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Palliative care vs. euthanasia?

Species: Dog
Breed: GSD
Age: 11-15 years

First let me say that this turned out to be long and probably rambling. I hope I'm not boring you or asking stupid questions.

While I listed a dog who I help take care of for family, who is nearing his end, my question is rather general and not necessarily specifically about him.

Anyway, I've seen on your website once or twice (and there may be more that I haven't seen), folks contemplating allowing their pets to pass away on their own, and you advise reconsideration of that plan, as it's not always peaceful.

Anyway, I guess I'm wondering under what, if any, circumstances an unassisted (i.e. no euthanasia) could be made peaceful? For instance, in human hospice (and granted except in few places in the US and elsewhere, we don't have the legal option of euthanasia/assisted suicide for people, which is a whole 'nother can of worms), I know that everything is done that possibly can be to ensure that the patient is comfortable. Aggressive pain management, meds for distressing symptoms like seizures or nausea/vomiting, etc.

I'm wondering, couldn't the same be done with pets? I have heard of vets and some universities that offer pet hospice, and euthanasia remains (as IMO it should) an option. And granted not everyone can realistically provide the level of care that would be required to ensure the pet's comfort.

I'm not against euthanasia, nor do I suggest that a pet be allowed to suffer without intervention (be it euthanasia or palliative care). But what has bothered me for quite some time, is that, aside from a few places offering pet hospice which may end in euthanasia or an unassisted death (a term I've found in my research and prefer to "natural death" as "natural death" would seem to imply leaving the pet to die in what could be a very distressing way, and honestly I'm not sure unassisted is the best term, since I would only advocate a pet dying on its own if its comfort is being ensured), it seems that "end of life care" for pets *is* euthanasia.

Sometimes it seems like one's only choices when a pet is dying is to either a) allow the animal to die a horrific and miserable death, or b) euthanize to spare the pet said horrific and miserable death. Well, if those are the only options, it's kind of a no-brainer...difficult call to make but most would consider option b to be the obvious choice.

I guess I wonder, to what extent that you know of, can a pet be ensured comfort during an unassisted (no euthanasia) death? From my limited knowledge of human end of life care, I know that a patient with severe pain or dyspnea can be given morphine to kill the pain or make breathing easier. As well there's options for controlling vomiting, seizures, and other things that certain conditions can cause.

I do know that one option for human hospice patients whose symptoms just can't be controlled any other way is to medicate them into an induced coma -- in which case for a pet I'd likely sooner euthanize, just because, well, by that point the only difference between an induced coma and euthanasia is whether or not the patient remains breathing. Not that that's the only situation I'd consider euthanasia, just that that's one option I know exists for people that I probably wouldn't do with an animal.

Aside from wondering how far one can go palliating symptoms for pets, I also tend to wonder just how distressing, for the animal, the actual process of what human hospice calls "actively dying" is. My understanding (again, limited) of human end of life care is that, when a patient stops eating and drinking, the body is just no longer registering hunger and thirst, and that the dehydration from not drinking may actually lower the pain threshold. With animals, we generally understand that to mean that the animal just feels like total crap and it's time to euthanize.

Also things that can happen at the very end, like seizures/convulsions, or agonal breathing. My understanding of seizures is that the person or animal seizing is generally unaware or minimally aware and it's harder on those observing than those actually going through it. And while agonal breathing has a rather disconcerting name, and looks bad to watch, my understanding is that it's more of an unconscious reflex than a conscious gasping for air, though it looks as such.

I'm remembering about a decade ago when I had rats, I found one of them cold and listless. It was at night when the vet I went to for rat care was closed, and the vet ER didn't necessarily have anyone familiar with rodents. So I held him and tried to warm him...this went on for about half an hour before he did the seizing/gasping (probably agonal breaths). I of course at the time thought it was conscious on the part of the little guy and just held him and talked soothingly to him hoping to be of some comfort. Then after a moment or so he went limp and passed. I remember mentioning it on a forum and was told that while distressing to watch, my rat was probably unconscious and not aware of what he body was doing. I think that's when I first learned about the idea of weird reflexes happening just before death that can be hard to watch, but may not be so hard for the animal to undergo.

Anyway, could you weigh in on the issue? Are animals still conscious at the time of their "death throes"?

Please forgive the long and rambling nature of this message, and again please understand that I'm not against euthanasia. I do think it should remain an option for our pets. But I'd like to think it could be just that, an option, with better alternatives than watching the pet suffer to death. So I wondered if maybe you could shed some light on the subject. Like I said, it's just bothered me for some time now that it seems that one can only let their pet die painfully, or euthanize.


Online vet, Dr. Marie

Dr. Marie replied:

Thank you for your thoughtful question. I can understand your point of view, but I think that there are great differences between the type of palliative care we can give people as opposed to pets.

If a person is terminally ill, then we will treat them palliatively which means, as you have mentioned that we do what we can to minimize pain and help with difficult symptoms. This definitely is an option for some pets, but it would require intensive care. I have seen vets who do palliative care. In fact, in my office we have considered offering this as an option to people who are not ready for euthanasia. The idea would be to have a veterinary technician visit the pet once or twice daily to administer medications.

However, one of the problems with this is that a veterinary technician can administer medications and some medical care, but cannot legally make medical decisions. So, in order for palliative care to really be an option for an animal, the animal would need to have regular doctor care. That is certainly possible, but to have a doctor visit your house once a day could be very expensive.

The next question I have though is "Why"? Why would you want to do palliative care for a dog? That may sound callous, but really I think we need to examine the motives. If this dog is dying, then what is the purpose in prolonging his or her life with medications?

With people, we have no choice as euthanasia is not an option. But, if an animal is dying and is in need of medications in order to stay alive, then personally I don't see the point in extending their life.

The main reasons why I see people requesting this is when the people themselves cannot bring themselves to make the decision for euthanasia. Or, I have had a few cases where they are ethically against euthanasia, even for an animal.

I will commonly prescribe pain medications, nausea meds, etc for a dying animal to help the owners get through the initial shock of a bad diagnosis and give them some time to come to the decision for euthanasia. But, I would usually recommend against a long term palliative treatment for a pet.

Regarding the process of death, we really don't know how the animal feels. If there are seizures then they are not conscious during the seizure, but they likely do not feel well both before and after the seizure. Another issue as well, is that the animal can't tell us what they are feeing and so we may not know if we are fully treating their discomfort.

Ultimately it's a personal decision. In 13 years of practice I have had two cases that I know of where an owner decided to not euthanize and then their animal died peacefully in their sleep. I can't tell you how many times I have had cases of palliation where the animals really struggled at the end. Sometimes an animal will be in respiratory distress and need to be rushed to the vet because they can't breathe. Sometimes there can be seizures that don't end. It is horrible to have to bring your pet to the vet while they are seizuring. Sometimes this will happen at 3 a.m. and emergency services need to be found.

So, when I give my advice to euthanize when an animal is terminal comes from experience. I would much rather have a controlled calm euthanasia where the owners can have a peaceful goodbye with their pets than an urgent situation with the animal in distress.

Hopefully this makes sense. Thank you for your question.

Dr. Marie.

---This question was asked in our Ask A Vet For Free section.---

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.