Last week one of my nineteen year-old patients died. Or rather, as the euphemism goes, I put him to sleep. In truth, it was a race. If I’d been a few seconds slower he would’ve beat me to it. Such was the extreme of his advanced decrepitude.
Foxy had been blind, deaf, chronically disoriented, episodically anxious, unable to walk without assistance and periodontially challenged in the extreme. What finally did him in, however, was heart failure.
One of Foxy’s heart’s valves had been on the fritz for a decade or so—since about the same time his owner decided he was too old to risk the anesthetic complications of dental anesthesia. Hence the horrific mouth I’d been treating at arm’s length for years now. Hence the probable valve infection that led to last week’s race to bring on his demise.
You might think the owner of such an animal a tad off—or even cruel—for keeping him alive in spite of what most of us would consider “apparent misery.” And you might be right—or not—depending on a variety of hard-to-assess variables. In any case, it’s a lot more common than you might think.
I’ve learned to reserve judgment when it comes to these cases—and not just because I have a thing for working with geriatric patients. It’s also because the owners of these older, decrepit animals often find themselves isolated from their families (at least on the subject of their pet) for choosing to keep them alive. It must be terrible to be have your human alliances suffer over the life and death of your beloved pet.
Additionally, owners of the furry living dead (as I lovingly call them) are almost uniformly willing to do anything necessary to improve their pet’s healthcare situation—well, OK, there are limits, financial and otherwise (reference Foxy’s teeth). But above all, they truly believe that their pet is NOT suffering. Not any more than the rest of us do in our advanced age.
If I, as the pet’s healthcare provider and advocate, can even remotely believe that this is true—then who am I to judge?
And yet I hear the buzz in the waiting room when these clients exit. “How can she…?” “Why would anyone want to…” and other versions of the riff my staff goes off on behind closed doors: “It’s sick, keeping him alive like that when he’s nothing but skin and bones and rotten teeth.”
And they might be right. But after Foxy’s demise I had to admit that apart from his advanced dental disease (which we managed with pain relievers, brushing and antibiotic therapy—absolutely half-assed given the state of his mouth, I’ll confess), this dog was well loved and arguably quite comfortable (as long as he was with his owner, at least).
In fact, I’ve had cause to know plenty of younger dogs who were pushed well beyond comfort simply because of their chronologic age. Who’s to say whether a deaf-blind-demented-lame 19 year-old dog is any worse off than a seven year-old hip dysplasia patient whose owners know they can’t afford the surgery but want to keep him going as long as they can?
Ultimately, the only ones who can make these decisions are their owners. Is it procrastination? Sure it is. We’re all putting off he inevitable when it comes to death. Is it potentially selfish and cruel? Yes, potentially.
It’s my personal opinion that it’s better to make the decision for euthanasia weeks too early than one minute too late. But, as with making medical decisions for our human family members, it’s a verdict best left to those who are closest to the patient—for better or…worse.
Add Comment41 Comments
Yes to your closing sentiment. However having recently...actually two years ago but it feels recent...lost a dog that could have been Foxy's twin, I can understand because if you're dealing with a dog that is already sick, has been sick for so long but still enjoying life it's difficult to judge. By the time I knew it was time for Marco, it was too late. Really up until a day or two before he died, Marco enjoyed laying in the sun, sniffing around and peeing on things, three of his favorite pastimes. Though I'm certain he bore us no grudges for his suffering I think he was telling us he was going but we didn't want to hear it. Certainly easier to see in hindsight.
Esmee November 25th, 2008 04:28:37 PM
Thanks for this post, it is simultaneously heartbreaking and heartwarming. I have been fortunate to have a few dear very, very old pets , though neither suffered with dental disease, both were somewhat emaciated, arthritic, dry coat, one losing most of sight and hearing. I'll never forget each of their last days, and though both died peacefully , neither had lost it "all" to the end.
If Foxy was managed with pain relievers, enjoyed his food, resting in the sunshine and strokes of his owner's hand, no one can judge appearances. Lot's of old humans look pretty decrepit too!
I have never been accused of potential selfishness and cruelty, choosing my and my pet's time for euthanasia, but as past readers know, I have no problem stating my one horrific NH veterinary experience of a clinic using my dying pet for THEIR selfishness and cruelly letting her suffer, including her last moments by illegal injection fully conscious.
any new subscribers are welcome to decide for themselves via web link Barbara A. Albright
Pocket's Story from NH November 25th, 2008 04:46:14 PM
A timely painless death is one of the greatest gifts we can give our dogs. It still amazes me that we can't have the same dignity as humans.
Christopher November 25th, 2008 05:49:26 PM
Thanks for this post. It's incredible whenever an animal seems willing to endure physical pain for the sake of being loved a little longer -- it says so much about the bond that we share with our pets. It makes sense that no one would want to cut that off. I don't suppose that animals are happy or unhappy in relation to physical pain anymore than humans are, except that they can't rationalize when the pain becomes too great (and honestly, most of us can't either if we're suffering enough). That's what I'd want to spare them by a timely, painless death, more than sparing them any suffering at all. Because they'll just continue loving us till the end!
Sarah November 25th, 2008 06:22:48 PM
I really appreciate this post.
Re: "the owners of these older, decrepit animals often find themselves isolated from their families (at least on the subject of their pet) for choosing to keep them alive."
I've been through this three or four times in the last 4 years. First with Toonces, who many thought should have been killed because of his brain damage although I had his diabetes well managed and he was comfortable as I could make him and was not in any kind of pain. Then I went through it with my mom and her dog, who had a double dx of kidney failure and cancer (I helped give him subqs 2x a day and we stabilized his kidney numbers, but after about 6 reasonably stable months, he started declining apparently from cancer). Then with my foster cat of 1.5 years who, after going into diabetic remission, lost her remission when she developed lymphoma which we treated with chemo to no avail and was PTS when it moved to her brain. Then with my mom's other elderly dog, who I adopted away from her to take care of his chronic conditions in the last year of his life.
In each of these cases I/we had people rolling their eyes and telling us we should have put them down yesterday. In each of these cases, I/we gave them every treatment we could, and then euthanized them when it became clear that they had turned the last bad corner and had begun to suffer. No one wants to see their loved ones suffer, including us. The judgement of others who want you to PTS because of diminished quality of life -- is hurtful, but frankly, I think it's often them projecting. Thinking: "You are giving up way to much of your life taking care of this animal, and you know where it's headed. I wouldn't do it, therefore, you shouldn't." I will remember that if they beat me into the nursing home.
In each case, though we knew they had their "final" illness, I/we felt that they were not "suffering" during the illness, because we did everything we could to prevent that (pain management, all supportive care, etc) and from watching the animals themselves we saw them doing some of their regular things. At some point, though, comes the day when there is nothing you can do to keep them comfortable, and that's where I draw the line. We believe that we knew when that time had come and that then, we did what we had to do.
I am definitely hoping not to go through this again for a while.
I believe that leaving it to the patient's loved ones, and being non-judgmental about it, is the best course. People told me I would look back and feel I had waited too long. But in each case, I felt we did it at the exactly right time.
Stefani November 25th, 2008 08:23:20 PM
Stefani, Odd that you would say that "I would look back and feel I had waited too long". Recently, that was suggested to me by a club member, my response was, "If I had taken YOUR advice, she wouldn't have lived for the "whole year" that she did!" Gosh, I don't think it should be suggested that Foxy lived nine years post dental cancellation in utter misery!
Although, my elderly dog's time slipped away slowly, "we", as in us, the vet, and all the staff knew the inevitable was near 2 weeks prior, when I brought her in for checkup wrapped in a blanket. She ate numerous dog cookies and the vet's question was simple: "Is she still Dottie?", well yes indeed she was, having held a cookie between her teeth, not wanting to eat it at the moment, but unwilling to relinquish it to any of the other dogs....brought me all the way back to her "weaning" her puppy Pearl...she wasn't a "generous" Mom when it came to food!
Although details may be admonished, there was one instant when I re-recognized Pocket shortly before death, despite no longer resembling the appearance of the Scottie I loved for 11+ years, it was brief and accidental, but I'll treasure that one moment before the tragedy I'll never forget.
For sure, true *euthanasia* is a gift and blessing I'll never take for granted. Barbara Albright
Pocket's Story from NH November 25th, 2008 10:11:58 PM
This is sadly a timely post in my life. I am spending the last hours with a much loved cat who is dying of dry FIP.
While she is not apparently suffering or in pain, her quality of life is not what it should be. It's a hard decision to euthanize or to simply wait and love them until nature takes it's time. But there in lies the problem. Nature is fickle. Sometimes it steals away loved ones quickly and without warning and other times it moseys in like a slow moving bank of fog. Leaving us torn between what our minds tells us and what our hearts tells us...
I have never euthanized a pet that I didn't later (no matter how good the reasons) second guess. I think it is just part of the greiveing process and I wish it was easier than it is. But I think that because we love our pets as friends, family and dear companions, those are the toughest decisions we can make.
I've have decided that tomorrow if she survives the night will be the day to make that decision because it is the right thing to do. And it doesn't matter how right it is. It hurts, I hate it, and I would be much happier to not to. But I will. Because I love her.
LorriM November 25th, 2008 11:51:36 PM
Right now, I'm on the "family member" side of this. One of my nieces has a GSD with a deformed front leg. I would have amputated it, but she chose not to and honestly he's gotten around very well all this time, and always been a happy dog. But now that he's older he's suffering some sort of degenertative joint disease in his back and/or hips and has really declined in the past couple of weeks. My sister-in-law is really wanting to push her daughter to put the dog down. My niece is resisting and getting defensive. I'm just trying to provide support to both of them. He's on pain meds and I don't think he's really suffering - but he soon won't be mobile and he's too big to carry outside so I think that will precipitate her decision. He is her first dog that was truly "hers", she got him right after she moved out on her own. So he's been there for all the big milestones of her life: graduation, starting her career, her marriage and the birth of her child. Letting go of him is going to be incredibly hard for her, and my heart breaks for her. She'll probably wait too long to put him down - she's probably already waited too long. But his pain is being managed, and like Dr. Patty said, the owner is really the only one able to make that determination.
Barb November 25th, 2008 11:58:11 PM
My dog had multiple life threatening illnesses last year (she's a diabetic among other things). People would hear me talk about her hospitalizations or watch me miss some social functions to take care of her; see me putting off getting a new car because of the expense. However, when said people meet this dog in person they always assume it's my other dog that's the sick one. They're pretty shocked to find out that the dog they're playing with is the one they've more than once quietly advised me to give up on. As long as she's eating, drinking, pain free and enjoying life and I have the funds, she gets a chance despite what others think.
Barb November 26th, 2008 06:47:50 AM
"It’s my personal opinion that it’s better to make the decision for euthanasia weeks too early than one minute too late."
I'm shocked you would say this. Haven't you ever had a single patient who you would've put down, but then turns around and makes a recovery? If it's ever happened even once, I'd rather wait well too long. Euthanasia isn't something you can change your mind about.
zandperl November 26th, 2008 08:06:41 AM
I'm with ZandPerl. Basically, I apply the same standards to my pets as I would to a human if I had the option with a human. As long as there is chance for them to come back to stable, without suffering, even if time will be short, I'd rather wait a moment too long than do it a month too soon. Watching them relish a meal or engage in some other small pleasure . . . it's one more moment of precious life. When it's gone, it's gone. I actually just can't bring myself to do it until I know that last final corner has been turned. This is the way it was with my father, watching him die. We had hope until there was no corner of the mind in which one could rationally find hope. When dying started, we didn't try to stop it and turned down other measures (or rather, I did -- my mother was not functioning). It's the same with pets. The only difference is we can give them a gentle push over into the abyss, sparing them the dying process.
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As for me, I think I will make sure to be living in Oregon, by the time I'm dying, which has a "right to die" law for the terminally ill. As long as several doctors agree that you have not long to live and are in pain, and as long as you, yourself can administer the drugs of your own volition, they can prescribe for you a fatal cocktail. Few people have taken advantage of it and even those that are pre-cleared often don't do it, as they find (I guess) dying isn't as intolerably painful as they imagined. But it's nice to have that out, I guess; I imagine it is very reassuring to them to know that if it's intolerable, they can stop it. I think this also passed by referendum in Washington state this year.
Stefani November 26th, 2008 11:22:10 AM
I actually have to agree with you on this one Dr. Khuly. I think that, for me personally, making the decision to euthanize early is better than waiting until too late. I have made this decision for my pets a number of times. It is heartbreaking each time, no matter what the circumstances. I feel like, for me (my opinion and choice only - not for everyone!) I would really rather euthanize my pet before they are completely decrepit. My Bear cat - he had a tumor in his mouth. I waited a bit too long with him, and it was such a horrible couple of weeks. He deteriorated quickly and it was painful to watch. I tried everything I knew (short of heroic surgery) but it was obvious that his time had come. He showed me, when the dr. arrived at our house for the euthanasia, that he understood. He never let anyone but me pet him, but he came up and let her pet him and he was calm and laid down with us. He seemingly knew that we were helping him. It was a peaceful euthanasia if there is such a thing. I knew I was doing the right thing by Bear. I didn't wait until he was completely failing or out of his mind with pain. It is such a difficult decision - no matter when it happens. Timing may never seem right. You have to make the decision for you and for your pet - no one else can tell you when it is right.
Tammy November 26th, 2008 11:44:51 AM
I agree with Dr. Khuly. My 18 year old cat, who I've had since 6 weeks of age, have chronic renal failure with decently high numbers. EVERY time I visit the vet, I am sure to reiterate to her -
It's not death I am afraid of, but suffering.
Death is part of life. Life is terminal. The biggest favor I can do for her is make sure every breath of life is as painless and enjoyable as possible. As long as I believe her daily joy outweighs her discomfort or pain, she will go on, but not a minute more. She HAS to die. Because she is lucky enough to be a pet and not a human, she doesn't HAVE to suffer, unless I let her. Time - more time or less time - is not something she understands now and certainly not after death. Seeking more time at the expense of her suffering is a selfish endeavor, in my opinion.
This leads me to another point. Our culture is very death-phobic. I got a real eye opener recently, proving how it's all about perception.
I post regularly to an online support group for owners of cats with CRF. It seems almost every day there is a post from someone who lost their cat, utterly destroyed emotionally. Understand that the type of people to seek out a CRF cat support group, and go through the amount of home treatment that most of us do, are also the type to be very, very emotionally invested in their pets.
Here is one of those posts, but unlike any other I've seen:
"first thing first, thanks to all those who have been so helpful on and off the
list providing insights and sharing your experiences. the Korat finished with
his body this afternoon sometime between 5:30 to 6:15 pm CST (vet tech wasn't
sure). we're Buddhists, and confident that he'll be returning to us in the
coming Spring.
please don't feel too sad for us. Wolfie really suffered the last few days with
the complications (us along with him) and he's now better. the ABP [erin: "all points bulletin"] is for a
grey and white boy kitten with a sweet disposition but a stubborn streak born
shortly after the above time/date. if you happen to meet one, please let me
know.
thanks bunches for everything!
Namaste..."
WOW. What a difference perspective makes.
(On a side note, I wrote the owner and they believe as much any Christian believes in Jesus that Wolfie had already "found" them in different forms two previous times - this was his third incarnation during their time with him.)
Erin November 26th, 2008 02:36:47 PM
And I meant to add, even if you're not Buddist, most agree that a body is just a body and not everything that is your pet - just the physical tool that is animated by something less tangible (some would call a soul).
Looking at it this way I think it's easier to see that euthanasia is just freedom from a torturous cage that one's body can become with illness and old age.
Erin November 26th, 2008 02:40:46 PM
LorriM: we share your sadness, many prayers for a kind passing for Springy, all are unique in life and very dear Barb: I hope your niece doesn't become resentful at this sad time for her, she should be trusted to know the moment for her GSD Erin: thank you for sharing, in my 20's I was convinced of reincarnation for animals, but now believe in all souls reunited someday.
Pocket's Story from NH November 26th, 2008 05:54:27 PM
Erin, it's funny you post from the CRF group. If its the one I'm thinking of, I was active on it about 8 1/2 years ago. I had a cat, LaPlume, that quickly went into advanced kidney failure, I don't know why. She'd had bloodwork 6 mos before and nothing was said about bad values, by the time I took her in, it was far advanced. I had only a brief time trying to save her, but in about 8 weeks, she crashed. She had HCM too, so she couldn't tolerate more than 35 ml of fluids which wasn't enough. I took her in hoping they would put her on IVs and bring her back, but after a conversation with the vet, I made a decision to PTS.
When I posted to the group about LaPlume's passing, a Buddhist member responded, telling me essentially I should not have euthanized my cat -- that suffering is a part of life, and it is through suffering that we work off our karmic debt for bad things we have done in this life or previous lives. She basically said that by cutting short my cats suffering (through euthanasia) I deprived her of a chance to work off karmic debt for bad things she had done in this life, or some previous life, and that thefore, instead of coming back as some "higher" life form like a human, she would be regressed to a lower life form, like a fly, in her next life.
Needless to say, I wanted to pop that Bhuddist right in the kisser.
Stefani November 26th, 2008 09:10:35 PM
PS -- Just to add, the majority of people on that CRF group were wonderful. That lady just came from left field, and I'm betting it was some wacky interpretation of Buddist philosophies . . .
Stefani November 26th, 2008 09:18:19 PM
The decision to euthanize is a tortuous one. My beloved golden, Toby, was diagnosed with lymphoma in the spring of 2003. He was literally a once-in-a-lifetime dog. We made the decision to PTS when he was no longer able to eat, even when hand-fed, he would take the food, and then regurgitate. The enlarged lymph nodes were blocking his esophagus, and also his trachea was compromised; he was having trouble breathing after minimal exercise. I still find myself second-guessing the timing, 5 years later.
Now I'm facing the same thing with Cooper, another Golden. He also has lymphoma. He is acting well, eating well, but losing weight fast. I'm doing everything I can to make his life enjoyable; plenty of good food, lots of attention, short walks with lots of sniffing time, etc. I refused chemo, since I didn't want him to have the side-effects for little return. I don't know when his time will be, though we are trying to keep him around until my son arrives home from college for Christmas break. I'm so glad that I can give him a 'beautiful death', which I firmly believe euthanasia is. I've attended too many deaths; I want his to be pain-free, with his family around him.
Sassy November 28th, 2008 12:55:08 PM
"It’s my personal opinion that it’s better to make the decision for euthanasia weeks too early than one minute too late." Dr. Kuhly: Do you speak animal lanquage? Did you ever ask your patients if euthanasia was what they wanted? I will NEVER have my pets euthanized--I would let nature take its course just as it would if our pets were living in the wild and not in captivity. http://alabamavetboardwatch.110MB.com
Fotini November 28th, 2008 05:03:02 PM
Sassy, my condolences. I hate lymphoma. I don't know how bad chemo side effects are with dogs, but they aren't that apparently bad with cats. Not the nausea we experience at least. But it's an uphill battle and it's a difficult decision, whether to go that route or not. Fotini, I pondered several times letting "nature take it's course," but for me, the problem was, that sounded like a good idea when they were LIVING wth the chronic, fatal disease that would take them. It didn't sound like as good of an idea once they were DYING. I actually went so far with Wolfie, the Yorkie, to call a home hospice group that believes in "natural death" and have a 1 hour conversation about what to expect if I chose that route. But when he started seizing and was panting (we decided the reason for the latter was pain because he was well oxygenated and had no chest infection) . . . nope, couldn't go through with it. I do however, believe this is a highly personal decision and no one has the right to judge anyone else. Almost all humans die without chemical assistance, and no one calls their families or the hospitals "cruel." To kill to your so as to spare him discomfort during dying is certainly a difficult thing to do.
Stefani November 28th, 2008 06:52:52 PM
Sassy, I, too send prayers for good time left with Cooper.
The one time I considered "natural death", I still changed my mind, the suffering is too great without medication to relieve it.
Don't forget, humans are given LOTS of medication at the terminal end stage: valium, morphine, tylenol, etc. in hospice, the hospital, or hospice at home.
That said, if a pet-owner believes in un-aided death, I think home-hospice including appropriate medications should be allowed
Pocket's Story from NH November 29th, 2008 03:46:09 PM
I worked extensively with a communicator when my beloved Belgian Shepherd was in her terminal illness (breast cancer). The dog wanted to pass on her own if she could. About 1.5 weeks before her death she asked for pain meds, and I gave them to her whenever she appeared uncomfortable (thank heavens for Tramadol, which appeared to ease her pain without sedating her and preventing her from doing the work she needed to do to prepare herself for death). It was tough to watch her sometimes, but I waited until she said she was ready for help passing to arrange for her euthanization. Her death-day was beautiful -- we did a lot of things she had enjoyed earlier in her life, and she was very happy all day. She took the needles gladly and slipped away surrounded both physically and spiritually by people and animals she loved. It was the right way for us.
kabbage December 1st, 2008 12:03:13 AM
Stefani: just goes to show, like you say, it's about interpretation! That's too bad though, even if someone did feel that way I don't think it was an appropriate time/place to say so. But like you, I've found it to be an especially kind and supportive group for the most part.
Erin December 1st, 2008 02:24:12 PM
Fotini wrote: "II will NEVER have my pets euthanized--I would let nature take its course just as it would if our pets were living in the wild and not in captivity." I wonder if you would continue to hold this intention if your pet had bone cancer and the bone broke while your pet was still alive. My first Greyhound had bone cancer in her hip socket. There was no way to splint it (which would not have happened in the wild, anyway) and amputatation couldn't remove all the cancer (again, this would not be an option in the wild). I waited "one minute too late" and the head of her femur crumbled. I will never forgive myself for the excruciating pain she endured on the way to the emergency veterinarian.
Sequoia's Mom December 22nd, 2008 04:48:13 AM
I too feel as if I waited "one minute too long". I just lost my 20 year old cat on 12/15. I was trying everything I could to make her better. Fluids, medicines, assist feeding, steroids, potassium supplements, etc. At times she would seem to rally. And I believed she wasn't in pain. On the day I decided to let her go, she died in my lap on the way to the vet. It was a horrible way to die. And I feel such guilt. I just didn't want her to die. Was she in pain? I'm not sure. Was she happy? In hindsight, she was just existing, not living. And it was my fault for not realizing sooner that it was time to let go. So like someone else said, evaluate if your pet is living a quality life and if the answer is no, then it is time. I will never forgive myself.
Jan December 24th, 2008 06:48:37 PM
Just too ease everyones mind - I euthanised Pocket in a very humane, kind and compassionate manner despite slanderous reports from the owner. Pocket was given propofol and beuthanasia through an IV catheter. It went smoothly and the O thanked me. This proceedure was done at the request of the owner and with consent contrary to what the Owner now says. I have a signed consent form. Everything she says about the proceedure that is contrary to this statement is untrue.
Cathy gajewski January 24th, 2009 12:50:36 PM
This is so difficult. My 20 year + cat is totally deaf, does not see clearly (cannot tell just what sight she still has), very arthritic (cannot groom herself) has failing kidneys. a heart murmour, only three teath so finds it difficult to eat. She has had medication over the last six months, steriods, antibiotics, two injections to aid kidney function in the hope that she would stop losing weight. She has no appetite and just wants to sleep most of the day and night. She is not drinking enough either. We are at the point when we must consider another injection to help her or an injection to end her suffering. She must be suffering although we give her lots of love and attention. She loves to be combed. We feed her hand to mouth to try and increase the amounts she eats. She has a variety of foods, Iams crunchy bits, fish, chicken, liver and kidneys with gravy. I mash it up so that she can manage it. She still only has such small portions. She has sachets of cat food too but really has taken a dislike to cans of cat food.
For 20 years she has given us a lot of affection and we do not want to see her suffer. Last Autumn she went though a period when she would not sleep in the house. We went looking for her and found her under a hedge really tucked away and protected by branches. Several times she did this. After we took her to the vet and she had a course of antibiotics she started sleeping in the house again. She put on a bit of weight and just before Christmas the vet gave her a steriod injection and she started eating a bit more.
All my family were home for Christmas and they all made a big fuss of her. She loved it and missed them when they all went back home. Since Christmas she has deteriated again and has had several visits to the vet who does what he can but has told us that all her problems are because she is old. She is very thin again and struggling and I should hate her to go off and die somewhere and we cannot find her. Also she cannot hear so she could get knocked down by a car. She does not like being shut in she has a cat flap and goes out into the garden.
We are very unhappy about the situation, but we have made a decision. An appointment has been made with the Vet for tomorrow at 3 0'clock, We are not going to prolong her life. We are going to take some last photographs and say our goodbyes and help her go with dignity. She has suffered enough. We will remember her as a happy cat who gave us so much pleasure. She loved our company and we loved hers.
She will be layed to rest with her sister (from the same litter) they were identical. who died a year last September.
I hope some of you out there understand our decision and believe we have made the right decision.
It is not easy. We are heartbroken.
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