Nearing the journey’s end

This is Part III of a four part series on planning for end-of-life care. In Part II, I covered what you can do if your pet receives a terminal diagnosis. In this article, we will focus on preparing for the final stages of an illness and making end-of-life decisions. In Part IV, I’ll share ideas for memorializing your beloved companion and finding emotional support.

 

Have an emergency plan. If your pet’s condition suddenly worsens in the middle of the night, what is your plan? Your options might include:

• Go to an emergency clinic. If this is your choice, do you want potentially life-extending care, comfort care only, or euthanasia? It’s OK if you don’t know or want more information before deciding. But if you do know, being able to express this to the emergency staff can help you avoid difficult discussions, misunderstandings, and additional heartache.
• If you wish to avoid trips to a veterinary hospital, you will want a veterinarian available to provide in-home emergency comfort care or a euthanasia after hours. House call and hospice vets are good people to ask if they provide after-hours services. Reaching out in advance is easier than searching for help when you are already stressed and worried about your pet.
• If you are absolutely sure you don’t want life-extending care, another option could be to have a small emergency supply (enough for 8-12 hours) of sedative and pain medication to keep your pet comfortable until regular office hours.

 

Talk with your family about when it’s the right time for euthanasia. No one wants a beloved companion to suffer. Each person and pet has a different threshold for “when it’s time.” Family members may not completely agree, and discussing your differences in advance will prepare you for times when emotions are running high. Tools such as The Pawspice Quality of Life Scale are useful for making objective observations. Your feelings and beliefs are also important, and shouldn’t be discounted completely. Grief counselors, pet loss support groups, and pet loss hotlines can be great resources if you still feel like you need more help.

Ideally, all the caregivers will have input on end-of-life decisions. It is not uncommon for more distant relatives, neighbors, and coworkers to have opinions, which they will freely share. Even when the intent is good, such unsolicited advice can lead to guilty feelings for those close to the pet. Remember this: no one knows your pet better than you. Gather the facts and do what feels right.

Euthanasia may not be an option due to religious beliefs or personal ethics. The natural dying process can be difficult for both pet and family, but with self education, professional guidance and careful planning, you can still aid a smooth transition. I highly recommend having a veterinarian trained in hospice care on your team.

 

Examine your spiritual beliefs.  You may have religious views or beliefs about death that will affect your actions and decisions. Rituals or scripture can provide a great source of comfort to those anticipating or grieving the loss of a pet. You could also seek out a sympathetic clergy member or spiritual advisor who understands the precious human-animal bond.

 

Consider your budget.  Having limited time or financial resources doesn’t mean you don’t love your pet. Strive to do what is realistic. The cost of end-of-life care varies widely, depending upon the needs of the pet, the ability of the family to provide nursing care on their own, and the length of the illness. A few hundred dollars may be sufficient if you are able to do all the nursing care yourself, the needed medications and supplies are minimal, and your pet’s condition doesn’t require frequent rechecks or special therapy.

Your hospice team may also include other professionals such as a veterinary technician to give home nursing care, a specially certified animal physical therapist, and other practitioners of acupuncture, massage, therapeutic laser, or botanical medicines. Services offered in the home will have a higher cost than those delivered in a traditional clinic setting. Many families consider this worth saving the time and stress of going back and forth to a clinic.

 

Plan for the final moments, but be flexible. Try to work out in advance who should be present and where you would like your pet to be when they pass away. If you have a strong relationship with your regular vet, they may be willing to come to your home if you ask. If they can’t accommodate your request, it is not because they don’t care – it is extraordinarily difficult, especially on short notice, to make space in a typical clinic schedule to provide the time and attention that you and your loved ones deserve. Increasingly more house call and hospice vets are available to provide this valuable service, so ask if you can get a referral or check online for providers.

Also consider whether you would like to perform any particular rituals, take photographs, or play some special music. If you will be at home, where is your pet’s favorite place, or where do they feel most comfortable? The backyard is a popular and beautiful setting for spending the sacred final moments.

Much as we may want to, sometimes we can’t plan everything to the smallest detail, especially if, as often happens, your pet’s condition suddenly changes. A scheduled euthanasia will offer more control over the circumstances and timing if that is important to you. If waiting until the “time is right” feels like the better choice, you may have to adjust other details, as it can be difficult to predict when that time will come.

What happens at a euthanasia appointment? If you have ever had surgery, from the patient’s point of view, the experience is similar. Most veterinarians will start by giving an injection of sedative and pain medication to help the pet feel safe, comfortable, and content. They may then place an IV line before giving a very strong dose of a general anesthetic called a barbiturate. The pet will quickly drift off into a deep sleep, and anywhere from a few seconds to a few minutes later, their heart will stop beating.

 

Understand the physical signs of dying. Death is not really a single moment or event, but more of a phase through which the body will transition over a period of time. Bodily functions will wind down one by one. The exact duration, order, and timing is unique to the individual. As euthanasia speeds up this process, we don’t always see all the individual signs. Understanding the physical changes can help prevent misinterpreting what is happening, which can cause unnecessary grief or worry.

• • In the last few days before death, the pet will have decreased interest in their surroundings, family, and friends.
  • It is normal and expected for their appetite to diminish or disappear. You can continue to offer treats if your pet still enjoys them. Large amounts of very rich foods may cause stomach upset, but otherwise, you can “break the rules” and offer whatever they like. You do not need to withhold food, by the way, prior to a planned euthanasia.
  • Some pets, just like people, experience a burst of energy in the day or two prior to the actual death.
  • If the pet is shivering or his paws and ears feel cold to the touch, you may cover him with a blanket, but don’t use an electric heating pad as it could cause burns.
  • You may see black stools with a consistency like tar. This often happens in the last 24-48 hours.
  • In the final minutes surrounding death, you may notice some unusual bodily movements that are normal to the process.
    • “Agonal” breathing, which despite its name is not painful, may occur as several very deep, almost spastic, intermittent breaths.
    • The front legs and neck may extend for several seconds, then relax near the moment that the heart stops beating.
    • You may see smaller muscle movements around the face and feet.
  • The bladder and bowels will often relax in the minutes to hours following death, allowing the remainder of urine and feces to pass.
  • Most pets will not close their eyes when they pass away.
  • The body temperature will gradually decline over several hours once the heart has stopped.
  • The initial relaxation phase is followed by rigor mortis, or stiffness of the muscles, in 3-4 hours. It will persist for 24-48 hours, during which it will not be possible to change the pet’s body position.

 

Know in advance what you want for aftercare. Whether you choose burial or cremation, it’s best to have this planned ahead of time. You can read more in Part I of this series.

 

I hope this information has comforted and empowered you if you must make this difficult journey with a beloved animal friend. It takes selflessness and courage, but the rewards can be many as you give your companion the gift of a peaceful and gentle passing.  As a final thought, I leave you with these lines from a Navajo chant:

In beauty I walk,
With beauty before me, I walk,
With beauty behind me, I walk,
With beauty above and about me, I walk,
It is finished in beauty,
It is finished in beauty.

 

Did you see the other parts in this series?

Part I – Steps you can take at any life stage to prepare for end-of-life

Part II – What to do when a terminal diagnosis has been made

This Page– End-of-life planning and decision-making

Part IV – Addressing your own emotional needs

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