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What is meant by the term “hospice care”?
A common understanding of what is considered hospice care for animals is still developing, as it is a fairly new field in veterinary medicine. Meanwhile, the term is being used in a wide array of meanings, so it is important in communications to clarify how it is understood by each individual.
The sense in which we at SPIRITS in Transition apply the term hospice is rooted in what is already well known from modern human hospice. We work towards offering a similarly high level of care for our animal family members and their caregivers as is available to us humans during hospice. Our efforts go towards helping to bridge the tremendous gap between what is currently available to humans versus companion animals when it comes to the end of physical life.
This includes that our work is also based on the foundational human hospice principle that the process of dying is embraced as a part of life that does not need to be feared or avoided, nor postponed or hastened. We completely respect that there are other forms of end-of-life care and encourage all animal lovers to follow their own heart in any decision making process. We also understand that those who do feel drawn to giving their animal hospice care, may nonetheless encounter limitations that make a euthanasia decision the best available choice. This can for example be due to the fact that the field of animal end-of-life care in general has not yet caught up to the standard of human hospice. Other restrictions of various nature (including limited time, financial and other resources, but also situational factors as may occur in emergencies etc.) may make it impossible to create the circumstances for a companion animal to die peacefully in its own good time.
While the focus of our efforts is oriented on modern human hospice, we support other forms of palliative and end-of-life comfort care for animals as well. This is also expressed in that our helpline volunteers neither advise for nor against euthanasia. Given that we don’t know ahead of time what challenges may unfold in the process of caregiving, we highly recommend that anyone aiming to support their animal in dying peacefully on its own under hospice care has to be ready to elect, and able to provide for in-home euthanasia through a veterinarian when necessary.
One explanation of the term animal hospice that is in strong resonance with our work was written by Guy Hancock, DVM, MEd, the director of the Veterinary Technology Program of the St. Petersburg Junior College. It is based on the philosophy of care to be found in human hospice care. To read Dr. Hancock’s explanation as posted on the website of The American Association of Human-Animal Bond Veterinarians, click on the different subjects on this page here.
I am not sure if my animal is suffering- how can I tell?
Suffering is a really wide term, and also is a very individual experience. We all know from humans that our pain tolerance differs widely, and also we want to keep in mind that many of us can be in various levels of pain without wanting to die.
Especially if pain comes on slowly, animals often do not vocalize to indicate they are in pain. They may just become quieter, or lose their appetite. These may be signs of discomfort in an animal during it’s life, however, when it comes to the dying process, as the life energy gets low, an animal may not be able to move around as much. As the body’s strength declines naturally, usually so does the animals’ desire to move, and it is likely to simply accept the situation the way it is.
Loss of appetite also can be normal in a dying animal, and does not necessarily mean suffering. Distinctly different from starving, we know from human hospice that hunger simply can cease to exist. When hunger is no longer experienced, to not eat is just a natural consequence, and suffering is more likely to happen if one is forced to eat in spite of the body no longer being able to handle food.
As the increasing need for rest and the decreasing need for food may no longer serve as good guides to determine whether an animal is in discomfort, oftentimes the way it breathes can be a clue. Increased frequency of breaths, and/or labored breathing can indicate the need to implement or increase pain control, whether with drugs and/ or in alternative ways. In the very last stages of dying, a more and more enhanced exhale is typical of the body getting ready to complete it’s function.
Trembling of an animal can be caused by pain, but can also be due to the animal’s increased need for warmth, as the body’s ability to regulate it’s temperature may weaken. Placing pre-warmed towels or blankets on the animal can help distinguish what is going on.
When implementing drugs or herbs, we need to take into consideration that their possible side effects can become more prominent when taken on an empty stomach by an animal which no longer eats, and in general as the life force starts running low. That is when other ways of soothing discomfort can become invaluable. Homeopathy, gentle body or energy work, warm towels and warm water bottles can do wonders when used in an effective manner.
As many of us are unfamiliar with the natural dying process, we tend to judge the situation from our very own perspective, concerned that we may let the animal suffer. Animals often have a very different point of view about suffering, and even if they clearly experience discomfort they are often not interested in having their life be ended any sooner than it will on its own. To have the caretaker remain peaceful enough internally to perceive the animal’s wishes is one of the most challenging aspects inside of providing hospice.
My animal no longer wants to eat. What should I do?
There are many reasons why an animal may stop eating. If it happens while providing hospice, we want to be aware that antibiotics and other drugs can actually be causing the loss of appetite, as when an animals life force dwindles, it becomes more sensitive to side effects.
If the animal is only days or hours away from it’s natural end of physical life, it is just as in human hospice, normal for an individual to no longer experience the sensation of hunger. This makes perfect sense from the perspective that on one hand digestion is an energy consuming process. When the life force is low, the body spends it’s remaining energy on maintaining the function of the heart, liver and kidneys, rather than on digesting food. This is particularly true as a dying body has no use for the nutritional value contained in the food anymore.
If an animal declines food, one may offer more tempting items that also may be easier to swallow and are offered at room temperature or slightly warmer, and at times an animal may still take food when being hand fed. If it however keeps turning it’s head away, it is best, for dogs and cats, to remove the food, as the smell of it can be nauseating for their sensitive noses. You can always offer it briefly again later, to make sure the animal has not changed it’s mind.
Horses, dogs and cats can still live for several days without eating. The body can actually draw from its stored energy reserves, which often becomes visible in the animal losing weight.
My animal does not want to drink anymore. What should I do?
Inside the natural dying process it is common for both humans as well as animals to lose their interest in drinking, often preceded by a period of not wanting to eat. Just as the body at a certain point can no longer handle, nor has any use for digesting food, there also can come the time when drinking is no longer feasible. Many people react to that by trying to hydrate the body of the dying either by giving fluids into the mouth, or under the skin. This is a great thing to do when there is still hope for recovery, or to slow down the progression of an illness such as chronic kidney failure.
Inside of providing hospice care however, it can mean extending the dying process, which may not be desirable anymore once the individual is close to passing.
From human hospice it is known that being dehydrated can actually lower the pain threshold of the individual. This can go as far as being able to lower or discontinue pain medication, which in turn may allow the dying to experience less of the possible side effects of those drugs, including nausea, dizziness and indigestion.
If it can no longer reach water on it’s own, you still want to make sure to offer water to an animal, as it may change it’s mind. Some animals may still drink lukewarm water when it would refuse cold water. Particularly outdoors in cold climates we need to make sure the water offered to an animal in a hospice situation is warmed. Some animals may still want to drink, but need support to hold up their head to be able to do it.
Once an animal has stopped drinking entirely, it may be only hours to a day or so away from passing over.