In human medicine, a patient may receive either palliative care or hospice care. Palliative care often leads to hospice care. For instance, a person with high blood pressure would still receive blood pressure medication under palliative care. In hospice care, a patient no longer receives medication for chronic diseases. The goal shifts from trying to treat a disease to keeping the patient comfortable. Hospice workers strive to address the physical and mental needs experienced when a patient approaches the end of their life. The patient will only receive drugs that help them remain comfortable during the process of dying.
The line between palliative and hospice care is less distinct in veterinary medicine. There are multiple reasons why a pet may need to transition to palliative or hospice care. Chronic or progressive organ disease, such as kidney, liver, or heart failure, occurs fairly often in veterinary medicine. Cancer, osteoarthritis, and neurological conditions, such as dementia, are not uncommon. Sometimes a pet is just old, with no specific illness but very poor quality of life.
Assessing the Pet’s Quality of Life
Pet owners often assume that if their failing fur buddy is still eating, they are enjoying a good quality of life. Appetite is only one measure of comfort or lack of it. The pet’s degree of mobility is an important factor. Mobility issues can interfere with elimination behaviors. Chronic osteoarthritis can make it painful for a pet to assume the normal posture for elimination. How well is the pet able to maintain adequate hydration? If getting up to get a drink of water is difficult or painful, are they staying adequately hydrated? How often are they willing and able to participate in favorite activities? Lastly, how engaged are they with the family in general?
Two women veterinarians created an organization called Lap of Love. They have each developed an assessment tool to assist pet parents in determining their pet’s quality of life. Their tools can be found here and here. After hearing one of these women speak at a veterinary conference, I started handing out their assessment tools to clients. If you are struggling with a tough decision, these handouts will help you define what you are seeing and what you are feeling. This calendar template will help you keep track of “good days” and “bad days.”
Assessing the Client’s Comfort Level With the Decision
It is important that the pet owner be able to understand and acknowledge their personal feelings about this process. I have had long conversations with clients who are afraid they are “giving up too early”. Some feel as if they are betraying their pet if they make a decision to euthanize. Many, many clients would prefer that a pet pass “naturally” as opposed to the owner having to make that difficult decision. I often tell clients that euthanasia is the last gift we can give the pets we love so very much.
I have personally experienced the passing of both my mom and my boyfriend’s mom while under hospice care. All things considered, both were relatively painless. In my mom’s case, hospice workers were there continually at the very end of my mom’s life. In the case of Alan’s mom, they were “on call” but ultimately I was responsible for providing the medication that relieved her physical and emotional distress. I knew the medication suppressed her respiratory drive. However, the endpoint was the endpoint… Was it better to make it as stress-free as possible, even if it hastened the process a wee bit? That was a conversation I had to have with myself. Because of my experience in the animal realm, it was not a difficult decision.
As I have said in the previous installments of this series, I am likely to err on the side of saving my beloved animals from pain and confusion. They might miss some “good days”, but when their bad days are really bad and fairly frequent, I make the call. I place a great deal of importance on their perspective of what is happening to them. If they can’t follow me from room to room, or they soil themselves because it hurts to move or squat, that is confusing for them.