What if Euthanasia Wasn’t an Option? The driver for palliative medicine

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I’ve often wondered what pet owners would do if euthanasia wasn’t a choice.  We know that today, veterinary teams have the expertise and drugs to perform highly skilled euthanasia procedures, as well as the authority to do so. If the pet owner requests it, and the veterinary team agrees (or animal shelter), the procedure is carried out.  But what if euthanasia wan’t an option? How would the pet’s care change?  

Let’s start by saying that from what I can see, the option for euthanasia is here to stay in companion animals.  Most agree that releasing a suffering pet from its body is a generous act of love and kindness.  Pet owners have shared how immensely grateful they are for the choice.  It’s very personal and thick with emotions such as sadness, anxiety, nostalgia, and relief. This gratitude often comes from knowing the end of life journey has reached its conclusion, ideally at the right time for the right reasons.

Having euthanized so many pets over the years, the notion of what to do if it wasn’t an option has been on my mind.  Practicing animal hospice care since 2008, I’ve come to see what palliative medicine is capable of.  Pain medications, infection control, nutritional support etc is better than ever in vet med. I imagine these therapies would be front and center in geriatric patient care.  Same for terminal illness management such as cancers, heart failure and more. Palliative medicine is already leveraged for dying patients, but perhaps not to the extent it should.  In fact, I would love to see veterinarians reach for palliative medicine as if euthanasia wasn’t an option.  In theory, the level of medical support for the dying would increase 10 fold to prevent suffering, which is almost guaranteed to happen due to all the maladies the dying face; pain, breathing difficulties, anxiety, dehydration, anemia and more.   In other words, animal hospice would be more like human hospice, just with the option to euthanize at the end if significant suffering couldn’t be avoided.  This approach is very attractive to someone like me who has seen her fair share of suffering over the years by patients who have not received adequate palliative medicine.  The level of care provided to dying pets may be quite involved, however its amazing what a few key meds can do to make a significant difference in a pet’s life.

Animal hospice recognizes death with and without intervention by euthanasia. The goal of animal hospice is to do everything possible to maximize comfort and peace for the patient and his or her human caregivers during the animal’s last phase of life. With proper care, hospice-supported natural death is possible in many cases.  There will be challenges along the way, but with a dedicated team of caregivers and options, natural death can be readily achieved.  Everyone who participates must be knowledgeable about:

         The patient’s health status.

         The goals for care as defined by the animal’s primary caregiver.

         The projected time course and clinical and behavioral changes associated with the dying process.

         The options for managing the clinical signs and syndromes associated with the dying process.

Picture a family whose aged dog was on a pain medication, and when the pain medication no longer proved to be enough, they elected euthanasia.  The veterinarian discusses the option for more pain meds and a few other therapies, but to the owner, that was as far as they wanted to go.  And that was their right as pet owners.  Euthanasia like any other procedure can be chosen when it is deemed best for all involved, hopefully the animal first and foremost.  Had this been a matter of guardianship, wherein the veterinarian was the lead decision maker, the veterinarian would explore whether the dog had a good chance for more quality time with quality medications.  If so, the family would have to provide said care until the veterinarian felt euthanasia was the only next step.  Since animals remain as property in the United States, the decision to euthanize is made in partnership between owner and veterinarian.  And euthanasia remains an option many will decide on for all manner of reasons, of which I’m glad.  I wonder though, how different geriatric and terminal illness care would look if we pretended it wasn’t.

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Dr. Kathleen Cooney

DVM, CHPV, CPEV, DACAW resident Founder, Senior Director of Education for the Companion Animal Euthanasia Training Academy

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