Veterinary Hospice or End-of-Life Care: An Evolving Field

A fabulous 2009 article, Veterinary Hospice: Ways to nurture our pets at the end of life, speaks well to the delicate issues in this emergent area.

As animal guardians, we must make choices for our pets, but on the whole, the veterinary profession – while excellent at offering medically oriented solutions – is not well equipped to help people make end-of-life decisions. These decisions are fraught with emotions and bring up all sorts of practical, ethical and existential questions. What value do we place on life? Does that extend to animals as well as humans? What constitutes suffering? How do we know when euthanasia is warranted?

It is reported that about 100 veterinarians nationwide offer end-of-life support as part of their regular services, compassionately viewing dying as the final stage of living. A few clinics, including the Argus Institute at Colorado State University in Fort Collins, are dedicated solely to end-of-life treatment for animals. Dr. Nancy Ruffing, a mobile hospice veterinarian in Pittsburgh, Pennsylvania, feels that “Owners have to have some type of a mental plan for what to do at the end of life, but you have to look at your pet critically when they’re having a good day so you can recognize the subtle differences on a bad day. You really have to be in tune with your pet, and that starts at the beginning.”

There is quite intense debate around the question: To end life or let life end? Dr. Kathryn D. Marocchino, who founded The Nikki Hospice Foundation for Pets in 1996, and has organized two animal hospice symposiums, speaks to this issue. “Hospice to vets means, ‘I will do everything to help you, but I have a quality of life scale, and when the dog reaches a certain number, it’s time for euthanasia.'”

At the symposium, Marocchino says only two veterinarians in attendance had ever witnessed the natural death of an animal. This fact suggests to her that euthanasia is used too frequently and too readily by veterinarians. “They’re not giving death a chance,” Marocchino says. “Euthanasia should be a last resort.”

The majority of people working in pet hospice, however, do believe that euthanasia is a necessary – and humane – tool. Some of them worry that the larger veterinary community, and the general public, will misinterpret the term “pet hospice,” believing that death without euthanasia is a fundamental tenet.

“Hospice is not about replacement of euthanasia,” says Dr. Robin Downing, owner of the Downing Center for Animal Pain Management in Windsor, Colorado. “In 23 years of practicing oncology, I have a fairly high conviction that the number of animals who die a natural death is few and far between. Most animals reach a point where they are actively in distress, and we have an obligation to let them leave while they still know who they are and who their family is. The only time a client has expressed regret to me is the regret that they waited too long.”

The subject of death prompts strong feelings in most humans, and there are no easy answers for doctors or people with pets when confronting an animal’s final days. As the veterinary hospice field grows, it is crucial that practitioners remain open to divergent opinions and values, says Shanan, who this year co-founded the International Association for Animal Hospice and Palliative Care. “We must humbly accept that the subjective experience of dying is a great mystery,” Shanan says. “Also, we are acting as proxy for the wishes of a patient who is not of our species. It is very easy to err no matter what guiding principle we choose to follow.” …

While some veterinarians may have been providing hospice care for many years, it may not always be labeled in such a way. And, one may have a difficult time in finding practitioners.

“There’s a Catch-22 right now, and that is we don’t have very many people who see themselves as providers in this area, and there are a lot of potential users of animal hospice who have no idea that it exists,” says Dr. Amir Shanan, who has offered veterinary hospice for more than 10 years in his Chicago general practice. “Pet owners don’t ask about hospice services, and veterinarians don’t offer information because, they say, pet owners aren’t asking about it.”

I have aggregated the following hospice-related resources at my foundation site, as veterinary hospice is a critical area to that of Canine Cancer.

• Dr. Hancock’s Veterinary Hospice Concepts & Applications
• AVMA Guidelines for Veterinary Hospice Care
• Dr. Ella Bittel’s Spirits in Transition
• Dr. Villalobos Pet “Pawspice” Home Care Tips
• Dr. Villalobos Quality of Life Scale
• Dr. Anthony Smith: Compassionate Care FAQ
• Informative Articles & Books on Animal Hospice
• Dr. Wolfelt: Center for Loss and Life Transition
• Angel’s Gate Animal Hospice Guidelines
• Taking a Bite out of Cancer
• Sanctuaries & Veterinarians Offering Hospice: State Listing
• Hospice Readings, Prayers & Spiritual Resources
• (North Texas) Animal Chaplain Services

In viewing dying as the final stage of living, one needs to learn more about these issues … sooner than later. Come and read more and hear from Dr. Jaime Glasser, who, this past weekend, live-tweeted some wonderful insights from the Second International Symposium on Veterinary Hospice Care.