Palliative care and pet hospice are emerging as viable professional options that every practitioner can and should offer the owners of terminally ill pets. Veterinary practices will encounter more issues with terminal diseases, especially cancer, because pets are living longer as family members in very caring homes. High-tech facilities can maintain seriously injured or ill animals for long periods. Modern technology forces pet owners into the dilemma of pulling the plug or enduring costly and potentially futile life support. Instead of offering only this either/or model, veterinarians should give clients the option to take terminal pets home on palliative care to die in the comfort and support of the hospice setting, or as I refer to it, Pawspice. Minimalist Medicine Patriarchal veterinarians relate to their clients authoritatively. They generally tell pet owners what to think and what to do rather than help them decide. They direct, persuade or control clients to elect either aggressive care or euthanasia. This dictatorial approach sends the message, “I am practicing ‘My way or the highway’ medicine.” Many pet owners flee this style of practice, which patriarchal veterinarians might claim is down to earth and practical. On the other hand, some practices are so busy that staff members are indifferent, overwhelmed, rushed or biased against treating terminally ill pets. These practices may offer only narrow options, such as a costly referral far from home or a “wait and do nothing” without much follow-up. If clients do not see a specialist, they may be told what to do with suggestions such as “You should let nature take its course” or “You need to put him out of his misery.” More Information The Society for Veterinary Medical Ethics offers a framework for ethical decision-making.Click herefor more information. . Check out Dr. Villalobos’Quality of Life Scale. Staff members and clients can use this tool to help evaluate terminally ill pets and make the final call. . Visit The International Assn. for Animal Hospice and Palliative Care online discussion board. Progressive doctors term this approach “minimalist medicine.” Minimalist doctors might be surprised or offended when their client consults the Internet, a veterinarian down the street or a specialist for a second opinion. Many owners investigate alternative and complementary medicine for more appealing options. When pet owners discover palliative and Pawspice services, they are relieved because many want to care for their terminal pets comfortably at home. They want to pay for pain relief and sophisticated, supportive, compassionate medical care. Educate and Validate We must educate our clients that natural death may be difficult and unkind for the animal and that many pets need assistance that should not be denied. Many clients want to have home euthanasia for their pets while the majority feels comfortable bringing their pets to the familiar veterinary clinic for that final visit. Unfortunately, one in three owners who euthanizes her beloved pet has lasting anguish over the decision. Asked about that anguish, clients often say they euthanized their pet too soon or too late! Why is this so? Is it a failure of communication? Is it part of the minimalist approach mentioned above? The most important role for the attending doctor and staff at this touchy time is to validate the human-animal bond and validate the client’s decision. Be sure to say something like, “We know how much you love Bullet and we respect the bond that you share. We know this decision is very difficult for you. But you are Bullet’s protector and by giving him the gift of a ‘well death’ (the definition of euthanasia) you are helping him pass over the rainbow bridge where there is no illness and no suffering. It’s kind and it’s right thing to do.” When to Move Forward Palliative and Pawspice care are emerging as the most viable options to help owners proudly avoid the heartache of overtreatment and overspending for terminal pets. If reluctance, disagreement or high costs create distress in the decision-making process, the attending doctor must reach out with options such as third-party payment, palliative care and Pawspice. A smooth transition to palliative and Pawspice care can be initiated once the doctor, specialty team, staff and family gain consensus with their decision to discontinue definitive care. When quality of life, palliative care and pet hospice are presented as viable options—with a positive professional attitude—clients will be grateful. There is no perfect choice, but the course taken should feel reasonably acceptable. The family may benefit from knowing they may feel a sense of relief once they have made their decision and that relief is a natural part of grief. Alice Villalobos, DVM, is a member of the American Assn. of Human-Animal Bond Veterinarians and is on the editorial review board of the Society for Veterinary Medical Ethics.
