At the end of last year a task force of veterinary experts published new 2016 AAHA End-of-Life Care Guidelines. These guidelines recommend dramatic changes to the way terminally ill pets should receive care as they approach their final days. Is your veterinarian following them?
On May 28, 2016 I made the heartbreaking decision to euthanize my beautiful dog Cody. That decision wasn’t made in one day, but slowly over a six-month period. Cody’s two-year battle with Inflammatory Bowel Disease was getting worse and affecting his quality of life. Still, if that was Cody’s only health problem I would not have made the choice to euthanize. We were dealing with it. But, Cody had also begun to have neurological problems. His hind legs crisscrossed when he walked and he could not hold his head straight. On his final day, Cody couldn’t figure out how to hold his head in a position that would allow him to take a treat from my hand.
The week leading up to Cody’s death was difficult for my veterinarian as well as me. I took Cody to see him three times. Even as an experienced pet parent who has raised 9 dogs and 6 cats, I had a hard time comprehending that we were coming to the end. I was in denial and I think my veterinarian was too.
At each office visit that terrible week, he did the same procedures he had performed during the previous visit. He gave Cody a quick exam and made a few recommendations. He never mentioned euthanasia or that he suspected Cody was dying. Finally, while I was on the phone with him during a nighttime call, he admitted that everything we were doing for Cody at this point, was like putting on a Band-Aid on a gun shot wound. His comment gave me the courage I needed to end Cody’s suffering.
Why we need the AAHA End-of-Life Care Guidelines
End-of-Life care seems as confusing for veterinarians as it is for pet owners. That’s why the American Animal Hospital Association (AAHA) and the Association for Animal Hospice and Palliative Care (IAAHPC) established a task force to create clear-cut End-of-Life Care Guidelines.
Leading veterinarians along with pet hospice and palliative care professionals, plus animal pain management specialists were tasked with the job. They came from the top schools of veterinary medicine in the country.
Heather Loenser, DVM, AAHA’s veterinary advisor worked on the task force. In an AAHA publication she said, “These guidelines have shown me how I can bridge the gap between the time of diagnosis of a terminal illness and when the animal passes away. Since this time can extend to be days, weeks, or even months, this gives the veterinary team multiple opportunities to provide invaluable care to the pet and pet owner, allowing the pet’s final time beside the owner to be as comfortable as possible.”
The Guidelines focus on patient comfort, minimizing suffering and establishing a supportive partnership between veterinary staff and the pet owner. They recommend that care be a team effort between the veterinarian, palliative care/ hospice care professionals, and the pet’s family.
Palliative/hospice caregivers are a critical part of the guidelines. These professionals are responsible for keeping a pet comfortable in their own home, managing pain, and providing veterinarians with medical updates. In addition, their knowledge can educate owners about the stages of a disease, how to recognize symptoms of pain, and support owners emotionally.
The End-of-Life Pyramid
The task force created a three-tier pyramid of guidelines. These include physical care at the base, social care in the middle and emotional care at the top. All three play an important role.
- Physical care: Pain management, managing symptoms, hygiene, nutrition, mobility, safety and environment.
- Social care: Engagement with the family, engagement with other pets, and mental stimulation.
- Emotional care: Dignity of the pet, the will to live, and assessing suffering and stress.
I wish my veterinarian had offered some of these resources during Cody’s final days. Having a team to turn to would have eased the panic I felt, not knowing if I was doing the wrong or right things for my dog. It is my hope that the End-of-Life Guidelines become common practice in the veterinary world. Pets and people will both benefit.