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Euthanasia, Part 1: Why?

Euthanasia, Part 1: Why?

Homeless puppaEuthanasia has been on my mind a lot lately. This year we have said goodbye to so many of our most beloved patients, it seems like the end of an era. I am at the point where I am saying goodbye to dogs I have known as puppies. One of the hardest things for all the members of our staff is seeing our clients try to ‘keep it together’ in our office while they undergo this most emotional of experiences. The phrase we most frequently hear in this moment is, “I was hoping she would just die a natural death.”

Many times, we hear this when the patient in front of us is laterally recumbent, panting, pale, and skeletal. Owners know that their pets look and probably feel awful. One thing I have told unknown numbers of clients over the years in this situation: we almost never see pets for an appointment like this too early. Here’s the deal, as I see it:

Our pet animals do not lead a natural life.

We have selectively bred dogs for a variety of unnatural qualities, like short, twisted tails, squat, compact bodies, muzzles that barely protrude from the skull, bulging eyes, flopping ears. We have bred dogs the size of teacups and dogs the size of small horses. Dogs turn out to have very plastic genes. Cats maybe not so much, but witness Persians, Scottish Folds, Devon Rex, Munchkins, Siamese—there is plenty of variation, if not as much in size.

We have domesticated them, and provide them with food and shelter not always available in the wild. We give them medical care to address common (and fatal) diseases, treat them when they are sick, brush their teeth (well, some of us do) or allow their veterinarian to perform dentistry procedures to remove excessive bacterial deposits in the mouth or abscessed teeth, we give them joint supplements and medicated shampoos. Some of us even provide acupuncture and therapeutic laser treatments. Consequently, our pets live far beyond an age that could be reasonably expected in the wild (I like to imagine packs of wild Shih Tzus when I say this).

One question this begs is: what do we mean when we talk about a natural death? Are we thinking of dying from the effects of disease, or starvation, or exposure, or being killed in a territorial fight with another animal? This is a common collection of natural deaths. No, in our minds, a natural death means curling up quietly on a pillow, drifting off to sleep, and never waking up. And once in a great while, this is what happens. Most of the time though, the story is quite different.

We diagnose many geriatric pets with diseases, in some cases metabolic diseases, such as diabetes, Cushing’s disease, hypo- or hyperthyroidism, and in other cases, cancerous or benign tumors. If you live long enough, chances are, you’ll have one or more of these types of diagnoses yourself. Few people die peacefully in their sleep at home of ‘old age.’ Why do we assume it will be different for our companion animals?

In my experience, many people are blissfully ignorant of the realities of the final stages of terminal disease processes. I consider this a perk of living as we do in a first-world country, where we have access to wonderful health care and where disease and dying are largely hidden from us. Unless you have watched a family member suffer through a terminal disease, or have had a previous pet with the same issue, you are unlikely to truly understand what those last days are going to look like.

For many animals, the end stages of several types of organ failure and cancers look very similar. It isn’t pretty. The pet is not eating, mentally foggy, and possibly in pain. Muscle wasting takes place, and moving around becomes difficult, even if it is not actively painful (although many older pets have arthritis as well). These pets can be nauseated, an unpleasant way to live. Congestive heart failure causes pets to be drowning in the fluid that builds up in the lungs, or unable to take a breath due to fluid in the chest.

At this point, many of our clients are hoping that their pets will ‘let go’ and pass quietly in their sleep at night. But the actual process of dying can take a long time. At some point, it becomes too hard to watch, or the pet simply stops getting up, or becomes agitated. We receive a number of faxes every week from the emergency clinics around town, letting us know that such-and-such patient presented at 3 a.m. laterally recumbent, taking agonal (dying) breaths, and was euthanized.

This is why we consider it a loving act to be able to spare our animal companions suffering. Death is a natural part of life, but that doesn’t mean that the natural way of death is in any way preferable to humane euthanasia. I personally hope that by the time I am diagnosed with some terminal disease, I will have the option to be euthanized at the time of my choosing!

I have made this pact with my own kitty, who at this time is pushing 16 years old, and starting down the well-trodden path toward renal failure. I have looked into her eyes and told her that I will not let her suffer. I will not let her become a cat skeleton covered in fur who can’t move and is too nauseated to eat, and has to receive so many mLs of fluids a day just to hang onto that tenuous thread of life. I know she doesn’t understand my words, but she knows I love her, and that I will take care of her.

This brings up the other objection many people have to the idea of euthanasia. We hear a lot about how the client isn’t comfortable “playing God” by deciding when Fluffy or Shadow will die. The truth that’s missed here is that you have effectively played God for the entire rest of your pet’s life, by feeding, sheltering, immunizing, and treating for illnesses. Why get right to the point of true suffering, and then stand back and say, it’s in God’s hands now?

For my part, I can’t imagine a God so narrow-minded that he would object to your selfless act of mercy on behalf of your faithful companion. If you want to be biblical about it, we as humans have been granted “dominion over the beasts of the field,” and regardless of how you interpret the ancient Hebrew ‘dominion,’ the responsibility for your pet’s well-being is yours.

‘Natural’ is a loaded word. I think that in this context, we have to take a hard look at what is truly natural, and what isn’t. Truly natural is not always better, despite how we have been conditioned.

Euthanasia, Part 2: When?

Euthanasia, Part 2: When?

Savannah's CakeA frequent question surrounding the issue of euthanasia is, how will I know when it’s time? How can I tell if my pet is suffering?

The short answer is, you won’t. That is, you may never be completely sure, and your pet may hide signs of suffering from you. Unless you wait until the point where your pet is actively dying, you will have doubts. And that’s okay. It means you have a conscience, and that you are concerned about doing the right thing for your pet.

Despite thousands of years of domestication, most animals still retain their instinct to hide injury, illness or suffering. In the wild, animals that are weak, injured or ill will starve or be killed. So there is a very powerful evolutionary drive to mask  any outward signs of problems.

Another contributing factor here is that unlike you, your pet isn’t worrying about tomorrow. Your animal buddy lives exclusively in the moment, whatever that moment may be like. Your pets will continue to try to go about their canine or feline business, until they simply can’t, anymore.

So my advice is this: you know your pet best. You will be the best judge of when his or her quality of life has decreased to the point that you should be thinking about euthanasia.

Quality of life can be assessed in a couple of ways. You can start a journal, and log good days and bad days. When the bad days far outnumber the good, it’s time to start thinking about your pet’s quality of life. This is a tough method for some people, because one good day in a month of bad days can give false hope.

Or, you can take a mental inventory of the things your dog has always loved to do. Does she love long walks? Playing with a favorite toy? Investigating every bush in the back yard? Following you around to see what you’re up to? Whatever the list, be aware when favorite pastimes drop off the daily schedule. Older animals do sleep more, but when your dog spends all but one hour a day sleeping, you have to wonder about his quality of life.

You have to be realistic. Your 17-year-old Labrador who can barely walk with arthritis is not going to miraculously get a lot better next month. How much can you take? Your lab will keep going until she gives out. Do you wait until she’s down and can’t get up? Many people do, because that’s what it takes to see that she is suffering.

One thing I find a lot of people have a very difficult time assessing is their pet’s daily level of pain. There is an anthropomorphic assumption many people make that their pet would cry or whine if he or she were in pain. Sure, we would, but human beings are wimpy, particularly compared to dogs and cats. If it takes your dog a minute and a half to reach a standing position from lying or sitting down, he’s painful. If your cat can’t jump up on the couch, she’s painful. If movement is restricted to to and from the food dish, or in and out to pee or poop, he’s painful. Unless you startle a dog or cat with a painful stimulus, you probably aren’t going to get the crying you expect from pain. I have seen dogs and cats with broken bones, who only vocalize when the break is palpated.

There are more subtle indicators also. A dog that breathes heavily and pants when he hasn’t been exercising or hot, is probably a painful dog. A cat that sleeps 23 out of 24 hours in a day is probably painful. You simply can’t assume that because he never complains, pain is not a constant presence in your pet’s life.

I wish that I never saw patients whose quality of life had so deteriorated that they were essentially already gone. I wish everyone was on the same page as far as preventing suffering and that no animal would have to suffer before the decision could be made to humanely euthanize. But the reality is that everyone is different. Everyone brings their own emotions and experiences to this decision. And many times, suffering has to occur before a person can feel like euthanasia is the right thing to do.

It’s about love. It’s about loving your pet enough to let go, and make the transition from life to death smoother and more comfortable for your faithful animal companion. What we do when we euthanize is to create the death everyone wants for their pet, snuggled in the owner’s arms, falling asleep. If you have ever been anesthetized, you know what it’s like. You are there, and then you are not there. It’s as peaceful as we can possibly make it. I believe that it’s our responsibility as pet guardians to provide this act of love if it’s needed.