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Keeping Hospice in Veterinary Hands

By Alice Villalobos, DVM, DPNAP

Posted: April 30, 2012, 4:30 p.m. EDT

Our focus with this article is on people who compulsively collect old or sick animals and proclaim themselves operators of pet hospice homes or sanctuaries. Unfortunately, most of these self-proclaimed hospice workers use little to no veterinary medical supervision. Their collected animals suffer to death without proper pain management, comfort care or the human-animal bond.

They might have started out as good Samaritans, working alone or with a group, rescuing animals and keeping a few, then a few more. Over time, they develop a strong urge to “save” more old and sick animals that were “abandoned.” That urge develops into a compulsive disorder.

They collect more and more old, sick and special-needs animals. When their animals die, they exhibit tearful distress, blind denial or experience a pathological enlightenment. Their compulsiveness to collect more animals winds up harming their animals, themselves, their neighbors and their communities.

A certain percentage of compulsive collectors of sick and old animals can maintain their operations for a time. But eventually many find themselves overworked, in debt, depressed and overwhelmed. The tipping point is when they acquire more animals than they can properly care for and house.

Another tipping point into the mental illness of animal hoarding is when the individual does not see the pain, neglect and harm that her choices have inflicted on the collected animals. Some such premises are so full of trash that the bodies of deceased animals are found among the debris.

Compulsive animal collectors offend their neighbors with noise from barking dogs, odors and excess trash. They might become indignant or righteous when questioned by family, neighbors, friends, their veterinarians or when checked by the police or animal control officials. They justify their compulsive behavior mostly by claiming that they are the responsible ones who saved animals from irresponsible abandonment.

If anything goes wrong with their income, their personal health or the health of a family member, they become unable to keep up basic daily chores of cleaning and feeding. When a lower standard of care and cleanliness becomes the norm, compulsive animal collectors may be accused of animal neglect and cruelty.

Then they find out that they have actually gone over the line and have become hoarders without realizing it. Case in point: the Angel’s Gate self-proclaimed animal hospice and thousands of other similar hoarding situations.

Why Veterinarians Need to Advocate
Veterinarians and pet owners help society’s companion animals escape the slow death that captivity creates.

When clients tell us, “I want my pet to pass naturally at home,” they usually mean that they want their pets to die peacefully in their sleep. We must gently agree with this final wish.

But we also must inform our clients that that is usually not how death comes for pets not given the gift of euthanasia. We need to explain that Mother Nature does not let animals suffer to death slowly; death comes fast for animals in the wild. In a natural environment, if an old animal becomes arthritic or sick, life ends quickly by predation or the elements.
 

pet death
Veterinarians are the best advocates for quality of life. We assist families in decision making for the gift of euthanasia based on medical expertise to avoid prolonged unnecessary suffering by the beloved patient.

Anti-Euthanasia
Certain “hospice” counseling groups encourage pet owners to consider (and strive for) a “natural death,” also known as “true hospice.” They recommend witnessing the death as a growth experience for the pet owner “to have the last dance with their pet.” They advise owners to reserve euthanasia only as an option of last resort.

This formula must provide that the patient has good veterinary hospice supervision. This requires proper around-the-clock pain, sedation and anti-anxiety medications that will assure that the pet has an endurable death in the company of its loving family. These families are never truly prepared for a “natural death.” If the pet dies peacefully and painfully in its sleep, that’s OK, but just as in humans, this seldom happens.

Veterinary school educators should discuss the anti-euthanasia concept in ethics and bioethics discussions. Are we breeding a generation of veterinarians who will refuse to euthanize their dying patients? Society expects veterinarians to provide euthanasia as the most compassionate way for pets to change worlds. Instead, veterinarians who eschew euthanasia will encourage clients to “hang on” for a few more days while their clients spend more money and suffer more emotional trauma.

Anti-euthanasia veterinarians prefer to send their dying animal patients home for the client to deal with. Unfortunately, this is often done without referrals for home hospice care. In response, some clients might release their unwanted dying animal on the side of the road. Some people take their sick old pets to shelters for euthanasia.

But most shelters require a three-day waiting period, during which the pet experiences intense anxiety, before finally being euthanized or being “saved” by a compulsive animal collector or death hoarder.

McMillan and Rollin state that prolonged anxiety is worse than pain for most animals. Ask any veterinarian what the most common symptom of end-stage arthritis is: panting, pacing, whining and crying, particularly at night. Hormonal fluctuations at night (cortisol down, histamine up) contribute to this phenomenon. This is why cancer pain for humans and animals is worse at night.

It is also widely believed that arthritic animals have inherent anxiety. The animal’s body senses that if it lies down, it won’t get back up. It’s a survival mechanism, because the dog won’t be able to get up fast enough to escape predators.

Animals removed from the only family they have known and placed in a multiple-animal environment may be subject to a major source of anxiety—another major flaw in the compulsive animal collector’s well-intentioned plan.

Serving the Bond
“True hospice” is a term used to distinguish end-of-life care that avoids euthanasia as a last resort. It serves best for individual pet owners who for religious, cultural or personal reasons will not end their pet’s life.

It also serves for people who are emotionally reluctant to decide on euthanasia for a dying companion animal. These pets should be provided with injectable pain management and close veterinary supervision throughout the stages of dying. Even proper injectable pain medication does not always halt the inevitable discomfort that comes with the systematic shut-down of body systems toward agonal death. 

The “true hospice” formula can serve the human-animal bond when properly orchestrated by the family with caring professionals. But this formula will not serve the majority of our profession or our society in general and it is horrible for animals in the hands of compulsive animal collectors. 

True Hospice and Death Hoarders
Many of the self-proclaimed pet hospice caretakers do not believe that euthanasia should be provided when their collected animals’ quality of life declines to a low point. Most collectors are operating on a budget and do not provide adequate veterinary supervision in the first place.

This sad situation causes a slow, drawn-out decline toward death for thousands of compulsively collected dying animals held captive to this cruel philosophy. When the animals go into the final active stage of dying, the onlookers might hold or caress that animal or express passive interest or hold a vigil.

As their animals die, hoarders may express compulsive grief, claim spiritual enlightenment or blindly dismiss the agony and death they are witnessing.

In 2008, I coined the term “death hoarders.” It was during the Nikki Hospice Symposium that I came to foresee the suffering and potential disaster for animals kept at self-proclaimed hobby pet hospice facilities, such as Angel’s Gate and many others. It shocked me to learn what was going on. Every veterinary team knows how time intensive and emotionally difficult it is to care for a dying patient. Aside from nursing and hygiene care, there is the important role of managing pain, symptoms and anxiety in the dying patient. (Read more about the symposium in Dr. Villalobos' bonus story, A Brief History of the Veterinary Hospice Movement.)

Pawspice
For many of the above reasons, I asked AVMA to officially call our veterinary end-of-life care program for companion animals Pawspice. The pet owner and the attending veterinarian are the decision makers. We can control the quality of life and death and especially how and when a beloved companion animal will die.

Most veterinarians do provide the gift of euthanasia when the quality of life declines toward death. The decision is difficult but it brings relief for all involved. The choice should be made on the basis of medical knowledge about the particular disease or condition, be it organ failure, end-stage cancer or simply senescence.

The Angel’s Gate story should not tarnish what the majority of the veterinary profession is doing for end-of-life care as a whole. Let’s keep veterinary hospice within our profession. We have been trained to identify pain and to prevent suffering in animals.

We are trained to communicate with the family and advocate on behalf of their companion animals. This is our duty; our oath is to not let animals suffer unnecessarily.

For information on how to incorporate veterinary hospice into your general practice, please visit www.pawspice.com and www.lapoflove.com.

Dr. Villalobos is a past president of the American Association of Human-Animal Bond Veterinarians and is president of the Society for Veterinary Medical Ethics. Her column appears every other month.

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Reader Comments
This is great IF the vets are good. I know some vets that are not. THere should be a checks and balances for both sides......


vicki qnderholt
bunnygroomer.com
vicki, calabasas, CA
Posted: 9/28/2012 2:17:58 PM
Dr. Alice Villalobos is a pioneer in the field of veterinary palliative care, and I respect her opinions and experience. She has brought these important topics, as well as those of the human-animal bond, to the attention of the veterinary community for many years. In this article, she once again brings attention to important issues.

There seem to be two topics in this article, one of animal hoarding and hospice care facilities that are unable to provide the intensive care that these animals require to support a death free of pain and suffering. I agree that the thought of the suffering that could occur without access to veterinary care is frightening. I must respectfully disagree, however, with the second point that I see in the article, which is that most deaths not induced by euthanasia are replete with pain and suffering. The idea that animals in the wild would be killed by predators or would die more quickly without veterinary care does not fit well with our current relationships with domesticated housepets. We do support them and treat their arthritis and cancer. Even in the wild, most animals do not choose predation to end their life, they hide themselves deep under a bush, seeking that quiet, peaceful death we wish for our pets and ourselves.

As a housecall veterinarian, one of my most called for and appreciated services is in-home euthanasia, which I strive to provide with as little discomfort as possible in a quiet, peaceful home environment. I am seeing a trend that as people become more aware of the options of palliative care for their animals and experience death of their loved ones through human hospice care, they would like to provide this same care for their pets. These are not people who are trying to prolong the life of their pet or are unable to let them go, they simply wish to support them in death as they have in life.

I agree fully with Dr. Villalobos that this care should be overseen by veterinarians and trained medical staff that can help people to recognize the signs of pain and discomfort in their animals. In order to offer this care, we must face our own fears and resistance to death. If we cannot offer this end of life care or “true hospice,” people and animals will suffer more in their attempts to do it without veterinary guidance. This may be a specialty service that not all veterinarians are able to provide. Hospice veterinarians can provide pain medication, oxygen support or euthanasia if the suffering becomes too much. If the animal is not suffering, but simply dying, there may be no need for euthanasia. These decisions must be made on a case-by-case basis, and as more information becomes available on hospice care, our profession will be more capable of supporting these animals as is done with human hospice care. Open communication and an understanding of the needs of all involved can make a huge difference in reducing pain and suffering.

Kris August, DVM
Kris, Ames, IA
Posted: 7/28/2012 7:42:52 AM
This article raises a good point of which others should be aware. There is a difference between the "never kill" movement and the "no-kill" movement. What is described here are examples of the NEVER KILL movement. The no-kill movement and it's supporters would never keep an animal in pain and suffering once a quality of life no longer exists. Peaceful Passings, located in Fluvanna County VA is a home-based rescue that exclusively serves senior, hospice, and special needs animals. We spent over $13,000 last year in vet expenses. We do euthanize when there is no longer a quality of life, so please be careful not to lump rescues like ours together with those of which you are writing. Oh, by the way, it was my vet that first made me aware of Veterinary Practice News. Our rescue is monitored by our state veterinarian and we comply with state vet standards of care, so please, we are not hoarders and are a little insulted that you would make the assumption that all of us who serve senior animals are horaders. That is just not true and short sighted.
Jackie, Bremo Bluff, VA
Posted: 5/14/2012 5:58:56 AM
Alice,

You know I have a great respect for you, but I disagree with your position.

Hospice is a philosophy that recognizes four forms of suffering at the end of life: physical (pain), emotional (fear), social (conflict), and spiritual (despair). Hospice affirms the inherent dignity and worth of every living being and promotes living fully in each moment leading to death. Hospice is attentive to pain and aggressive in pain management.

As any person who has experienced hospice care with humans – whether personally or professionally – can tell you: hospice works. People die peacefully and without pain. Families come together. Communities find peace. It is almost always a transformative experience for all those involved.

We have a long way to go before we in animal hospice can claim to have matched the pain control that human hospice has achieved. Many veterinarians are not comfortable with prescribing the narcotic medications that are the mainstay of human hospice pain relief and recommended by veterinary pain specialists. Where human hospice has gone completely needless, animal hospice still relies on CRI and IV medications, which are often deemed inappropriate for home administration.

In our hospice, we universally see animals die without pain (some with euthanasia and some without), in the loving embrace of their families, creating a sacred and important time in the human and animal bond. We let the animal tell us when he or she is done and we honor their choice.

And the animals amaze us at every turn – with their determination to continue living, their joy, and their spirit. We almost always see them living longer and doing better than anyone predicted (which is also true in human hospice) and their families are grateful to be able to give them the gift of a peaceful end of life, surrounded by those who love him or her, and the choice of when to leave us.

Those of us in the animal hospice care profession should not be confused with animal hoarders or uninformed well-wishers. We are highly trained, compassionate, experienced professionals who are either veterinarians or work very closely with a veterinary team to provide the highest quality of care to our patients. We need many more animal hospice programs to serve every community of animal caretakers. We need the veterinary community to support and promote this life affirming model.

Euthanasia before the animal or human is ready, before adequate pain control has been provided, before simple techniques for dealing with aging and disease have been offered – is not the answer.

Hospice care, based on the human hospice model of skilled professionals supporting family caregivers in their own homes, is the kindest, most compassionate gift anyone can give their animal and their family.

Heather Merrill, CT
Founder and Director
Certified in Thanatology: Death, Dying and Bereavement
New England Pet Hospice, Inc.
www.NewEnglandPetHospice.com
Heather, Sudbury, MA
Posted: 5/10/2012 1:37:59 PM
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