Pet Suffering, QOL And Euthanasia

DISCLAIMER: The following comments are related to my own opinions based on many experiences and a significant amount of research. This information is not espoused by the general veterinary clinician and is not commonly acknowledged in the veterinary community. In fact, most if not all, would be refuted by 98% of veterinarians.

I receive many phone calls in regard to pet “suffering” and “quality of life” issues. In my opinion, these specific terms are related to our “human” viewpoint and not the pet’s. Animals are not emotional about the infirmity affecting them, we are! They are dealing with their situation moment by moment, and each moment is a “new normal” for them. They adjust and adapt as their bodies allow them to. 

Dogs are conditioned beings. Their existence is governed, either by genetic conditioning (in born traits specific to their breed), or by external conditioning (environmental, training and natural habits). Dogs are also “people attachers.” Their lives revolve around their pet moms, dads and families. Unless they have severe cognitive dysfunction, they respond to, and engage with their people even when they can’t walk, or have cancer. They aren’t concerned about the disease process.

Cats are “place attachers.” They are comfortable as long as their environment remains stable. They are also less affected by external conditioning and more instinctive in their approach to life than dogs. We are really just big litter mates to them. They either tolerate us, like us or neither. 

Cats are also more adaptive to disease and change than dogs, and are able to adjust, over time, to their afflictions. They hide their pain better and are quite instinctive in their approach to death. Dogs want their people with them even when they are dealing with disease. Cats, on the other hand, want to be left alone in many cases. Both species, although different in their view of life, are not concerned about the future or the past. They just deal with the “now.” 

Compassionate euthanasia has been used in the veterinary field since the beginning of veterinary medicine. When an individual becomes a veterinarian, they take a solemn oath: “Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health and welfare, the prevention and relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge. I will practice my profession conscientiously, with dignity, and in keeping with the principles of veterinary medical ethics. I accept as a lifelong obligation the continual improvement of my professional knowledge and competence.” My focus in this missive is the statement, “prevention and relief of animal suffering.” The wording provides an important concept that makes euthanasia an ethical consideration whenever a veterinarian is faced with making a terminal diagnosis for a pet. Because veterinarians have taken an oath to relieve animal suffering, they believe, in general, that a terminal condition such as end stage kidney disease, cancer, inability to walk, or congestive heart failure (plus many others) should result in compassionate euthanasia and that is often part of the discussion when the pet family is told of the diagnosis. This is an understandable approach from the veterinarian’s viewpoint. It certainly was mine for most of my veterinary career. However, in the last few years that I have been mainly treating elderly cats and dogs, I have changed my way of thinking and approach to the end of life for many of these pets. 

Death is a natural occurrence for every living thing. We can somehow understand it with humans, but when it’s a beloved pet, it becomes an extremely emotional situation. Euthanasia is often the solution because it’s been used for that purpose for many generations of veterinarians. The public, due to the fact that euthanasia is such a common recommendation, believes that when a pet (not necessarily their own) has a terminal condition, euthanasia must be the end result so the pet (not necessarily their own) doesn’t “suffer.” However, there is no over sight for euthanasia of pets. No one advocates for the pet because we, simply put, do not want them to “suffer.” As I stated earlier, I don’t believe they suffer. The humans associated with them do. 

The reason I’m concerned about this is related to the many situations I have encountered with pet owners where euthanasia was a forgone conclusion and recommendation because of an ominous diagnosis, but when it didn’t necessarily need to be carried out in such haste. So many of the phone calls I receive start out with: “My veterinarian recommended that I make plans for compassionate euthanasia as soon as possible so my pet doesn’t suffer.” I almost cringe when I hear those words. They are often associated with tears and reluctance to go further with the conversation. Usually, after a few minutes and with gentle probing, I find out what is going on. It’s never an easy discussion because it’s been a shock to the individual’s emotional stability. Pet moms and dads usually respect their veterinarian who’s oath requires the veterinarian to “relieve or prevent suffering.” But there can be a problem associated with a diagnosis that led the veterinarian to recommend euthanasia. Many of the animals can, and do, live a much longer and comfortable life even with a critical and/or terminal disease. Because I only deal with end of life situations, I come in contact with many terminal cases. I try to give a different perspective and advice in relation to what is going on. I have seen numerous instances where euthanasia was almost required, not just recommended. One case stands out as particularly onerous. It involved a middle aged cat with cluster seizures. The kitty’s parents could not afford a neurological work up. They were told the cat probably had a brain tumor and should be euthanized. The owners did not want that done at the hospital and requested the cat be released. At that point, the well known neurologist actually required the owners to sign a medical directive stating they would have the cat euthanized or the animal would not be sent home with them. I received the call from the devastated people. I was taken aback by the requirement, but went to their home to perform a compassionate transition. Merlin took off the moment I entered. I began the conversation with the owners about the process and what to expect. During the discussion, Merlin came out of hiding, as cats often do. He did not seem to be severely neurologically diminished and was alert and engaged. I was puzzled and after the physical exam, was even more so. He seemed quite normal. After more discussion, it was decided to try treatment with long term phenobarbital and short term Dexamethasone SP. Merlin lived eight years longer and eventually died of end stage renal disease. I can relate many more examples where the owners were told euthanasia was the only option. Yet many lived comfortably for a variable time after. This discussion is only meant to give you another viewpoint in regard to compassionate euthanasia. There are many cases where euthanasia is a release for a dog or cat in distress. We are fortunate that we are able to perform this act of kindness. But, I believe, it should not be done in haste because it was recommended. It is your choice only and I feel it should be determined by you using your intuition, and not because of pressure from an outside source. Being emotionally resolved that you are making the right decision is paramount for your emotional stability after the fact. Please call me to discuss this important decision. 

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