“Doc, how will I know when it’s time?”

We have heard from countless pet owners that the death of their pet was worse than the death of their own parents. This might sound blasphemous to some, but to others it’s the cold truth. Making the decision to euthanize a pet can feel gut-wrenching, murderous, and immoral. Families feel like they are letting their pet down or that they are the cause of their friend’s death. They forget that euthanasia is a gift, something that, when used appropriately and timely, prevents further physical suffering for the pet and emotional suffering of the family. Making the actual decision is the hardest part of the experience and I’m asked on a daily basis, “Doc, how will I know when it’s time?” Let us shed some light on this difficult discussion. 

As veterinarians, our job is to assist the family in the decision-making. There is not one perfect moment in time in which to make that ultimate choice (unless the pet is truly suffering, something we are trying to prevent in the first place). Rather, there is a subjective time period in which euthanasia is an appropriate decision to make. This time period could be hours, days, weeks, or even months. Before this subjective period of time veterinarians will refuse to euthanize a pet because a good quality of life still exists. After this period, however, we may push for euthanasia due to obvious sustained suffering. During this larger subjective time however, it is truly dependent on the family to make whatever decision is best for them. Some owners need time to come to terms with the decline of their pet while others want to prevent any unnecessary suffering at all.

Everyone is different and entitled to their own thoughts. After all, pet owners know their pet better than anyone, even the vet!

Pain and Anxiety

Pain is one of the most important topics that we discuss in veterinary hospice care. Many professionals believe that carnivorous animals, such as cats and dogs, do not “hide” their pain, rather pain simply doesn’t bother them the same way it bothers humans. Animals do not have an emotional attachment to their pain like we do. Humans react to the diagnosis of cancer much differently than Fluffy does! Fluffy doesn’t know she has a terminal illness, it bothers us more than it bothers her. This is vastly different than prey animals like rabbits or guinea pigs, who must hide their pain to prevent carnivorous attacks. If you’re interested in learning more about pain and suffering in pets, grab Temple Grandin’s book “Animals in Translation” and read chapter 5.  

When discussing the decision to euthanize, we should be just as concerned about anxiety in our pet as we are about pain. Frankly, anxiety is worse than pain in animals. Think about the last time your dog went to the vet. How was his behavior? Was he nervous in the exam room? Did he give you that look that said “this is terrible!”? Now think back to when he last hurt himself, perhaps scraping his paw or straining a muscle after running too hard. My dog rarely looks as distraught when she’s in pain as she does when she is anxious. It’s the same for animals that are dying. For example, many end-stage arthritis canine patients begin panting, pacing, whining, and/or crying, but many of these symptoms are due to anxiety, usually arising secondarily from the pain. This is akin to being stung by a bee but not seeing the bee itself; you may be more anxious at the lack of knowledge of the origin of the pain (and therefore about the unknown duration or potential augmentation by more bees) instead of strictly the pain alone. Due to hormonal fluctuations and other factors, these signs of anxiety usually appear worse at night. The body is telling the carnivorous dog that he is no longer at the top of the food chain; he has been demoted and if he lies down, he will become someone else’s dinner. Anti-anxiety medications can sometimes work but for pets that are at this stage, the end is usually near.

Waiting Too Long

An interesting trend that we did not expect when starting our hospice practice is that the more times families experience the loss of a pet, the sooner they make the decision to euthanize. Owners experiencing the decline or terminal illness of a pet for the first time will generally wait until the very end to make that difficult decision. They are fearful of doing it too soon and giving up without a good fight. Afterwards, however, most of these owners regret waiting too long. They reflect back on the past days, weeks, or months, and feel guilty for putting their pet through those numerous trips to the vet or uncomfortable medical procedures that did not improve their pet’s quality of life. The next time they witness the decline of a pet, they are much more likely to make the decision at the beginning of the decline instead of the end.   

What about a natural death?

Yes, there are those pets that peacefully fall asleep and pass naturally on their own, but just as in humans, this type of peaceful death is rare. Many owners fear their pet “passing alone” while others do not. Occasionally we are asked to help families through the natural dying process with their pet. For different reasons, these families are against euthanasia. We explain everything we possibly can, from how a natural death may look, how long it may take, what their pet may experience, etc. Inevitably, almost all of these families regret doing this. Most of them comment afterwards “I wish I would not have done that, I wish she didn’t have to suffer.” A natural death can be difficult to watch, especially for non-medically oriented people. Most people can watch a human family member in pain much more easily than they can their pet. To an extent, we can talk other humans through physical pain or discomfort, but there is no comforting a pet that is suffering. Families take this guilt difficultly and we do our very best to not only readily suggest euthanasia when appropriate, but prepare families for a “worst-case” scenario should they chose to wait. (Of course death is nothing to be fearful of and if your pet does happen to pass on his or her own, it is certainly not a bad thing; it happens in nature frequently!) 

Weigh Your Options Carefully

If the most important thing to you is waiting until the last possible minute to say goodbye to your baby, you will most likely be facing an emergency, stress-filled, sufferable condition for your pet. It may not be peaceful and you may regret waiting too long. If a peaceful, calm, loving, family-oriented, in-home end of life experience is what you wish for your pet, then you will probably need to make the decision a little sooner than you want. Making that decision should not be about ceasing any suffering that has already occurred, but about preventing suffering from occurring in the first place. Above all, our pets do not deserve to hurt.  

We are here to help make this time a bit easier on everyone. Veterinary hospice care is aimed at maintaining comfort, quality of life, and the human animal bond for as long as needed; we are here for you!