Animal hospice care: the unhurried death

Dying – enjoying life as fully and comfortably as possible,
like snoozing below the bee buzzing branches of the blooming cherry tree.

In March 2020 I spoke to my vet about the processional grief counseling she offers. My oldest dog Louie (at least 13 years old but possibly older) was doing well by senior dog standards but I like to be prepared. I was wondering if it was possible for dogs to die naturally, something you don’t hear about very often. Predominantly, a dog’s life ends with their human’s so-called last act of kindness administered by a vet, euthanasia.

Dogs (and all animals) know how to die and there are blessings that come with allowing them to die well on their own terms as long as their human can manage (considering financial, time, emotional,and other limitations to care).

Four months after the conversation with my vet Louie had an episode of vestibular syndrome (an ear disease effecting balance) and a stroke. Four weeks after that he was diagnosed with lymphoma (cancer of the lymphatic system).

Since that episode, Louie hasn’t been able to get up anymore. In addition, he didn’t want to eat or drink at all in the first four days. In the past I likely would have chosen to have him euthanized. Instead I kept Louie comfortable at home under my vet’s guidance and with the use of homeopathy.

From the night he had the stroke on I made Louie a comfortable and safe place to be, away from the other dogs and close to the couch where I have been sleeping next to him since.

What does hospice care for animals entail? If you research the topic you will find no unified definition. There are big discrepancies in understanding. The terms palliative care, end-of-life care and hospice care are commonly used interchangeably. However, they mean very different things. Ella E. Bittel is a holistic vet and founder of Spirits in Transition. I found the information on her extensive website resonates deeply with me. It is rooted in what is already well known from modern human hospice care.

Palliative care refers to caring for an animal when there is no cure for their health condition. There are special needs but the animal isn’t necessarily terminally ill. The aim is creating the best quality of life for the animal and their humans.

End-of-life care is an umbrella term referring to any type of care to the terminally ill. When talking about humans that includes hospital settings, residential care facilities or in home. Some countries in the world permit terminal human patients to take lethal medications as one option in end-of-life care. Not many patients elect that option for themselves. If vet care is given to a terminally ill animal up until it is euthanized it is considered end-of-life care entailing palliative care.

Hospice care refers to a very specific type of end-of-life care. The dying receives palliative care and is allowed to live out their life as fully and comfortably as possible. Euthanasia is available when all measures fail to maintain efficient comfort. It’s an exception, performed at time of need, not the rule.

What’s the difference between hospice and other care given to an animal at the end of life?

“Hospice recognizes that death is a natural part of the cycle of life, not a failed medical event, and does not have to be feared or avoided; the focus is “intensive caring instead of intensive care” without prolonging or hastening death.1)

“Quality-of-life scales as currently offered by veterinarians attempt to make an inherently individual process “objective” and serve as a guide for when to euthanize. They are a classic example of end-of-life care other than hospice. These scales disregard the basic hospice principle of not hastening death. They categorize normal symptoms of the dying process that generally don’t involve discomfort to the dying patient as unbearable suffering.” 1)

Normal symptoms of the dying process

Did you know that loss of appetite is a normal symptom of the dying process and is not the same as starvation? Other symptoms can be loss of thirst, dehydration, incontinence, loss of mobility and more. The following chart gives an overview of common symptoms of dying. The left column describes the hospice-educated understanding of the symptoms listed in the middle column. The right column gives the widespread “common” understanding.

This overview is derived from 1)
If you are having trouble reading this chart, here’s a higher contrast version that’s easy to read.
Pain and suffering

When thinking about my animals dying my biggest fear was them suffering unnecessarily. It seemed my responsibility to make sure I would deliver them from it at the right time. But when is that exactly? We all feel pain, human and animal alike. Suffering, however, might be a human specialty.

Pain is inevitable. Suffering is optional.

Pain is a physical sensation or signal that tells us something is happening within our body in relation to an event or situation. Suffering is created by the interpretation or story that we tell ourselves about the pain in the form of thoughts, judgements, beliefs, etc. This is explained well here.

“Often the animals themselves are less in pain than they are frightened and sedation would be more appropriate. Most of the heavy duty restricted pain medications co-incidentally have quite a sedative effect built in as opiate derivatives. Nonetheless, the actions surrounding perceived suffering require a balanced approach.” writes Dr Pearson from Paws to Heal veterinary clinic.

In the same article she says, “Animals know how to cope given the right environment. It is we who need to rediscover or redefine our own coping mechanisms; take back control from the brainwashing of advertising and fear based hype surrounding health issues such as pain management and feel more confident that animals can cope with life and its lessons. They can actually teach us much if we give them the opportunity.”

Found on the above mentioned Spirits in Transition website is the following observation, “Suffering is a really wide term, and also is a very individual experience. We all know from humans that our pain tolerance differs widely, and also we want to keep in mind that many of us can be in various levels of pain without wanting to die.”

Pain relief is available. As is help with letting go anxiety and restlessness. There are homeopathic remedies that work very well in relieving unpeace in the dying animal (and carer) and help feeling calm and serene. A homeopathic vet will be able to choose the appropriate remedy for your animal. Transition Essence from the Australian Bush Flower Essences works similarly, helping to better cope as well as ease the fear of death and helping one come to terms with it.

There are many aspects to caring for a beloved fur family member who is dying. There are more articles on the subject in the works that I’ll be sharing on this blog.

Please, share this article if it spoke to you to help educate pet parents that even though euthanasia is always an option, it’s not the only one.

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