End-of-Life Decision Making: The Patient’s Needs

It’s important to consider the pros, cons, risks and benefits of starting any proposed treatment plan with your pet. This will depend on many different factors related to both your family and to the patient.

This can be especially true for hospice patients, whose needs may be simple or very complicated. We must consider what care is going to be necessary and whether there are sufficient resources (time, energy, emotional and financial) to carry it out. Can your pet’s needs be realistically met by the proposed treatment plan?

First, let us consider the patient’s physical, social, and emotional needs. In part two, we will discuss the family’s needs and resources. 

Here is a checklist, adapted from the AAHA/IAAHPC 2016 Guidelines on End-of-Life care, of the common issues that are faced by many elderly pets and their families. If you don’t know the answers to some of these questions, a veterinarian who knows your pet well can help guide you.

The Patient’s Needs

Physical Needs

• Is the pet in pain, and if so, can it be adequately controlled so that they can enjoy good quality of life?
• Are there other symptoms that are causing discomfort or distress? If so, are they also manageable to ensure comfort? Examples include:

Difficulty with or labored breathing
Mental confusion
Gastrointestinal upset, loss of appetite, inability to eat
Itching
Anxiety
Sores or painful skin rashes
Dental disease

• Can good hygiene be maintained? If the pet is incontinent, can their skin, fur and bedding be kept clean and dry at all times? Are there infections or discharge causing unpleasant odors?
• What are the patient’s current nutritional needs, and are they able to take in enough food to meet them?
• Is the pet able to get around without assistance? If not, is this affecting their enjoyment of life? For example, small dogs and cats can easily be carried from place to place, and so impaired mobility may not be a problem for them. This may be a different story for a Great Dane who is completely unable to get up on her own.
• Can a disabled or confused pet be kept in a safe environment free from hazards such as stairs, obstacles, slippery floors, etc?
• Can a comfortable environment be maintained? For outdoor pets, can they be sheltered from the weather, insects, and other animals? Is available bedding clean, dry and soft? Is the temperature right? Is the environment free from loud noises or other factors that might be upsetting to an elderly animal?

Social Needs

• Is the pet still able to and interested in interacting with family members in their usual way?
• Is the pet able to be with the family and participating in the normal routines of life?
• Are their interactions with other pets in the home changed? Are other pets annoying the patient?

Emotional Needs

• Is the pet’s dignity able to be preserved? This is different for every animal. Some dogs and most cats, for example, are fastidious about personal hygiene, and having accidents in the house due to incontinence may be distressing for them.
• Does the pet seem stressed or anxious? Are they frequently pacing, panting, or restless?
• Is the pet able to fulfill their usual role in the household? For example, many dogs consider themselves protectors of the family. Are they enjoying regular companionship?
• Is the pet still interested and engaged with the world around them, or are they beginning to withdraw into themselves?
• Is the treatment itself distressing for the pet? How long will it need to be continued, and is the benefit worth the stress?

 

You may be thinking that this seems like a lot! It certainly can be, and the help of a trained veterinary hospice team can make it more manageable by, for example, helping you explore ways to solve mobility or safety challenges. Scheduling problems or caregiver stress can often be alleviated by hiring professional help to assist with caregiving duties.

Sometimes, there are just too many challenges to overcome, or it’s not realistic to meet all of the pet’s needs. That’s OK, too – and facilitating a peaceful, gentle passing with the gift of euthanasia (which comes from the Greek “good death”) can be a selfless and loving decision, as hard as that may be.

Finally, know that there may be no “perfect” decision or time. We all make the best decision we possibly can, based on the information we currently have. If that choice comes from a place of love, then that is what is most important.