“Is it time yet?” the client asks.
I know what she is asking. She wants to know if it is time for me to euthanize her beloved companion. As a house-call veterinarian, I deal with many terminal patients and hear this question time after time. Enough times, in fact, that I thought it would be helpful to blog to my readers some guidelines about this all-important decision.
First- NO ONE CAN TELL ANOTHER PERSON its time. I see family feuds in which one member wants to continue treatment while another thinks the pet is suffering or the costs are too much and they pressure the first person to put the pet to sleep. Nothing but bitterness and regret come of such situations. I strongly feel that the owner of the pet gets to make the decision, and everyone else in the family should be helpful, offer their gentle advice, but ultimately, support the owner. Remember, the owner is suffering, too, and often the decision is not only about the current situation with their pet, but often involves many facets affecting their life, and this decision can be the proverbial “straw that breaks the camel’s back.” Saying goodbye to a family pet is a tremendous loss to the entire family but pressuring someone to make the decision causes resentment, regret and can sometimes backfire.
I understand the other side of the equation as well. There are times that one feels that an owner is ‘going too far’ or is blind to the pain and deterioration of the pet. In those situations, I want your veterinarian to be the guide and adviser, thus keeping the family as a support system for the owner. If your veterinarian is not helping you- get a second opinion, or if you feel someone you know is not getting good advise- ask him or her to get a second opinion. There should be no animosity from your vet about a second opinion if you have a good, trusting relationship and you approach the request with something like this statement: “I am struggling with this illness and feel confused and frightened about what is happening. Can you recommend a colleague of yours that I could meet with and have him or her take a fresh look at my pet and the records so I can get his or her input as well? Then I’d like to schedule a consultation with you so we can review your colleague’s findings and make some final decisions.”
Perhaps the second veterinarian will see something new, or has a different approach, or perhaps they will see a level of suffering that you and your normal veterinarian can not see since you have witnessed the changes over a long period of time and can’t see an accurate picture anymore.
But I stress, if anyone, including a veterinarian, wants to force you to do something you are not comfortable with, seek additional support. If your veterinarian is connected spiritually with your pet and can identify with you, he or she should be able to help you make the decision, not make it for you.
Second- If you are debating whether it is or is not time, you are getting close. The very fact that you feel the need to question it, is self-explanatory. Start preparing yourself. Do not lie to yourself. You must listen to the realities of the medical situation and understand what the progression of illness causes to your pet. If you do not take the time to truly understand what your pet is enduring, you are not being fair to your dependent companion.
Third- Make a Quality of Life activity list. Initially decide what percentage of normalcy you think is considered Quality of Life. Do you think if you could do 50% of what you liked to do is enough, or do you think you should be able to do more? Do you think only 20% is sufficient? Find this number in your heart, then put it on a piece of paper and fold it up and place it in a drawer.
Then get a fresh sheet of paper and separate the page into two columns and label one, Things My Pet Has Always Loved To Do. Picture your companion as she was in her prime… did she play fetch? Jump on the couch even when you told him no? Try to steal bananas out of the fruit bowl? Love to eat so much that she would scarf down the food before you even left the room? Like to walk to the mailbox with you every day? Greet you at the door with tail wags and slobbery kisses? Get upset if he soils in the house? Cuddle on your lap and kneed your thigh while you watched CSI? Go through a typical ‘perfect’ day in the past and list everything that he would do. Really think about it and spend an hour or so thinking, smiling and reminiscing over the best times together.
Then start on the second column. Here you make check marks next to the things your pet is doing now. Does he eat? Does he greet you anymore? Can he control his bowels? Is he growling at people now instead of licking them? Is he listless when before he used to bark at every car that drove by the house?
Now calculate your percentage. Are you above it or below it? If you are below it, you need to take an honest look at your companion’s quality of life.
Fourth- Evaluate pain. Many people do not know how to evaluate the level of pain their pet is in. Try to chart the level of pain you perceive in your pet on a scale of 1-10 every day. Pain can be assessed by the tension lines around a dog’s mouth/eyes/cheeks. By rapid breathing. By lack of eating. By abrupt changes in behavior. By vocalization or lack thereof if your pet used to vocalize often. By random wandering. By limping or reduction in walking. By shifting positions often. By never moving at all. By licking/rubbing or chewing a spot on themselves. By drooling. By walking with a short stride, hunched back. By weight loss. By so many other things that are unique to your pet that only you can know… We are blessed with taking care of these pets and along with that comes the responsibility of knowing when they are in pain.
Lastly Fifth, evaluate spiritual health. Is your pet happy? Has your pet’s spirit already left even though the body remains? Or is your pet in the most difficult of positions when the mind and spirit appear fine but the body has given out? And if so, does being in that state make your pet anxious, upset, confused, miserable or terrified?
So, now I hear the question repeated, “Doc, is it time?” and my mind races down all these things as I try to formulate an answer. Note, I have not discussed diagnosis, prognosis, or cost. I contend that these should not be deciding factors for this all-important decision. Certainly they are valid, and must be discussed, and they will influence you, but I will always ask you to make the final decision as if these three factors did not exist.
I cannot tell you yes or no. Ultimately, it is not up to me to decide. I have been humbled through the years when I thought an animal should definitely be put down yet it miraculously survives and flourishes so I will never tell I person they MUST euthanize. Neither will I tell them no, for I can not understand the intricacies of the bond between an owner and pet and I have unsuccessfully tried to save an animal against an owner’s better judgment because I thought it should not be put down, only to see it succumb shortly thereafter in agony.
However, I will help guide you through evaluating Quality of Life. I will be medically clear on the realities of what is happening and will not allow you, the owner, to lie to yourself. I will help you create an activity list. I will show
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you how to recognize pain and discomfort. And most importantly, I will hold your hand as you try to see inside your pet’s soul and see if he or she is spiritually happy, content or ready to ascend to another plane.
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