End Of Life Dialogue

Frank dialogue is needed about terminally ill pets.

End-of-life discussions are sad, but inevitable conversations for most everyone who keeps pets. Is it time to say goodbye? Should we stop treating? The only certainty is that open discussion must take place to help avoid regrets and suffering.

I recently read an article by a human physician who had helped obtain extensive cancer treatments for a female patient. After engaging in an exhausting and expensive war on the cancer, the woman died. In perhaps the saddest part of the story, her husband has since expressed great regret at spending their last months together battling the inevitable instead of enjoying the precious moments remaining.

The doctor involved was making a case for dialogue, emphasizing the importance of families voicing their thoughts and wishes when a life is waning. As I’ve often said in discussing possible treatments for my own patients, “Just because we can treat doesn’t mean we have to or even that we should.” Obviously pets are not people and the availability of euthanasia for animals changes the conversation drastically. However, anyone who habitually keeps pets knows what it is to suffer with them through illness and wonder how best to help.

For some, the choice to euthanize comes quickly; a painful, but valid decision to end the animal’s suffering. Most pet owners agonize over taking a life. They wrestle with guilt tangled up with loss and muddied by the belief that nature might be best allowed to take her course.

On one hand can I count the number of my patients who have “gone quietly in the night” and most of those were unexpected heart failures. Nature’s “course” is rarely peaceful or pretty.

That does not mean we should blithely euthanize sick dogs or cats that can be treated. If there’s hope for good quality of life for a patient that will tolerate treatment from owners willing and able to provide it, then treating is the best option. But none of that can be known if the questions are not raised.

Human doctors are being advised to discuss end-of-life issues with any patient who might reasonably be expected to die within a year. Perhaps this is a bit arbitrary and doubtless difficult, but far better than leaving it unsaid and forging blindly ahead with treatments as if there was no choice.

A new branch of veterinary medicine is starting to bring hospice care to the animal world. Vets and technicians are training in the art of helping terminally ill patients enjoy their last days with their families. Familiar concerns about pain control, mobility and nutrition are addressed along with continence issues, mental stimulation and methods of not just maintaining, but enhancing the human-animal bond through difficult times. In some areas, mobile hospice teams offer home visits to help with ongoing care and provide for euthanasia if that becomes necessary.

Because veterinarians, like human doctors, are trained to treat illness and technology keeps giving us better tools to use, we can become too focused on attacking disease. We may forget the battle is not always in the best interests of the patient or family. We can choose to treat or, instead, to palliate without treatment. With animals, we can choose to euthanize. If you have a pet that’s terminally ill, talk to your vet about the options. The only wrong choice is to allow suffering.

Dr. Fiona Gilchrist
Hillcrest Animal Hospital – Quinte West/Trenton, Ontario
May 2014