The Covenant of Compassion - Home with Dignity

The Covenant of Compassion


Making The Decision To Put Your Pet To Sleep

On the surface, the decision to put your ailing pet to sleep seems like it would be simple. I’ve heard it discussed by pet lovers and even veterinary professionals using a common sense statement like: “your pet will let you know”, or “you will know when the time comes”. After almost 40 years in veterinary practice I can tell you they don’t often let you know and the real answer is more complex – medically and psychologically. This is not a decision you cannot take back, so to arrive at a serious answer for such an important question, you need to consider several factors, some of them not so obvious.

I’d like to say something like: “I hope you never have to make this decision”. However, if you love dogs or feline friends are your fancy, you will be faced with this decision many times in your life. In one of the best books I’ve read on dog obedience by the Monks of New Skete, they make this statement and it could not be more true:

“The biggest problem with dogs is that they don’t live long enough. They always seem to leave us behind when we are the most vulnerable, most in need of their biased, affirming, presence. Dogs make us believe we can actually be as they see us, and it is often only when they are gone that we realize their role in what we’ve become.”

So if this is true, you might as well learn (and teach your children) how to intelligently make this very difficult decision and how to deal with and experience loss.

There are four categories of factors that must be considered:
1. Medical factors
2. Family, social, physical, psychological factors
3. Financial factors
4. The “Covenant of Compassion”

Medical Factors:

Medical facts are probably the most important and usually the first factors that get us to arrive at this decision. Here you need to rely on your veterinarian’s assessment as they are best suited to take into account all of your pets medical history and its current health status. This opinion should be based on the results of tests and x-rays, or perhaps from surgical findings. But it is important to have a doctor’s opinion of how your pet will do in future days and months. This is best done by a highly experienced veterinarian as they have seen decade’s worth of cases and that experience is especially valuable when dealing with an end-of-life case.

In every case of an in-home euthanasia I see, I always perform a confirming exam. I’m often surprised when a pet owner does not know the condition that has taken their pet away from them, or understand the many options they have for treatment – some that are not expensive at all. I find some veterinarians will send you off to a specialist immediately. That is often a 3 to 5 thousand dollar commitment. Then it is sad when, at this point, the pet owner makes the decision to put the pet to sleep. In this example, no one in the chain of care has even mentioned the middle ground approach. It is possible that some basic treatments or procedures, costing hundreds, not thousands, may save your pet’s life!

Sadly, I’ve had many cases where the owners were reluctantly deciding to put their pet to sleep based on the fact that their veterinarian told them “nothing can be done”. When in reality, they had simply reached the level of that particular veterinarian’s expertise, or understanding of pain control, or desire to dig into the medical literature and care about taking diagnostics or treatment to the next level. Today, much can be done to find the actual cause of disease and begin a variety of treatments. This gives you valuable options. Consequently, I am a huge proponent of the (experienced) second opinion.

There is another side of this Doctor / Client relationship that also may not be best for you and your pet. Some veterinarians may become overly treatment oriented and perhaps begin to treat beyond a point that they really should. This is especially true with some specialists, emergency clinic veterinarians, and those that work in teaching hospitals. Therefore, your second opinion should be from a practicing veterinarian who has decades of experience and an eye for the overall health of the pet and your family.

When you seek this opinion, make sure they know you are asking them to give you an honest assessment of your pet’s status as it relates to an end-of-life decision. They should take into account the medical data, and, very importantly, listen to what you have to say as well. This can give you hope in further treatment or assurance that euthanasia is the right thing.

When your veterinarian has done a good job and there is a clear diagnosis of a life-ending disease or condition, and you know for a fact your pet has reached the end of what their body can endure, then you don’t need another opinion.

Here is a quick look at medical factors that should lead you to a decision for a kind and compassionate end of life.

Breathing:

Just as in human hospice, this is the number one consideration when assessing an animal’s condition. They must be able to breathe without much struggle. Many dogs will not lay flat on side, they may be unable to sleep well for long periods, they may pant, or show a blue tongue, and they may simply be exhausted from coughing or seizures and they can become restless or anxious because they just can’t get comfortable. If they are show open mouth breathing, if they can’t sleep fully on their side for long periods and want to be upright all the time and certainly if they are gasping for air at any time – they are having trouble breathing which is pivotal in making an end of life decision

Pain:

Pain can come from many conditions, but the most common is moderate to severe pain from chronic arthritis. These dogs will show signs such as, difficulty laying down or getting up, falling, stumbling, hesitating, toe dragging, knuckling over or stiffness and the loss of muscle mass that goes along with not using the legs normally. Often these dogs won’t even get up to eliminate. These are all signs that the pain of arthritis is becoming severe and perhaps too bad to support any acceptable quality of life.

Pain is also generated from a variety of other severe medical issues such as cancer, injuries, and congenital malformations. Remember animals are designed to mask their pain and they often do not cry out, even though they are in pretty bad pain. This stoic characteristic causes many pets to endure more pain than they should. We have to advocate for them and know they are in pain, even if we don’t perceive what we would think of as overt pain.

Appetite:

A fairly consistent sign when animals near the end of life is the loss of appetite and or thirst. You may have also noticed a significant weight loss over time even if they are still eating. But this is something I see very consistently near the end of life.

House Breaking Schedule:

As pets age it may become more and more difficult for them to physically get outside to eliminate, so they eliminate in their bed or on the floor. It may be they are “forgetting” to go outside, when in reality they suffer from “doggie Alzheimer’s disease”. In some cases our pets are unable to get up because of pain or muscle weakness, it may also be too painful to simply posture to defecate and some dogs fall over trying. In other cases they may not be able to control their eliminations and they may leak uncontrollably.

Laying in urine/feces may lead to serious skin infections and pain and I’m convinced it bothers these animals to no end. Remember they have dignity and we do not want to rob them of that. This is part of our Covenant of Compassion. Our “deal” with them is to not let them suffer or be miserable or lose dignity. Loss of house breaking routine is a definite sign that something serious is happening with your pets medical or mental health.

Family, social, psychological and physical factors:

Besides the obvious medical issues, there is the harsh reality of what it takes to care for a disabled or immobile pet. In some cases it is overwhelming – especially if you are dealing with other stress and medical problems in your own life or family. You have to consider everyone in your home environment including home obstacles such as stairs or backyard decks.

Additionally, your social situation is important. Families or individuals dealing with a recent divorce, a new baby or an elderly mother in the house must consider their overall ability to devote the time and abilities needed for care. This means everything from giving medications, to getting a very heavy dog up from the basement, then in and out of the house several times a day. Also, does your current family situation cause you to feel pressured to make a decision or does it allow for you to include everyone with the idea of a well thought out process to arrive at an end-of-life decision? Just as important as pure medical factors, these social factors are extremely important.

Your pet’s psychological status is also important. If your pet no longer expresses joy and interest, or fails to respond to family, toys, or other pets, they may be psychologically depressed or physically weak. It is very clear to me that pets may become depressed and frustrated that they can no longer do the things they enjoy most or even just the little daily things that they used to be able to do. Consequently when their mobility is severely affected, when they cannot interact with the family as they used to, they are often suffering. Don’t forget, there are medical consequences to immobility that typically complicate any primary medical problem.

Financial Factors:

Medical care and nursing care, physical therapy and long term medication is expensive and if you do not have your pets insured it is sometimes simply impossible for you to cover bills into the thousands of dollars. While few want to make a decision to put a pet to sleep purely because of money, it is an important factor in providing the pet what they really need to face a disease or disability. It is one of the major factors that, along with others, affect your decision. (Please see the article on Pet Insurance. This simple health policy can be the difference between successful treatment and euthanasia).

Assess Quality of Life On A Timeline:

I have constructed both Quality of Life Evaluation Form (QoL) and End of Life Decision Making Form (EoL) http://homewithdignity.com/pet-loss/. These are calculations that can give you a number with which you can compare “normal” or standards. Please download one of these forms from my website and use it as a tool to help you, either one time, or over a period of time. It helps many people to have a “number” for a guide.

Beyond a form or a number, many times the condition is such that you “just know” when you take a real look at your pet’s daily life. You will know better than anyone if the bad days are outnumbering the good ones, if this wonderful pet is failing rapidly, or if pain has increased to the point of suffering. This is when your intuition says your pet no longer enjoys life – even life with your love and wonderful care and even in your comfortable home. Combine this “pet owner’s intuition” with all the medical facts you have gathered along the way to make the right decision.

If you know you will be facing a long term illness or decline, but you want to do everything you can, then I suggest you keep a journal or log and watch your pets’ over all condition, behavior, appetite, and signs of pain. This can be extremely valuable for you and your veterinarian in evaluating quality of life over time.

The Covenant of Compassion:

I’ve coined this phrase to indicate the “deal” with have with our pets. It is an agreement, a contract if you will that is our promise to our beloved pets that we will not let them suffer, we will not do things to them “just because we can”, and we will only do things that help their struggle and nothing that prolongs it. It takes real compassion to make this covenant because it means that when the relationship is no longer fitting the agreement, then YOU must decide to end it. That makes it hard, but the purest of love.

Remember, one of the most wonderful things about animals is how they live in the present. When our pets are suffering, they don’t reflect on all the great days they have had before, or ponder what the future will bring. All they know is how they feel today. By considering this perspective, we can see the world more clearly through their eyes, and their eyes are what matter. We can see that the Covenant of Compassion we have made with them comes into play at the end of their life in a very real and painful sense. It is one thing to be mentally prepared to uphold your end of this contract, it is another to face the reality that “today is the day” and we have to make the call.

No one ever wants to say goodbye. Making this decision is very, very hard. We often get stuck in indecision and then we can’t decide or take action because of the fear of our loss and anticipated grief of their passing. We keep hoping that they will take the choice out of our hands and pass on their own in their sleep. But all too often what happens is our pet ends up suffering while we linger in indecision. This is the last thing we want for our beloved pets.

Our pets need us to be strong and push through the fear of loss and take action – compassionate action – that will relieve them of the suffering you know (and an experienced veterinarian knows) is coming their way. That is the Covenant of Compassion. It is easy to enter into this covenant, but it is not so easy to uphold your end.

Finally, a quick word about regret. Regret is an emotion that is hard to live with. We neither want to regret our choice of making this decision too early, or making it too late. This is why you should consider all these factors, talk only with people who understand, and incorporate the opinion of your veterinarian, and don’t be shy about getting a confirming opinion from another general practice veterinarian, or one who focuses on hospice and end of life care.

Sometimes, to end a pet’s suffering, we must begin our own. It is the unfortunate but necessary part of pet ownership and responsibility. It is the most unselfish act of love that we can ever offer or experience.

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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. www.HomeWithDignity.com.  

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