Global Veterinary Ethics Congress
GlobalVeterinaryEthicsCongress.blogspot.com
Donald H DeForge, VMD
Veterinary Hospice
End of Life Care for the Pet Your Love who has provided Unconditional Love to your and your family!
- This report will emphasize ways that palliative care teams [out-patient veterinary Hospice Teams] can support patients and families as they cope with their experiences of loss and grief.
- The End of Life Stage is the stage of life when the Human-Animal Bond reaches its highest pinnacle. It is the duty and responsibility of the veterinary team to supply unconditional love to the pet and pet advocate.
- This is the Stage of Life that brings the Human Animal Bond to its pinnacle. The doctors and veterinary nursing teams must be devoted to helping pet and pet family with compassion and empathy.
- The palliative care team in a newly constructed out-patient Veterinary Hospice can support patients and families as they cope with their experiences of loss and grief.
- It is very difficult in Hospice to support the patient who is a member of your practice family at end of life and at the same time provide emotion support to the pet advocate with a devoted level of empathy.
- It can be accomplished through meetings that describe the importance of Hospice Care.
- End of Life Palliative Care is not the same for dogs and cats. The Hospice concept is the same but the Palliative Care Team must work with the family to establish a pain control-quality of life environment for the pet that needs help, based on physical needs, more than at any other Stage of Life.
- From the AVMA:
Pet Hospice Care
Pet hospice care, also known as palliative care, is an option if your pet is suffering from a terminal illness and a cure is not possible. The goal is to make a pet’s final days or weeks more pleasant with the proper use of pain medications, dietary strategies and human interaction.
A participating veterinarian will teach pet parents how to provide intensive home care to keep an ill pet as comfortable as possible. Hospice care requires an active commitment and constant supervision from pet parents, who work with their veterinary team to make sure their pet’s life ends comfortably.
If you decide hospice care is the right course for you and your pet, you will become your pet’s primary nurse and caregiver, as well as the link between your pet and the veterinary team. Consult with your primary veterinarian and see if she recommends Hospice care for your pet based on specific needs.
Pet hospice is not a place, but a personal choice and philosophy based on the principle that death is a part of life and can be dignified.
When considering hospice care, pet parents should be very careful not to prolong the suffering of pets who are in pain or experiencing poor quality of life.
The health care Hospice Team has to allow the client to vent; feel their pain; and help them understand the difference between palliative care and futile care at the expense of the patient. The Hospice Team does not designate a date and time for euthanasia.
The Team does have a responsibility to explain to the pet owner when poor quality of life is becoming prominent and discomfort is leading to only "uncomfortable" days for the pet they love.
As creators of Veterinary Hospice Teams, it is our responsibility to understand the history of Hospice for humans in the United States.
There are many misconceptions about Hospice. It is often misunderstood and this results in Hospice services being underutilized.
The word “Hospice” was derived from the Latin word hospes, which means both “guest” and “host.” Dating back to the 11th century, the concept of hospice referred to a place of hospitality for not only travelers and pilgrims but also for the sick and dying.
Dame Cicely Saunders was a nurse working with terminally ill patients. She became a physician and in 1963 started talking about what end-of-life care could really look like.
During this talk, Dr. Saunders presented pictures of terminally ill cancer before and after receiving Hospice care. The difference in the patients’ appearance and overall wellbeing was astonishing. This one talk began the discussion of end-of-life care in the United States.
In 1972, Dr. Elisabeth Kubler-Ross testified before the US Senate Special Committee on Aging about the right to die with dignity. This included the right to make decisions about one’s end-of-life care and to die at home.
Dr. Kubler-Ross became well known in the Hospice community, and many hospice workers enjoy reading her work. She helped pave the way to Hospice as we know it today.
In 1974 the first hospice was founded in the United States.
Dr. Kubler-Ross gave a talk at Yale University and she talked about what specialized care for the dying could look like. She focused on comfort care (palliative care) rather than treatments and focusing only on a cure.
Today, Hospice is not a place at all, it is a philosophy of care. End-of-life care can take place wherever a patient calls home. While there are hospice houses and inpatient hospice units, it makes up only 4.8% of hospice care in the United States.
Grief Model Background--DABDA
Throughout life, we experience many instances of grief. Children may grieve a divorce, a wife may grieve the death of her husband, a teenager might grieve the ending of a relationship, or you might have grieved the loss of a pet.
In 1969, Elisabeth Kübler-Ross described five common stages of grief, popularly referred to as DABDA. They include:
Denial
Bargaining
Acceptance
Kübler-Ross now notes that these stages are not linear and some people may not experience any of them. Others might only undergo a few stages rather than all five. It is now more readily known that these five stages of grief are the most commonly observed in the grieving population.
As veterinary Hospice Team Members, we must realize that we are not social workers; psychologists; and/or psychiatrists. We do have the responsibility to understand grief so that we are prepared to face together the difficult times for the family and close friends of the patient reaching End of Life Care.
Some team members will feel uncomfortable in Hospice Palliative Care. Those team members should not be forced into an uncomfortable situation. With time and experience, they may ask to join the Palliative Care Hospice Team. For certain individuals this can be a painful transition. Allow your team member to tell you when they are prepared.
Hospice Care is a triad of pet advocate; pDVM; and appropriate specialists/Pet ER doctor based on medical history.
The pDVM should contact any and all specialists to see if they can help with Hospice Care of the patient they have treated medically or surgically in the past. This specialist-pDVM contact can be accomplished by Telemedicine.
The local ER Critical Care Center should be informed when end of life is close to alert them about a possible call from the pet advocate for euthanasia if the pDVM's hospital is closed.
Important Elements of Hospice Care:
This care must be tailored to the patient and the reason[s] that the pet is in Hospice Out-patient Care.
Proper Nutrition-all patientsPain Control-all patients
Fluid Therapy if indicated to control
dehydration as needed
Antibiotics if indicated
Immunosuppressants if indicated
Weight monitoring-all patients
Blood pressure monitoring-all patients
Vital Oral Diagnostics as indicated
Cardiovascular Testing as indicated
Telemedicine videos showing the pDVM and the Hospice Team how the patient is able to locomote and get up and down, at home, after lying for long periods. Most veterinary APPS have a way to upload photos and movies to the Health Care Team.
House Call visitations as indicated-this has been a problem with COVID-19 and has been replaced almost completely with Telemedicine re-evaluations.
Working with the client to assist in the cost of medicines at home with Pharmacy Discount Cards.
When to say Good-bye:
If your patient has a poor quality of life and is suffering, continuing Hospice care may not be the right choice for that patient.
When this time comes, it will accelerate communication with the client to decide on euthanasia well before they were prepared for it.
Electing to say goodbye to their pet is never an easy decision. It is important for the Hospice team to work closely with the client and family members when it may be time to say goodbye.
Telemedicine videos to the Hospice Team can help the client visualize the pain that their pet is experiencing. Telemedicine has been catapulted into a NEW vital role in medicine with the advent of ever improving Internet Technology Platforms.
Always remember that you are the guide and your presentation will be weighted by the pet advocate. Gentleness; being a good listener; and multiple communications are necessary to allow the patient not to suffer and for the correct end of life decision to be made by the pet advocate.
Internalize the importance of the Human-Animal Bond to the client. Let the pet parent know that saying good-bye is extremely painful but it is also necessary, at a point in time, to stop severe discomfort in the pet they love.
Saying good-bye is returning unconditional love to the pet who has offered it freely to the family every day of their lives.
