** In anticipation of National Hospice and Palliative Care Month (November).**
Slate magazine recently ran a review of my book, The Last Walk, which explores the practical and moral challenges of end of life care for our companion animals. Doree Shafrir, the review’s author, nicely captures the central themes and tenor of the book, and I’m thrilled to see the issue of animal end of life care getting national attention. I would like to use Ms. Shafrir’s essay as a springboard for discussing exactly what animal hospice is and what it is not. There are three common misconceptions that I’d like to clarify.
Misconception #1: Animal hospice is a place you take your animal for care.
Hospice is not a place you take your animal; rather, it is an approach to end of life care. Death is accepted as a natural and inevitable process, and not something to battle against. Instead of trying fix an animal’s problems with surgeries or other interventions, the focus of care is on keeping an animal comfortable and maximizing the quality of his or her remaining time on earth. It is about doing everything we can to keep an animal free of pain and suffering, and full of joy and love.
For people, there are free-standing hospice centers. But the majority of hospice care—about 80%–takes place in the home, and in many ways, this is the best scenario since home is often where a person feels most at peace.
For animals, hospice really needs to take place at home. This is partly because there are no hospice facilities for pets. But even more important is the emotional well-being of the animal: our animals don’t understand the concept of going to a new, strange-smelling place, and stress is exactly what we want to avoid with an ill or dying animal. For some caretakers of dying animals, hospice will involve some trips to the veterinarian. But many people (and animals) prefer to have a mobile vet come to the home. One of the best things about hospice care for animals is that it stresses the value of home: dying animals are often most comfortable at home, in the presence of their family and in familiar surroundings.
Misconception #2: Death is lovely and peaceful and all about rainbows and wet noses.
We might picture a smiling dog eating bacon treats and getting belly scratches, presumably while she lies dying. But I think pet owners need to be aware that the dying process isn’t always so pretty. Some animals who are ill or dying don’t want to eat and don’t want to be touched, and hospice care is about far more than feeding treats and giving caresses—though these can be important components of care. Hospice care may involve making frequent appointments with a vet, administering pain medications (sometimes even learning to give injections), buying or cooking special diets (sometimes feeding by hand), helping disabled animals move around and go to the bathroom, getting up in the middle of the night to provide care, and many other things as well. Hospice is not for everyone: an animal’s human guardian must make a commitment to doing hospice right, because half-baked care can wind up causing far more suffering than an animal should bear.
Misconception #3: Animal hospice is about “natural death.”
Animal hospice is sometimes assumed to be equivalent to “natural death.” In other words, hospice is sometimes thought to be an alternative to euthanasia. Although there are a few hospice practitioners who are strongly opposed to euthanasia, the vast majority of hospice vets embrace euthanasia as an option that should remain on the table, for if and when an animal’s suffering becomes too great.
All death is “natural”, whether it takes place through euthanasia or by “natural” causes such as the gradual shutting down of organs as a result of disease. And at the same time, very little about our pets’ lives is “natural.” Nearly every aspect of their lives is carefully orchestrated by us—when and what they eat, where they go to the bathroom, whether or not they are allowed to reproduce and with whom, where they sleep, how much physical exercise they get. To proclaim that we should just step back and not interfere with their dying is absurd, and also problematic for the animal. Dying needs to be carefully managed to control pain and suffering. We may still strongly desire to avoid euthanasia, and might strive for what animal hospice vets call “hospice assisted natural death,” which involves working closely with a veterinarian to provide effective palliative care. But hospice care should never be used as an excuse for needlessly prolonging suffering in an animal.
If you are interested in finding out more about hospice care, check out the website of the International Association of Animal Hospice and Palliative Care.