The “Dear ER” Letter

Make A “Dear Emergency Staff” Letter

If you have a pet near the end of life, you should know in advance you can get help at any time.  This may mean calling your veterinarian at the normal clinic to get their emergency numbers in advance.  It may mean you have entered a home hospice program where you would have a 24 hour number to call.  It could mean you have already made contact with and arrangements for an in-home euthanasia doctor.  However, as life happens these events do not always follow our plans or convenient hours.  So plan now for an off-hours emergency.

You may need to ask yourself some hard question, for example: What will you do if your giant breed dog who has debilitating arthritis is in the basement and suddenly begins to have a severe medical problem such as bad pain or a seizure?  Make plans now on how you would move your dog, who you will call to get help, what tools or aids to you need to move a very large dog and where you will go if you must take your dog somewhere in the car. This may likely mean a late night trip to the veterinary emergency clinic.

Frequently, pets who are not ready for euthanasia may have medical symptoms that need treated, but you want symptom treatment only, not heroic therapies or diagnostic procedures.  In other words, you may have the need for emergency care that is palliative or symptom control in nature.  Most veterinary emergency clinics are very treatment focused, but you want only symptom control, such as pain relief, stopping seizures, or help with breathing etc.  Palliative care means we treat the signs of disease to ease the pet’s suffering, but we do not treat the disease itself.  This may be difficult to explain to an emergency veterinarian or staff.  Consequently you should make a “Dear ER” letter that explains this desire in advance.

You might think of this as sort of an “advanced directive” for your dog or cat.  A letter that simply states your wishes should you have to be seen by a veterinarian that does not know your pet’s medical history. This way the doctors will provide exactly what your pet needs without starting deep and expensive treatment care.

This is important so I have made an example letter for you here.  Please feel free to copy this sample letter and put your pet’s name and your name on the letter.  Have it handy to present in an emergency, or better yet, take a photo of it on your cell phone to show the attending doctor.  I have a few critical medical items for my own health on my cell phone in case I’m in the emergency room and cannot explain some special issue.

Dear Emergency Staff:

My dog (cat) is under the care of my veterinarian for (the illness).  I am here now because my pet is suffering from a symptom of this disease but I am not ready for euthanasia at this point unless it is absolutely necessary.  I also understand that my pet is critical and this symptom may be a sign of impending death. 

However, I request that you treat the side effects of my pet’s disease.  I wish to opt out of diagnostic procedures or extensive medical treatments.  Please control the major symptoms my pet has now. 

I hope this simplifies your role and that you can focus on management of symptoms.  I respect your professional judgement in providing this type of palliative care.  Also, if at all possible, please contact my veterinarian, Dr. (your veterinarian) at this number; (###-###-####). 

I hope this helps should this stressful situation arise.

Dr. Jim Humphries has been a veterinarian for 40 years and provides hospice and end of life care for pets in the Colorado Springs area.  He has served in the US Army Veterinary Corps, and as the veterinarian at CBS News and CNN. He is a consultant for several veterinary pharmaceutical companies.  In addition to practice, he also serves as a Visiting Professor at the College of Veterinary Medicine at Texas A&M University.