End of Life Care – A Veterinarian’s Perspective

I have been practicing veterinary medicine for over three decades.  The advancements in diagnostic testing and treatment options that I have seen developed for companion animals has truly been amazing.  Unfortunately we often still will reach a point where further intervention does not benefit the pet and at that time, it becomes the veterinarian’s job to counsel the family as to their options and prevent suffering of their patient. 

This is definitely one of the most challenging aspects facing the veterinary health care team.

Is Putting a Pet to Sleep the Hardest Part of the Job?

Our practice treats a large number of aging dogs and cats with a variety of chronic, debilitating conditions and our goal is to preserve the quality of our patients’ lives, prevent painful conditions, and help the family make the difficult decisions that lie ahead.  While people often say, “Putting a pet to sleep must be the hardest part of the job”, I disagree and tell them that since we only perform euthanasia when it is appropriate, it is much easier than the journey that gets us to that final visit.  Whether it is in our office, or as an in home visit, euthanasia is a procedure that allows us to fulfil our obligation to our patients to keep them free of pain and suffering.

The decision does not come easily for families and I am often asked, “How will we know when it is time?”  As a younger veterinarian, I often passed the buck on this one and would tell owners that they will know when it is time.  However, as I have gained experience in palliative and hospice care, I do not think that this is the situation and owners often need guidance.

The Four Stages of “End of Life” Care

Our practice of end of life care is based on four stages. 

Stage One

The first is to encourage owners to pursue an accurate diagnosis.  This is important because many chronic diseases are not terminal in the short run.  Finding out exactly what type of illness we are dealing with is important so that we can offer a realistic prognosis and develop the best treatment plan. Some illnesses lend themselves to successful intervention which can lead to a cure or at least a meaningful extension of a quality life for some period of time. Others have a guarded prognosis for any humane existence beyond the immediate future.

Stage Two

Old age in itself is not a disease and once a specific diagnosis and prognosis are established, the veterinarian and family need to have a frank discussion about their particular situation.  Armed with facts, the road forward can be established.  If curative treatment is not a realistic option, owners can opt for palliative care.  Many animals that enter our palliative care program are not currently critically ill or dying. Their disease, although serious, has not progressed to the point that they cannot continue with their daily routines, although often at a somewhat reduced level.

Our goal is to maintain or improve quality of life for both the pets and their family. The most common conditions that we treat palliatively include chronic kidney disease, severe arthritis, neurologic conditions, heart disease, and cancer. The emphasis is on control of pain, maintaining body condition through exercise and nutrition, and slowing the progression of the disease process.

Stage Three

Once we are not able to provide palliation of the clinical signs of the disease process, we move into the third stage, hospice care. Our hospice patients are terminally ill, and rapidly losing the ability to lead a quality life.  While hospice care can technically be provided on an inpatient basis, we do not currently provide that for our patients.  Our hospice patients are cared for at home, by their families, with the guidance of our veterinary professional staff. 

Home visits by doctors and licensed technicians help design a hospice program that prevents pain and suffering as long as possible.  It is imperative that our staff and the family work as a team, during this intensely stressful period. While we sense the desperation of our clients as they try to find a way to prolong the life of their beloved pet, we encourage our clients to be realistic about their pet’s condition and discourage prolonging life beyond the point that is humane.

Stage Four

When we reach that point, we come to the final phase of our end of life care, euthanasia.  This is a discussion that is started at the beginning of hospice care so owners are prepared.  Veterinarians have taken an oath to prevent animal suffering and we often are required to offer an objective evaluation as to the condition of a pet. Our doctors and staff have a deep sense of compassion and have all had to make that difficult decision when it became apparent that our own dogs or cats were terminal and suffering. 

Humane euthanasia, either in our office or in our client’s home is never an easy decision, but rather, one that after introspection is the kindest thing that we can do for our pets.  While we hope that they will pass quietly in their sleep, this is often not the case and prolonged suffering is a cruel end to a long life for a beloved companion.

So, while euthanasia is often the final service that a veterinarian can provide for his or her patients, it is not the hardest part of the job. The road to this point is much more difficult as we often have to bear witness to human anguish and animal suffering. Our team’s goal is minimize both, empathizing with both the family and the patient, and providing a humane alternative for end of life care.

Keith Niesenbaum, DVM

I’m excited to announce my new Senior Dog Care Support Service

I offer 1:1 support on everything from health & wellness advice and training tips, to preparing to say goodbye and grief counselling. You can find details on all the packages I offer by visiting the Senior Dog Care Support Service page. If you have any questions or would like to book your FREE 15 minute chat, please email hpearson141@gmail.com

 

Bio

Dr. Keith Niesenbaum received his veterinary degree from The University of Pennsylvania in 1984 and practiced as an associate veterinarian for 5 years before starting Animal Bedside Care, a veterinary house call practice on Long Island, NY.  The practice grew and he has owned several animal hospitals and a boarding kennel in the intervening years.

He currently owns and practices at Crawford Dog and Cat Hospital in Garden City Park, New York. The practice emphasizes low stress, fear free visits and incorporates house calls as part of its regular service menu.

Doctor Niesenbaum has special interests in wellness care and the early detection and prevention of diseases, especially in older pets.

Outside of practice, is often seen riding his bike or running with his dog, Bella who has recently become a bit of a Facebook video sensation

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3 thoughts on “End of Life Care – A Veterinarian’s Perspective”

  1. Great information for all pet parents. I remember when the vet came out to put my last horse down when he took a turn for the worse through the middle of the night. I had expected to be with my best buddy to the last breath. But the vet told me to go inside the house to the furthest point away from the barn and he’d come get me when he was done. That was so difficult. It still is to think that Macho went through the last moments without me and a substitute vet (our regular vet was out of town). When the vet came to the door (which is about 2 acres from the barn) his eyes were full of tears and he had to continue to wipe tears away. So, I know the process of euthanasia is difficult for vets. It has to be otherwise they’d be heartless. Even if it’s the right thing, it’s not an easy thing, especially with a big animal like a horse that goes down hard. I still miss my boy.
    Nice guest post, Hindy. I’m sharing with my pet parents.

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  2. Great post and all pet parents should read it as we hoping for miracles when I pets are suffering is not fair to them and in a way selfish on our part. Having just lost Layla and letting her go in my house, was tough but I am at peace that she is not suffering. Dr Neisembaum explained it so well I am sure it will help pet parents when the time comes.
    Thanks for this fantastic post

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  3. This is the clearest and fairest summation of ‘end of life’ case I have seen in a long time. Dr. Niessenbaum is right to say that euthenasia is the prepared for end and as such while it is difficult the pet owner knows that the event is coming.

    No, it will not be easy, goodbye never is, but we are supported by the steps we have taken to provide the best care for those we love. Our consciences are clear and we take that step with a bit more courage and strength.

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