End-is-near issues

Click to access the 2016 AAHA/IAAHPC End-of-Life Care Guidelines.

Hospice and palliative care

The American Veterinary Medical Association has published guidelines for veterinary hospice care.69 Veterinary hospice care is defined as “giving clients time to make decisions regarding a terminal companion animal and to prepare for [its] pending death. The comfort of the animal must always be considered.69 In human medicine, “hospice and palliative care are considered to be the model for quality, compassionate care for those facing a life-limiting illness or injury.70 Palliative care, based on the animal’s specific requirements, might include outpatient/home care; pain management; easy access to food, water, and litter; wound management; a stable and consistent environment; good hygiene and sanitation; clean bedding and padding; and mental stimulation. Visits to the home by veterinarians and/or support staff may be offered or encouraged whenever possible.

Nutritional maintenance is paramount. Balance the pet’s need for a particular therapeutic diet with maintaining caloric intake. Reassess the need for all ongoing medications and treatments in pets with end-stage disease and an anticipated short life span. Consider whether medications should be reduced, stopped, or changed, particularly in light of their side effects and risk-benefit analysis. Medications or combinations of drugs that might otherwise be contraindicated or used cautiously (e.g., narcotics, NSAIDs) may be considered as the best or only choice for maintaining a good quality of life.

Personal decision-making

Provide guidance and resources for clients to deal with debilitating or chronic disease, with dying and death, and with euthanasia. Consider the client’s state of mind and the impact of the client on the pet. Consider and discuss the client’s realistic ability (given financial, physical, and time constraints) to adequately care for the pet. Discuss the effect of the aged or sick pet on other pets and the potential impacts (both positive and negative) of introducing a new pet.

Discuss specific criteria for reevaluation of the senior animal and for deciding upon euthanasia. When possible, help the client consider end-of-life issues at this time (i.e., during the “anticipatory grief” period), rather than during a terminal crisis.