Kristi Freeman, D.V.M. - What Is Pet Hospice

One of the most difficult decisions a pet owner faces is when your
beloved pet has been diagnosed with a terminal disease or has a
poor chance of survival due to age, injury or other factors.
What if you are not ready to make the decision of euthanasia or you
feel strongly that euthanasia is not an option?

Today, there is a relatively new option called Pet Hospice. This is a
service where your pet, under the direction of a veterinarian, is
allowed to live out his or her remaining days at home with as much
dignity and comfort as possible. This involves at-home nursing care,
pain management and bereavement planning.

In a hospice appointment, Dr. Freeman assists the caregiver with
home visitations and prescribing medication to help control your pet’s
disease or any associated pain.

How do we know when an animal is in pain? Assessing just how
much pain can be difficult. Some of the signs of pain in dogs and
cats include abnormal actions, such as:

Posture–hunching, refusing to move or lie down, flinching, trembling.
Movement–limping, circling, restless, pacing.
Vocalizing–whining, crying, being too quiet or sometimes even purring.
Losing housetraining.
Licking a certain area excessively.
Decreased appetite.
Decreased grooming.
Fast breathing.
Dilated pupils.
Aggression.

As a pet owner, you have a close relationship with your animal and
are best one to note any change of behavior. Some animals will hide
their pain very well and the presence of pain is realized only after
medication is begun and the pet responds favorably. It is very
important that you do not self-prescribe medications to your pet
without first consulting your veterinarian. Some over-the-counter
medications are toxic to pets. For example, acetaminophen (Tylenol)
should NEVER be given to cats!

The final phase is Bereavement Care. Together, you and Dr.
Freeman can discuss final arrangements such as cremation, or plan
a funeral, the making of a memory album and locating a counselor or
pet loss support group.

The goal of Pet Hospice is to provide comfort and dignity with a better
quality of life during your pet’s last days, while allowing you the
opportunity to come to terms with the imminent loss of a beloved
friend.

Clearly distressed, tears in her eyes, Margaret said, "I still
wonder if there was something else I could have done..."
Margaret's feelings and questions are typical for a grieving
human who has just euthanized a companion animal.
Questions torment, such as "Could a different treatment
have been tried?", or, "Would a different pain medication
have given a few more days by providing greater comfort?"
Such questions raise the possibility that the decision to
euthanize was made too soon. For those who languish, this
time would be less painful if there was a method to
determine for certain when euthanasia should be
administered.

There are many factors which contribute to such a decision.
Some, such as chronic painful suffering, are clear indicators
for an immediate euthanasia. Others, such as stiffness or
incontinence are less clear. A system is needed which helps
the human companion evaluate a pet’s totality of
circumstance, and then yields a clear, unambiguous answer
regarding euthanasia.

Methods:

Quality Of Life... looks at the overall experience of a pet's
present existence.

Pain Assessment... looks for signs of pain and suffering.

Insight... looks into the companion animal's mind, in order to
find out what they want us to do.

In this article we present three methods for making a
euthanasia decision. All three should be used in order to fully
evaluate the pet's circumstances. None of the methods are
difficult to use. Two of the methods (Quality Of Life and Pain
Assessment) ask questions which correspond to numerical
values. The numbers are added, and the Recommendation
Table is consulted to determine if euthanasia is indicated.
The third method, Insight, uses a thought experiment to look
into the companion animal’s mind, in order to find out what
she wants done.

The Quality Of Life Assessment is divided into seven
categories of life experience such as walking and affection.
As an animal ages, or as the course of a disease
progresses, the quality of an animal's life experience will
deteriorate. For example, a young cat can jump up onto a
couch, whereas an older cat with arthritis will reach a point
where he can no longer jump.

The Quality Of Life Assessment evaluates a companion
animal's decreasing quality of life. Some characteristics are,
by themselves, indicators for prompt euthanasia. For
example, a pet who can no longer arise without assistance,
or an animal that has lost bladder or bowel control, and who
urinates or defecates on herself.

Quality Of Life Assessment

Walking

8	No longer can walk
8	Walks to eat, drink, or toilet only
1	Stiff, cannot run

Arising

8	Cannot get up without help
3	Arises slowly, is stiff

Eating & Drinking

8	Is not eating &/or drinking
5	Losing weight &/or dehydrated

Playfulness

3	Does not play anymore
1	Limited playfulness, reduced play interest

Toileting

8	Urinates or defecates on self
8	Painful urination or defecation on a chronic basis
3	Cannot hold urine or feces indoors / has accidents

Affection

5	Shows aggression when approached (fangs, growling)
3	No longer shows affection even when petted or rubbed
1	Only shows affection when laying down

Artificial Life Prolongation (ALP)

8	Is on 3+ ALP measures
5	Is on 2 ALP measures
3	Is on 1 ALP measure

	← Total Points

Recommendation Table

Total Points Action

1-3	Re-assess every 90 days
4-7	Re-assess every 30 days
8+	Euthanasia recommended

Many characteristics are not, by themselves, an indication
for euthanasia. For example, stiffness and reduced interest
in play have small numerical values. Adding the smaller
values together may generate a score which is high enough
to indicate the time has come to euthanize, or the score may
only indicate that the pet should be re-evaluated periodically.

The Pain Assessment allows the human companion to
estimate the amount of pain which a pet is experiencing.
Unfortunately animals do not speak in human languages, so
they cannot tell us in our language what amount of pain they
are experiencing. As a result, the human companion must
look for behavioral signs which are then interpreted as
indicators of pain.

Pain Assessment

8	Cries or moans when moving or re-positioning
4	Avoids all but necessary activity such as eating or toileting
2	Cannot climb stairs or inclines
1	Stiffness
	← Total Points

Consider the example of a 14 year old German Shepherd,
named Corrie. Her Quality of Life Assessment numbers
were: Stiff (1), Arises slowly (3), Limited playfulness (1), for a
score of 5. A score of five is not an indication for euthanasia;
rather, it simply calls for re-evaluation every 30 days.

One day Corrie began to cry when she arose from lying
down. This continued for two days, so this new behavior was
not a transient symptom. Using the Pain Assessment
method, Corrie's score was found to be an 8. Though her
score on the Quality Of Life Assessment was still a 5, the
Pain Assessment score indicated that Corrie had reached
the stage where euthanasia was the humane action to take.

The third method is subjective and does not generate scores
which can be checked on a recommendation table. Using
the Insight method the human companion answers
three questions in the way the pet would respond. Doing so
illuminates the pet's wishes. When we put ourselves into our
animal companion's mind, we may find that they want to be
released, even though we - their human companions - are
not ready to let go. The desires of the pet should be honored
as a final act of love and respect for them.

Insight Method

   1. Do I want to be alive any longer?
   2. Do I still enjoy life?
   3. Am I ready to go?

When it is time for a beloved pet to be euthanized, typically it
should be done within a day. If the animal is suffering, it
should be done right away. If a veterinarian will make a
house call, euthanizing your companion animal at home
allows your pet to transition in a familiar environment. This
reduces stress for you and your pet.

There will never be enough time to say goodbye to a faithful
best friend; however, there are activities for saying goodbye
that can be meaningful.

Saying Good-bye

* Gather humans and animals who love the pet, for a chance
to say good-bye. The humans may want to light candles and
put them in a sand tray while they share a few special words
or memories. Soon, the room will be illuminated by many
glowing candles.

* Share a special time alone with the pet. Make a special
meal, go to a favorite park, and spend time cuddling and
petting. You might want to bring a camera for pictures.

There are many ways to memorialize a beloved pet, such as
making a contribution to a local animal rescue organization,
or building a web page with pictures of your pet.