EDITORS' NOTE: This is special bonus content for Alice Villalobos' May 2012 column, Keeping Hospice in Veterinary Hands. The veterinary literature advocating for pet hospice as a professional service has been evolving since the 1990s. Two main groups have organized the pet/animal/veterinary hospice movement. Historically, the first group is the Nikki Hospice Foundation, founded in 1996 by thanatologist Kathy Marrachino, Ph.D. Nikki organized the first and second veterinary hospice symposiums in 2008 with some veterinary faculty and in 2009 with almost no veterinary faculty. I was an invited speaker at the 2008 event and Dr. Dani McVety attended the 2009 event. Our thoughts are recorded below. As of Jan. 17, none of the veterinarians listed on the website as part of Nikki’s Board of Directors are still serving. An official statement of the University of California, Davis, Veterinary School says it has severed its relationship with the Nikki group and has nothing to do with the symposiums even though they will be on the Davis campus. This begs the question: Is there any veterinary oversight for organizing the third Veterinary Hospice Symposium scheduled for July? We hope that veterinarians will have a greater faculty presence at future Nikki Hospice organized event. The second group, founded by Chicago hospice veterinarian Dr. Amir Shanan, is called the International Association for Animal Hospice and Palliative Care (IAAHPC). Hoping to be inclusive and balancing all aspects of hospice care, this group has a very good handle on what it takes to provide the unique veterinary services that comprise specialized end-of-life care. Dani McVety, DVM, attended the first annual IAAHPC meeting in October 2011 and was encouraged. Dr. Villalobos' Thoughts on the 2008 First Veterinary Hospice Symposium Organized by the Nikki Hospice Foundation I was invited to be a guest speaker at the first Veterinary Hospice Symposium organized by the Nikki Hospice Foundation along with Drs. Robin Downing and Tamara Shearer. We are among the original prominent practitioners, authors and leaders in the national veterinary hospice movement. But other invited speakers set my doubts in motion about the domain, practice and purpose of animal hospice. One lay speaker, a self-proclaimed pet hospice worker, professed her spiritual enlightenment as she held an old dog during her slow death from bladder cancer. When I asked, I found that this poor dog died without pain medications or veterinary comfort care. Another such invited speaker was Susan Marino, the Angel’s Gate self-proclaimed animal hospice owner. Her talk and pictures were just too good to be true. Given the vast amount of work it takes to properly care for end-of-life and special-needs animals, I saw through it. Her pictures showed only a few caretakers and dogs jumping into a swimming pool at her private home. We all wanted to give her accolades, but I knew from her website and ads that Angel’s Gate had a lot more animals than the pictures showed. This made me apprehensive. One can barely take care of a dozen special-needs animals 24/7 at home before being physically, mentally, and emotionally overwhelmed. It takes a lot of time and volunteer work to do a good job caring for old, sick, special-needs animals. That is, if one is operating the animal “hospice” facility conscientiously. Marino is now facing charges for animal cruelty, neglect and hoarding. Dr. McVety’s Thoughts on 2009 Veterinary Hospice Symposium Organized by the Nikki Hospice Foundation On the ride to the hotel after stepping off the plane, another veterinarian I had just met leaned toward me and said, “I think there are a lot of anti-euthanasia people here.” She was right. Immediately, I was astounded at the lack of veterinary discussion during this two-day event. Even more, I was appalled that a veterinary college would allow such an event to be held on its campus. Here was an entire group of people, with only a few veterinarians, preaching about how pets deserve a “natural” death. There was no medical discussion about pain management, symptom management or veterinary oversight. A speaker (Ph.D.) spoke about the dangers of vaccines—he commented that vaccines have no place in veterinary medicine. Later, I spoke with many veterinary attendees who were very concerned about the trend evident here. At a round-table discussion the last night, I brought up the fact that hospice is a medical model and we need to keep it that way. Needless to say, this was not met with much enthusiasm. On the plane ride home, I was truly amazed that this group of people did not think highly enough of the eight years of college education that I and other veterinarians completed for the right to be called “doctor.” We worked so hard to get where we are and to properly manage cases to prevent pain and suffering. How sad for them to think that they can do a better job–with little or no medication–than veterinarians can. What’s even more sad to me was the fact that this was called a “Veterinary Hospice Symposium.” No veterinary medicine was talked about, only ways to skirt actual medicine. Dr. McVety on the 2011 IAAHPC Hospice Symposium This meeting was much more balanced and I believe has the right approach. Founded by a veterinarian who understands the difficulty with this concept, the symposium was fair. There is still the underlying issue of non-veterinary professionals doing hospice work, but this was limited to only one speaker. The speaker of most concern to me was a self-proclaimed “pet lover” that wanted to bring personalized hospice care to other families after the difficult loss of her personal pet. Although well intentioned, this person had a completely misconstrued idea of how medication actually works. While explaining to me why she was so upset with her regular vet–who refused to prescribe morphine to her dying pet (for an unknown reason)–she told me that if her pet had had morphine, he would have had “a perfect passing instead of a painful one.” This is a completely unfounded and uneducated view of what medication is used for and how it works. She now wants to “support” others going through a similar situation without the help of a veterinarian who, in her mind, let her and her pet down. Other speakers were mostly veterinarians who discussed topics ranging from pain management to starting a hospice service. The IAAHPC anticipates having at least some split-room talks next year, for veterinarians and non-veterinarians. This should support the veterinary versus non-veterinary approach to medical hospice care. No Oversight or Regulation Unlike human hospice, there appears to be no oversight or regulation to the numerous amounts of groups calling themselves “pet hospice” or “animal hospice” around the country. A quick Web search found at least five groups that are run by thanatologists, crematory owners, dog groomers and simply “pet lovers.” One such website states as its mission: A world where no animal has to be euthanized based on age or medical challenge when a quality of life remains. This is an altruistic and non-specific statement that relies on a subjective definition of “quality of life.” As pet hospice grows in popularity, it is important for veterinarians to offer this service at end of life. The approach is to provide comfort care over curative care. Hospice is—first and foremost—a medical model. Non-veterinary groups and hobby animal collectors use the term “hospice,” and when they get into trouble, it negatively affects the medical field. Summary Various people, groups and veterinarians will approach animal hospice differently. People involved range from veterinary professionals to social workers to hematologists to chaplains and pet loss counselors and, unfortunately, compulsive animal collectors, who are afflicted with a complex mental disorder and ultimately become death hoarders. The human animal bond drives end-of-life care for companion animals, but the animal’s best interests must always be held as the highest priority. When all those involved view their actions and practices from the perspective of the animals’ best interests, we will find the right path to approach end-of-life care. <HOME>
