There may come a point, when a pet is fighting a terminal disease, where the cost of treatment can become more than its benefit. In the advanced stages of diseases such as cancer, kidney failure, or neurological disorders, sometimes treatments cause pets pain or make them ill, without any hope of curing their disease. At this point, owners should make a decision about which is more important for their pet: quality of life or quantity of life. Pet owners have the option of stopping aggressive treatment and letting their pets end their life comfortably in the intimate, caring surroundings of their own home through hospice care.
Pet hospice care is a relatively new concept, modeled on the practice in human medicine that began in the 1960’s. Hospice is not a specific place, but rather a philosophy that promotes an alternative to death in an impersonal, clinical hospital environment. It functions on the principle that death is a part of life and terminal illness and death can be experienced with dignity, as an animal rests at home with its loving family.
The goals of hospice
Hospice is focused on giving pets a safe, caring, intimate end-of-life experience in their familiar environment. As such, it is not geared toward curing a pet’s disease, but rather toward keeping the disease from causing the pet any discomfort. Hospice care focuses primarily on providing pain control and physical and emotional comfort to the pet. To prevent the anxiety of hospital visits and to allow pets and owners the maximum amount of time together, pet owners provide as much care as possible at home. Owners are trained to attune themselves to their pet’s physical and emotional needs, and often find that the increased attention and physical contact allows them to feel close to their pet at the end of its life. Owners are given one-on-one time to come to grips with their pet’s progressive disease and can say good-bye in their own way. Hospice helps to make a pet’s death a kinder, more intimate experience for both pets and owners.
What hospice care requires from pet owners
Though it can be extremely rewarding, hospice care requires preparation and work from pet owners. First, owners have to actively search out a veterinarian comfortable with hospice philosophy. According to Dr. Eric Clough, DVM, AAHA member, and along with Janice E. Clough a promoter of Hospice for Pets, many veterinarians have been practicing what is essentially hospice care for years, but are unfamiliar with the term. It may take some time for owners to find a veterinarian who has studied hospice or is willing to learn about the subject. Once they have found such a veterinarian, owners will have to learn how to care for their pet. Veterinarians and technicians teach owners how to administer medication, feed their pet, keep it clean and comfortable, and monitor and document the pet’s pain and general health. Working as a team, the pet’s family and their veterinarian and veterinary staff can make a plan for the pet’s treatment, to be adapted as the owner and pet’s needs change.
After instruction and training from their veterinarian, the family takes over the day-to-day care of their pet. One of their most important responsibilities is medication. It is much easier to prevent pain than to relieve pain when it is already present. In hospice care, medication is given preemptively, before pain actually starts. Medication is generally given on a regular schedule, rather than in response to symptoms of pain, in order to keep the pet comfortable. It therefore becomes the caretaker’s responsibility to monitor their pet closely for signs of pain, such as agitation or vocalization. These are signs that pain management is not working and that a new plan needs to be discussed with the veterinarian. Caretakers also need to observe and monitor their pet’s behavior and physical state. They become the eyes and ears of the veterinary team, recording any changes in their pet’s weight, temperature, eating habits, mobility, and other characteristics. Dr. Clough points out that, most importantly, pet owners need to stay flexible. Hospice is a trial and error process. Sometimes medications, feedings, and other treatments are not effective, and they need to be changed by the veterinarian and the family until the pet is comfortable.
With the goal of visiting the hospital as little as possible, caretakers may also have to take over medical tasks that make them uncomfortable. Sometimes pet owners are nervous about handling injections, IV medications, blood, or feces. In this case, Dr. Clough suggests, owners should work with their veterinarian to develop a treatment plan within their comfort level. Sometimes medications can be given orally or rectally instead of intravenously, for example, or the sight of blood can be minimized using careful bandaging. Dr. Clough suggests that when veterinarians warn owners about what to expect, explaining in detail the physical effects of the pet’s disease, owners become less fearful. Often, as pet owners adjust to their role as caretaker, they find that they can handle more than they thought and may even come to enjoy the physical intimacy of caring for their pet. If the pet’s illness ever becomes more than a caretaker can handle, their veterinary staff is available to help.
Euthanasia: When hospice comes to an end
Though it provides a valuable alternative to end-of-life hospital care, hospice is not a substitute for euthanasia. Though pets are sometimes able to die comfortably at home, often hospice works as an intermediate stage between treatment and death. It can be a hard decision for caretakers to make. After months or more of caring for a progressively worsening pet, it becomes difficult for owners to choose a final ending point.
Dr. Robin Downing recommends in Pets Living With Cancer: A Pet Owner’s Resource (AAHA Press, 2000) that pet owners establish a bottom line for their pet’s quality of life before the time comes to make the decision about euthanasia. At what point is their pet’s quality of life no longer acceptable: when the pet can’t control its elimination, when it can no longer stand or walk, when it becomes disoriented and no longer knows where it is, or when its pain is out of control? With this bottom line established ahead of time, owners can know they will make the right decision when it comes to the sad and stressful final days of the their pet’s life. The act of euthanasia can become a final gift of comfort to an animal in a great deal of pain. To continue the hospice experience, veterinarians will often agree to euthanize pets at home, allowing pets and owners to experience death in safe, familiar surroundings.
Hospice can be a wonderful, caring option for terminally ill pets. However, pet owners should keep in mind that pet hospice care may not be for everyone. Some owners may not be ready or able to take on the often painful, emotional, and time-consuming work of the day-to-day care for a sick pet. Hospice may not be the right decision for owners who live alone, have a heavy work schedule, or are not in good health. Owners should carefully consider whether they have the resources necessary to care for their pet at home and talk to their veterinarian about what is right for them.
Whatever decision pet owners make, it is good to know that hospice exists as an option. Hospice allows pets to pass away feeling safe and loved and gives pet owners a chance to say good-bye at their own pace. It can transform the frightening circumstances of terminal illness and the loss of a beloved friend into a life-affirming opportunity. In the words of Dr. Clough, -Death isn’t losing the game. Death is unavoidable; it’s a part of life. If you make death a safe, loving, comfortable experience, then you’ve won the game.