Ali was a beautiful golden retriever with a large liver mass in her abdomen. She had seen both her regular veterinarian and the local specialists prior to my visit with her. Her owner wanted her to be comfortable, and was open to euthanasia if he could not make her comfortable. She was already on some pain medication but she was not eating or moving much so he called me, a hospice veterinarian, as a last resort.
Initially, we changed Ali’s medications, added new ones and made a specific plan for her. The owner called me a few days later to thank me — she had jumped up on the bed that morning, which she hadn’t done in months. She spent the next few months enjoying life, hiking with her owner, traveling short distances and playing.
A few months later I was called out again – Ali had reached the active phase of dying. She was breathing harder, her abdomen had swollen with fluid, and she had stopped eating. But she was otherwise comfortable, so instead of euthanizing her that morning, we decided to give her one more adventure. Ali and her owner went out to a field and sat in the sunshine, where she died in his arms. It was a beautiful death for them both.
Euthanasia isn’t an easy decision for pet owners to make, even for animals with terminal illness. Deciding when, where, and how only adds to the emotional aspect of that choice, and it’s during those discussions that they often ask veterinarians why euthanasia is recommended over taking the animal home to die a “natural” death.
Natural death, when supported by hospice, can be a graceful death, but there are a few myths that must first be dispelled:
5 Myths About Natural Death
1 – All natural death is bad.
A “natural death” in nature can be difficult, sometimes violent (think: predator, car accident, shot by gun or arrow). But, in some cases, a natural death can be simple (like a heart attack). Then again, a natural death from something like cancer, which is a slower, more progressive disease, requires pain medications to manage pain, anti-nausea medications, sometimes chemotherapy, and radiation for palliation.
As a hospice veterinarian, I deal with the dying process from the palliative perspective, making an animal comfortable and managing clinical signs, sometimes up until their natural death. Hospice supported natural death can be as gentle a passing as euthanasia for some diseases, but family members must be aware of what will be involved. There can be significant nursing care toward the end, just like in human hospice, and there must be a veterinarian involved. A veterinary nurse, counselor or other mental health professional, respite care professional, groomers, and even pet sitters all can help provide a good quality of life as the animal progresses through their disease.
2 – Suffering always occurs during a natural death.
Life is suffering according to Buddha. However, the definition of suffering varies from person to person, so it’s not very helpful when dealing with end of life patients. If I remove “suffering” from the lexicon and, instead, define in terms of distress, I can better help my patient and their caretakers know what to watch for as the animal is going through the dying process. I can define distress by organ system and also include terms of emotional distress, giving caretakers more tools for evaluating their beloved pet so they know when to call their hospice veterinarian.
3 – If natural death occurs, I won’t have to make a decision for euthanasia.
This is technically a true statement. We all die. A natural death will eventually occur given the correct set of circumstances and disease processes, but it might not be a quick process and you shouldn’t kid yourself – there is pain involved.
But we can provide a quality dying process with animal hospice, and a quality natural death at home following a terminal diagnosis needs support from an animal hospice veterinarian and team. In animal hospice, patients are monitored as they go through the dying process so that medications can be adjusted or added as needed, and clinical signs are defined so that everyone can assess where the animal is at any time. This team helps care for the animal, supports the family, and can also help make a decision for euthanasia if needed.
4 – Euthanasia is the only way to help an animal die.
Euthanasia is one way that we can help our beloved pets transition out of the world, and it’s a gift to be able to do it. However, we do have new options that were not available even five years ago.
Animal hospice is another way to give an animal a quality dying process. We help the animal to have a good quality of life, and sometimes, we support them all the way to a natural death. An animal hospice veterinarian has additional training in advanced end of life care, either through a human hospice-run program or through the IAAHPC conferences that have been given over the past five years, and we expect an additional certification process to come soon. A hospice veterinarian should be supportive of the patient and the family, helping them know what to expect during the end of life process.
5 – Quality of life is the most important aspect for end of life care.
While quality of life is important, so is will to live and the quality of the dying process. Owners need to know that the quality of life discussion doesn’t mean they list the five most important things in their animal’s life, then choose euthanasia once three of those things go away. Remember, these are not generally puppies or kittens; these are often elderly patients who are approaching the end of life, so just as 80 year-old humans are not the same as 20 year-old humans, they can still have a vibrant life even though they are not doing the things they used to do. If an 80 year-old human can be supported through walkers and medications, so too, can our end of life animal patients.
Animal hospice with a hospice veterinarian who has further training in end of life care can provide enormous support and comfort for the end of life patient and help owners make the right end of life decisions for their pet and their family. Euthanasia is one way to relieve suffering –there’s nothing wrong with making that choice, and it can give our patients a gentle death – but know that it’s not the only way to relieve suffering. If you do make a euthanasia decision, make it because it is the best option for everyone involved.
Dr. Lynn Hendrix is a leader in the Animal Hospice field. One of the authors of the IAAHPC guidelines for Animal Hospice and now a VIN contributor for Animal hospice, she also does public speaking on various hospice topics and has been a contributor to the IAAHPC conference for the past 4 years. She owns Beloved Pet Mobile Vet based in Davis, CA focusing on Animal Hospice and End of Life Care.