Posted on February 13, 2017
Guidelines for End-of-Life Care
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.
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
- 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.
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.
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?
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
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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.