Summary: challenges and opportunities

The overarching goal of EOL care in veterinary medicine is to maximize patient comfort while minimizing suffering, utilizing a collaborative and supportive approach with the caregiver client. The primary means for addressing caregiver needs is competent, nonjudgmental, and empathetic EOL communication, including recognizing, acknowledging, normalizing, and validating the human emotional and spiritual distress associated with the caregiving role for a terminally ill pet when a strong humananimal bond exists. Other channels include suggesting resources such as books, articles, websites, support groups, and, in some cases, referral to a counseling professional.

A companion animal practice that gains a reputation for providing EOL care in a skillful, compassionate way will retain clients and gain referrals as a result. As the art and science of EOL care continues to evolve in veterinary medicine, practitioners will likely be influenced by the precedent set in human hospice care.

Although there is a great deal to be gained from lessons learned on the human side, it is important to remember that veterinary EOL care has unique characteristics and challenges that are distinct from human EOL care. Because pets are incapable of verbalizing their needs and wishes, veterinarians and their clients must resort to interpretation of animals’ behavior in their efforts to understand these needs. Recent advances in brain imaging techniques and longitudinal studies of animal behavior offer exciting insights into animals’ emotional and cognitive capabilities, though it is not possible to completely ascertain the motivation explaining an animal’s observable behaviors.

In spite of the growth of the pet insurance industry, financial considerations are a primary concern in many veterinary EOL decisions. Finances often dictate the extent and length of the client’s ability and willingness to provide their pet professionally guided EOL care. Various physical and infrastructure constraints also exist in veterinary EOL care. These include limitations on facilities for extended care, hospice services, hospitalization (e.g., in rural areas), and staffing to provide home assistance to owners. Physical constraints include lack of specialized equipment to handle non-ambulatory patients, especially large canine breeds. These limitations also influence many EOL decisions.

Although many owners consider their pets family members, there are profound differences between animals and human family members. This fundamental distinction often guides clients’ decisions regarding pet EOL care.

Euthanasia, a legal and widely accepted tool in veterinary care, is a double-edged sword. On one hand, it provides an end to animal suffering when it becomes medically, financially, or physically impossible to maintain the patient’s QOL. On the other hand, it leaves significant numbers of caregivers struggling with doubts regarding the decisions they made, which prolongs and complicates their grief experience. As the value of animal hospice care and its availability increase, so will the feasibility of ethically managed, high quality, hospice-supported natural death, and the decision to euthanize will become more nuanced. Navigating complex medical and ethical realities in the face of intense human emotions is one of the greatest challenges of veterinary EOL care and a central theme of these guidelines. A satisfactory decision to euthanize is heavily dependent on open, honest, and empathetic communication with the client.

It is likely that some of these challenges will be resolved by advances in veterinary EOL care. Veterinary medicine is a resourceful and innovative profession with a history of responding to societal change, including the growing population of canine and feline pets and the deeply embedded role that pets play in the lives of their owners.

The AAHA/IAAHPC Task Force gratefully acknowledges the contribution of Mark Dana of the Kanara Consulting Group, LLC, in the preparation of the Guidelines.