Posted on February 13, 2017
Guidelines for End-of-Life Care
Photo Credit: Shea Cox, DVM
Some truly lovely guidelines pertaining to end-of-life care for pets have recently been published. I use the word lovely because everything within this document feels exceptionally loving and humane, not only for the animals, but also for their human companions. The guidelines were a collaborative effort, created by the International Association for Animal Hospice and Palliative Care and the American Animal Hospital Association.
Here are some examples that will give you a sense of the wisdom and compassion found within these End-of-Life Care Guidelines.
End-of-life care and decision making embody the critical final stage in a pet’s life and are as important and meaningful as the sum of the clinical care provided for all prior life stages.
End-of-life care should focus on maximizing patient comfort and minimizing suffering while providing a collaborative and supportive partnership with the caregiver client.
Timely, empathetic, and nonjudgmental communication is the hallmark of effective client support.
Veterinarians should not allow an end-of-life patient to succumb to a natural death without considering the option of euthanasia and ensuring that other measures to alleviate discomfort and distress are in place.
Hospice care
The end-of-life care guidelines defines animal hospice as follows:
A philosophy or program of care that addresses the physical, emotional, and social needs of animals in the advanced stages of a progressive, life-limiting illness or disability. Animal hospice care is provided to the patient from the time of a terminal diagnosis through the death of the animal, inclusive of death by euthanasia or by hospice-supported natural death. Animal hospice addresses the emotional, social, and spiritual needs of the human caregivers in preparation for the death of the animal and the grief experience. Animal hospice care is enhanced when provided by an interdisciplinary team approach.
There are many similarities here between animal and human hospice care. The major difference is that, in human hospice, death is neither hastened nor postponed. With the exception of a handful of states, euthanasia is not legal in this country.
Some people do not believe in euthanasia for their pets, and these guidelines accept that the pet owner has the ethical and legal right to choose for or against this process. However, animal hospice does not accept the decision to allow a pet to die without euthanasia unless effective measures provided by a veterinarian are in place to alleviate discomfort and distress.
Hospice care pyramid
The end-of-life care guidelines feature a three-tiered “Animal Hospice Care Pyramid” that illustrates the many ways in which the hospice patient’s care is to be managed. The base of the pyramid addresses the components of maintaining the patient’s physical comfort, including:
- Pain management
- Management of symptoms
- Hygiene
- Nutrition
- Mobility
- Safety
- Environmental needs
The middle tier addresses the animal’s social engagement with family members, both people and other pets in the household. The goals are to provide mental stimulation and avoid social isolation.
The very top of the pyramid addresses the emotional needs of the animal specifically at the end of his or her life. The objectives here are preservation of dignity (maintaining grooming, managing self-soiling with urine and feces), stress reduction, and, to the greatest degree possible, preserving the animal’s role in the household such as providing human companionship and barking at the UPS truck.
Client support
Found within these end-of-life care guidelines is a lengthy description of how hospice veterinarians can attend to the emotional needs of their clients. It is well recognized that most people begin the grieving process for their pets well before death occurs. It makes sense then that hospice care veterinarians must be prepared to provide emotional support at the time of their very first client interactions.
Other topics
The end-of-life care guidelines are rich with other important information including the specifics of the euthanasia process. Throughout, empathy is stressed. An example is, “Never rush the process- clients want, and and need your undivided attention and you have an obligation to give it to them.”
The guidelines also address compassion fatigue amongst veterinarians and their staff members. In depth suggestions for detecting this issue and providing emotional self-care are included within this document.
I encourage you to take a look at these end-of-life care guidelines. While no one wants to think about the loss of a beloved animal, reading this piece is ironically restorative in the sense that it’s filled to the brim with suggestions for creating a loving and gentle final passage.
Would you ever consider hospice care for your pet?
Best wishes,
Nancy Kay, DVM
Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook
Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health. There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at http://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.
Having just recently shared our greatest gift of love and allow our 7.5 year old BMD to pass away peacefully, I was interested in reading the article “Guidelines for End-of-Life Care.” Upon reading the article, it is comforting to know that our veterinarian and his wonderful staff provide those very same aspects of hospice care, mentioned in the article, every time one of our beloved companions have become terminally ill. We know that our furry companions have always received compassionate care, proper palliative treatment when call for and pain management providing comfort from our vet and his staff. While it has always been an emotionally difficult time for us, it is comforting to know our loved companions are treated with thoughtful loving care. We have always had great communications with our vet of twenty years and place a great deal of trust in his honest opinions every time we’ve had discussions with him. We know that his primary focus of consideration is for our furry family member, yet he never loses sight of keeping us included as well. He keeps us well informed as to what to expect and when, what options of treating their symptoms there is and seeing that our loved companions are being kept as comfortable as possible. If and when possible we are able to take them home with us to keep them socially involved in familiar surroundings. The support we receive from our vet and his staff during these times is returned in kind by us, for we know it presents an emotional strain for them as well.
Thank you so much for sharing your story. My heartfelt condolences are with you during this difficult time.
Warm best wishes,
Dr. Nancy
Jane, what a blessing you are to the world of animals!
Hi Jan,
My oh my you have your hands full, but how enriched it sounds like your life has been because of these amazing animals. Best wishes as you and your lovely pets carry on with whatever will arise.
Hats off to you,
Dr. Nancy
Hats off to you Stephanie for embarking on this endeavor with your Corgi, and hugs to him as well.
Warm best wishes,
Dr. Nancy
This is how I have always managed the end of my animals’ lives; I cannot imagine doing it differently. My 16 year old malamute has been incontinent for over a year. He has no control, and is terribly embarrassed when it happens. It always seems funny (ha ha) to praise him when he is incontinent, but I don’t want him to feel bad! So I stroke him and tell him he is a good boy, and I know he can’t help it.
I think the hardest part for everyone is figuring out when the animal is ready; I watch my boy daily; but as long as he enjoys his food and walks, we are okay. I have been blessed to get wonderful info from first, my old vet (retired) who told me it is time when they are not having any fun. A friend who is a government vet added that because we have a spiritual connection with our animals whether or not we know it, when the decision is made the animal often perks up the day before, making us wonder if we have misjudged…when the animal is excited because they know the pain and tribulations are about to end. All my animals die in my arms, looking into my eyes.
I have a 16 year old mix medium sized dog who is in chronic renal failure. She was diagnosed almost 2 years ago! She is now in the last stages of not eating much, but that’s OK. I am letting her guide me as to what, how much and if she wants to eat. I recognized this as a natural way of her becoming closer to dying.
She is my heart dog-the one who got me started in serious registered therapy animal work. She)has been my partner for over 11 years in that work and then as my companion and partner her at home.
I will be so sad and upset when she leaves, but also, I will feel some relief as I know her body won’t have to struggle each day. Her spirit is still shining and her will is strong, so as long as she wants to be here, she will.
Thank you as always, Dr. Kay, for your coverage of topics important to us as pet caregivers.
(I also have an 12 yr old calico cat who has lymphoma and I am doing the same for her
Thank You for a timely article for my family. We just put Charley Girl down three weeks ago. I have been confronted with a lot of comments that I waited too long or that I should have given her more time. It is difficult to know when the time is right to make that final decision. I hope this article will help others.
It was exceptionally hard to make this decision in Charley’s case. She was a young Shepherd with Degenerative Myelopathy. Everything about her screamed of life but for the increasing paralysis. Her inability to walk was never an issue. When the paralysis started affecting her ability to control her bowels, I started to notice subtle changes in her. She would not look at me whenever I had to clean up after she had an accident or she became very anxious whenever I left the room.
We made changes to help alleviate the anxiety. We put her on a schedule for going outside, I slept beside her on a chair and we had home visits from a veterinary acupuncturist to help with anxiety. After twelve months, she was soiling herself faster than I could do laundry. We had several deliveries to the front porch and though she perked up her ears, she no longer barked. Now, this is a girl who went through my front door after someone on the other side…twice. I have a quarter inch thick piece of plexiglass on the front door because the first time, she not only went through the glass but also through a thin piece of plexiglass! If this girl was no longer interested in someone on the front porch, was she interested in continuing with life? I think it made her depressed to know she could no longer protect. I think she knew she was vulnerable now and that is why she wpould whine and get anxious when I left her. I think it was time for me to give her the final act of love and let her go. But still…I still wonder if she wanted to continue just a little while longer. It is such a hard decision
Great topic and great paper – I currently provide hospice care to my quadriplegic corgi with DM (degenerative myelopathy). My corgi’s DM is very late-stage and caring for him is similar to caring for a baby (diapering, bathing, feeding, stroller walks, etc.). It is one of the most difficult and rewarding things I have ever done, but I am fortunate that I can stay home with him every day. In reality many owners cannot do this, and they should never feel guilty if their responsibilities prevent them from providing this type of care. Euthanasia can often be the most humane choice and the last gift we give our beloved pets.
My corgi is otherwise physically healthy, but he is also happy and engaged, which is equally important in my opinion (the social/emotional part of the pyramid). I don’t want to post a link here, but I highly recommend “Scout’s House: When Is It Time?” quality of life scale for caregivers. It is a tool to evaluate your pet’s condition (and your own). I refer to it at regular intervals to monitor my corgi’s slowly deteriorating condition. Sometimes I get too emotionally consumed in the care-giving process, and this scale helps me assess the situation more objectively and consistently.