Animal hospice care: euthanasia

Hospice care is based on the principle of embracing the process of dying as a part of life that does not need to be feared or avoided, nor postponed or hastened. An unhurried pace, neither rushing nor dawdling. It is a wide-spread practice in human end of life care but fairly uncommon when it comes to our animals. It is not a topic taught during veterinary training and so it is understandable that it is considered best vet practice to euthanize a dying animal. But is this true or is it just a lack of education?

Let me be clear from the start, I am not against euthanasia. All the animals I have shared my live with so far died by euthanasia except for the last one, my dog Louie. The idea that companion animals such as dogs can live out their lives, receive hospice care and die on their own just like people do does not occur to many. The practice of euthanasia is widely accepted to be the humane and kind thing to do. PETA says on their website, “If your animal companion’s quality of life has diminished to the point where therapy or medicine is no longer able to help, euthanasia is the only humane choice.” These words are echoed on many a vet’s websites.

It is no wonder then that when asked by their clients if their pets can’t just die at home a vet might feel uneasy, suspecting that the animal parent can not quite bring themselves to make that final decision: they hold off on the active euthanasia of a critically ill pet in the hope that the pet will just “die in its sleep.” [italics quoted from Pet Informed]

Not many animals just die in their sleep. Instead, dying is a process that can take days or weeks. It is a decline that is said to be hard to witness. The more I learned about the dying process and its normal symptoms such as weight loss, the easier it was for me to be at peace with the changes unfolding during Louie’s final days. I wasn’t scared because having educated myself on the topic I knew what to expect. And in the moments I felt unsure, I had a knowing vet by my side to reassure me that what was going on was perfectly normal.

There is this phrase commonly used around euthanasia, “to put the animal out of its misery.” I believe that at times this is an applicable argument. But to generally equate dying with misery and suffering is a mistake born from ignorance. This article provides some great food for thought, addressing how to reduce unnecessary suffering and what animals can teach us on the topic.

In a society that worships youth and growth, decline and death are shunned and feared. Multi-million dollar industries feed off the forever young dream. Beauty is narrowly defined and what deviates must be removed, improved or hidden. Body shaming is a cruel yet common occurrence. And to top it all off, the collective mind in the last 100 years has made science – what can be measured, named, categorized – it’s sole trusted source of information. Everything that can’t be proved (yet) automatically is suspicious, less credible or considered not valid at all.

The result is a society that outsources death. It happens for the most part in an institution, behind the curtains of everyday life. How many people have been present at another’s dying moment? Have seen a dead person? And I don’t mean on TV. Most people are terrified of growing old. Consequently, all reminders of decline and decay are avoided. What is pushed so desperately out of sight can only be hideous and painful! I found the opposite to be true. And so have other people I have spoken to who have given hospice care to an animal. By not running away, one is actually able to take a look. Curious? These photos of geriatric farm animals are a good start to get acquainted with the beauty of ageing. And the story behind them illustrates how worthwhile taking a peek is. The photographer who was struggling with grief and fear around her parents’ illnesses found insights and healing she never expected.

Do you remember the 450+ pilot whales recently stranded on Tasmania’s west coast? In an article about rescue efforts I learned, “But the biggest obstacle rescuers face is the whales’ social bonding. Long-finned pilot whales are highly intelligent and live in strong social units.”

“[…] their behaviour hampers rescue efforts: many pilot whales re-strand themselves to be with their family.”

“So when dealing with mass strandings, it’s important to realise the emotions and bonding between the whales are very likely beyond what humans can feel. One well-documented example of their emotional depth is the pilot whale seen carrying its dead calf for many days.“

Pilot whales are not the only ones who behave like that. “We know from killer whales, which also have strong social bonding, that if a close member of the group strands, others will attempt to join to die together.”

What a different approach to and understanding of death whale society has. I’m not sure if I agree that humans are unable to feel that kind of bonding. Rather, I have a sense that we humans have overemphasized individuality at the cost of more family/community minded values, especially in western society. In addition, many are also estranged from nature which means being out of touch with its cyclic rhythms. We have forgotten.

“All around us, everywhere,
beginnings and endings
are going on all the time.
With living in between.”

So starts the book “Lifetimes – The beautiful way to explain death to children” by Bryan Mellonie and Robert Ingpen. It describes that dying is as much a part of living as being born. It helps to remember. It helps to understand.

There are many reasons why we think we can not or should not let an animal live out their life. A great majority of animals are euthanized for conditions that are neither life-threatening nor would keep an animal from enjoying life if they could receive some special care. Two common reasons are mobility issues and incontinence, both cause inconvenience to the human but in many cases can be managed well. There is an abundance of products available to make life easier such as ramps, carts, wheelchairs, dog nappies, etc.

Another common reason for pet parents to choose euthanasia is receiving the news that their animal has a terminal disease. Death upon diagnosis, even when they are still reasonably healthy. The fear of their dog suffering is so strong, that mere anticipation of it is too much for some people to bear and they choose to euthanize. Is this kindness? I’ve heard people say that they would make that same choice for themselves if they could.

Interestingly, in places where it is legal for humans to end their life with medical help, when their condition has progressed to the degree they previously thought would be the time for assisted dying, it is known that some change their minds. Suddenly viewing things differently. It’s hard to know in advance how a situation will be, how we’ll feel about it and how our understanding might have changed. Life is precious. I believe it’s good to have a choice as well as the freedom to change your mind.

One of the major reasons humans think about choosing euthanasia for their animals or themselves is the fear of losing dignity. What is dignity? “The English word dignity comes from the Latin word, dignitas, which means “worthiness.” Dignity implies that each person is worthy of honor and respect for who they are, not just for what they can do.  In other words, human dignity cannot be earned and cannot be taken away.” (agingwithdignity.org) For me this applies to animals as well. And I think they know this better than we do.

When my dog Louie had his stroke most of his body was paralysed. At first, that was a frightening experience for him, wanting to get up but being unable to do so. He was frantic. But this initial shock wore off quickly and he surrendered to my assistance, relieved and grateful. In the beginning, there were times of frustrations for him when I didn’t catch on to what he wanted or needed, for example, toileting. So he had to pee in his bed. Lying in his own puddle was distressing because the wet was uncomfortable and not because he had lost his dignity. I cleaned up the mess and everything was fine again. It didn’t take long at all for us to improve our communication, for me to be more cued in to his needs. Plus, I made it easier on both of us by Louie wearing a belly band (doggy nappy) when I couldn’t give him my undivided attention.

Providing hospice care for my dying dog in fact was a time of great dignity and grace. I honoured and respected Louie as he lost control over his body and most of his abilities, and beauty revealed itself in many moments throughout each day. By accepting and surrendering to the end of his lifetime I was entering a sacred space that otherwise stays hidden. Befriending the dying process turned the experience into something rich and nourishing for me, adding layers and textures beyond just sadness and grief. And the moment after Louie took his last breath I had this deep sense of completion, I had done right by him.

Financial or time constraints are two more reasons why people choose to euthanize their pet. Part of being a responsible dog parent includes budgeting for your dog’s health and care costs. Pet insurances are one way, having a special savings account for that purpose another. However, there are other solutions available if there are no funds. Ask someone to lend you money or sponsor your dog. Find a charity that pays for medical costs or equipment like Hailey’s Wheels for Life. There are also specialized rescues or sanctuaries taking in an ill or dying animal.

If you work full-time, you might find a pet sitter or someone who can look after your dog while you are not home or consider taking vacation time or speak with your boss if working from home would be an option. Where there is a will, usually there is a way. Sometimes it just takes a little effort and creativity to find it.

Another common reason for euthanasia is that an animal is dying. This loops us back to the quote found on the PETA website from the start of the article, “If your animal companion’s quality of life has diminished to the point where therapy or medicine is no longer able to help, euthanasia is the only humane choice.” Loss of appetite and consequently loss of weight or having stopped eating completely are considered two very common measures determining a diminished quality of life, followed by the decision to euthanize. This reflects a lack of education about the dying process as these are just normal symptoms of dying and nothings needs to be done beyond comfort care. The body knows what it is doing.

We know from dying humans that not wanting to eat anymore as they are nearing their end of life is not experienced as suffering. The dying body simply doesn’t need the nutrients any longer. This is very different from starvation where you’d want to eat but you can’t – either for lack of food or a physical condition that makes it impossible. The dying are simply not hungry anymore and it can cause them agitation and stress when well-meaning but ignorant loved ones or medical professionals want to convince them to eat or accept artificial nutrition.

Some people decide to euthanize their dying animal because they feel like they just can’t watch them decline any further. I am not judging anyone who makes this choice. It can be so distressing to witness someone we love change to the point where we feel they are not at all anymore who they used to be. These changes can be caused by physical or mental (senility) decline. I wonder how one’s perception might change, however, if one would reframe their understanding of the dying process.

Change is the only constant. But change is scary and stressful. Even the good kind, like graduating or moving to a new place. The Chinese character for change is made up of two symbols – uncertainty and opportunity.

Uncertainty is what sets off code red in our limbic brain. The main fuction of this brain region is that, “It can record memories of behaviours that produced agreeable and disagreeable experiences, so it is responsible for what are called emotions in human beings.” And, “The limbic brain is the seat of the value judgments that we make, often unconsciously, that exert such a strong influence on our behaviour.“

The second symbol of the Chinese character for change is opportunity. To me this points to a way of dealing with uncertainty, choosing our focus. We can go with the limbic system’s automatic response of avoiding that which hints sadness, confusion, any form of potential suffering. But we can also consciously override this survival mechanism and adopt a gentle openness, a willingness to expand our previous knowing and understanding. Dealing with change can be a life practice. After all, change is going to happen, whether we like it or not. And so is death.

Being at peace with dying doesn’t mean not feeling sad or heartbroken. It means embracing the fullness of it. Life is complex, not black and white. No matter how much part of us seems happier when it can put everything into its own neat box. The “not knowing” makes part of us so very uneasy. The truth though is, that we really don’t know much. We think we do, our diaries are planned out for the week, month or year. Which makes us forget that we are operating on an illusion which is that everything will unfold how we think it will. I am not suggesting to not make plans. I am just pointing out that they can lull us into a sense of certainty and control we simply don’t have.

The intention of this article is to raise awareness that euthanasia as end of life of a companion animal is a choice, rather than the only option available. I’ve touched on a few considerations and am going deeper into the topic in the book about animal hospice care I am currently writing (which will be published next year). If you are interested in learning more about it in the meantime, the Spirits in Transition as well as Bright Haven websites are excellent resources. What does hospice care for a horse look like? Here is one personal account of it and here are some on-line classes for further education.

We love our animals and want to do the very best for them. By expanding our horizon on what caring for them means, we can do even better.

Some people feel guilty about having euthanized a companion animal in the past. Guilt in itself only makes us feel miserable and that really doesn’t serve anyone or anything. But understanding guilt as a doorway to exploring if more was possible … I’d call that useful! Agonizing over what is done can serve the purpose of wanting to find a different way. Ditch the self-flagellation and start researching. So, when the end of life of another one of your animals comes you can put your mind at ease, knowing that if you choose euthanasia it’s a better informed choice than in the past. Alternatively, you might choose hospice care, allowing death to happen in its own time, discovering the gifts of this sacred journey.

It is the secret of the world
that all things subsist and do not die,
but retire a little from sight
and afterwards return again.
Ralph Waldo Emerson