten days for Daizy.
It was not as peaceful for my friend. It was important to ensure that Daizy was comfortable, and not in pain or nauseous. End-of-life diseases cause varying amounts of discomfort and pain, so treatment must be individualized. For kidney failure, we watch for vomiting and ulcers on the tongue. Care for this condition requires frequent doses of medication. My friend was unable to leave Daizy for more than a couple of hours at a time. Luckily, my friend was a stay-at-home mom who volunteered in many places around town but was still at a place in her life that she was able be home every couple of hours. She also had other extended family members who could step in and help when needed. Hospice is a program designed to provide a caring environment for meeting the physical and emotional needs of the terminally ill and their families, whether the patient is a person or pet. It is the care given in the time from when you stop trying to cure the disease to the time of death. The goal is to give care so as to maintain good quality of life for the pet, for as long as possible, by managing symptoms of the disease, such as pain and nausea. The main difference between hospice for people and for pets is that veterinary hospice allows for euthanasia.
Deciding when, or if, to euthanize is incredibly difficult. Many people hope that their pets will be able to die naturally and peacefully at home.
Unfortunately, the peaceful part can be hard to come by. As my friend discovered, it can take a lot of time and work to take care of a dying pet, keeping the pet clean, comfortable, and free of pain. Depending on the disease, the time frame of when the hospice patient will die is difficult to call, no matter what TV would have us believe. It is a good idea to think in advance about when euthanasia might become part of the hospice care, and be willing to change your mind. Although my friend and her family did not think they wanted euthanasia when they started down the hospice path, it became clear that it was the right thing to do when Daizy's quality of life declined to an unacceptable level. They decided to put Daizy to sleep when she could no longer walk around the yard. It was the right time for Daizy and her family.
That time is different for everyone, but it is important that everyone involved pay attention to the quality of life of their pet and, just as importantly, that of the family.
Defining quality of life is difficult and individual to the family and their pet. In general, if an animal is in pain, they probably have a diminished quality of life. Animals hide pain so it is important to be attentive to it. For cats, signs of pain and discomfort generally include sitting hunched up, hiding, and not interacting with family members. For dogs, signs can also include reluctance to move, lameness, lack of tail wagging, whining, panting, shivering, and dull eyes, as well not interacting with family members. If an animal is nauseous all of the time and vomiting, they probably have a diminished quality of life. Another component of quality of life can be the ability to do that which your pet most loves, be it eating, lounging on a couch with you, or chasing a Frisbee.
Providing hospice care for your pet is hard. It’s time consuming and emotionally draining. In both human and veterinary hospice, it takes a team to provide care. Caring for the pet’s physical needs is only one part of the equation. There also has to be support for the caregivers. As my friend found, she could not leave Daizy for more than a few hours at a time, so her life became constrained. She needed her family to help take care of Daizy’s physical needs. As she watched her dog get sicker and sicker, she also needed emotional support. She needed to know that it was okay to grieve the loss of Daizy. Hospice teams, especially human, are usually quite large with diverse members (clergy, nurses, physicians) due in part to the need for emotional support for family members as well as the hospice team.
Hospice for a person is about the spiritual journey both for the dying as well as the living. Hospice for pets is also about the journey ― spiritual or otherwise ― of the family with their four-legged companion. For both human and animal hospice, it is a time for introspection, sharing memories, and saying good bye. It is a time to work through the emotions evoked by the loss of a beloved family member.
None of that is easy, nor is it required.
You do not have to provide hospice care; it is not for everyone, and there is nothing wrong with not doing it. Even though it has become popular in some circles of veterinary medicine, it is still a choice. Before deciding to embark on that path, consider your time, available help, finances, and emotional temperature. Think about your physical stamina compared to the size of your pet; do you have a 5-pound Yorkie to keep clean and move around or a 100-pound Golden Retriever? Do you have help in providing what can be round-the-clock nursing care?
Ask yourself what you expect to get out of the process, and what your goal in providing hospice is. For some people, the idea of holding on as long as things are not too bad is the only approach they feel they can handle emotionally; and yet some cannot bear to extend an already difficult time. Choose whatever works best for you, your family, and your pet.
Most importantly, do not be afraid to decide that euthanasia is appropriate at any point. After all, you don’t know where the hospice path is going to lead or what quality of life issues might arise.
Your companion trusts you to do your best by him in whatever form that comes. Communicate your feelings to your veterinarian. Your veterinary team needs to know your goals and wishes so they can provide the best care possible to you, your family, and your pet. Other than allowing your pet to suffer, no decision about choosing hospice or euthanasia, or both, is wrong.
Gwen Francisco, LVT
September 23, 2016