(Author Lamar Hankins is the founding editor of this blog and has commented extensively on a wide range of end-of-life issues. – Jay Niver, editor)
When I read Gary Wederspahn’s recent post about pet euthanasia, I had already written the first draft of this post. As Gary noted, those of us in the movement for expanded end-of-life choices often say, or hear someone else remark, that pets are allowed to die more peacefully and humanely than humans.
I just went through that experience with our beloved Mini Australian Shepherd, Woody, and started thinking anew about the differences in his death and the death I want for myself.
I discovered in the last few weeks that the veterinarian literature about pet euthanasia is extensive and focuses not only on the technical protocols, but also on helping pet owners with their grief and on the ethics of how veterinarians respond when a pet in poor health cannot be cured or helped to live a satisfying life.
As we considered the decision to ask our vet to end Woody’s life, I became acutely aware of a major difference between Woody’s end-of-life situation and what I have advocated for these past nearly 30 years: We did not know what Woody wanted. An important reason for stress among veterinarians is the inability to communicate with their patients. This also creates stress for pet owners.
At the age of 14, Woody had become nearly deaf. He had cataracts in both eyes that, were he human, would have rendered him legally blind. His prostate was so large that he could not be catheterized to drain his distended bladder, even under anesthesia. The vet used a syringe to drain the bladder and give him temporary relief. Nevertheless, urine was able to leak constantly from his urinary tract, which meant we often confined him to a part of the house with no rugs, though we used old towels under him when he was lying down in other parts of the house to allow him to continue as normal a life as possible.
Two years ago, while on a walk in the neighborhood, Woody collapsed and could walk no farther. The cause was diagnosed as arthritis in vertebrae along his back. For all of these conditions, he was prescribed a series of antibiotics, pain medication, tamsulosin, and gabapentin, along with his customary heartworm and flea medication, and protection from rattlesnake bites.
For several weeks before his death, he found it difficult to navigate through his doggy door into the backyard. For the last week of his life, by the end of each day, Woody was unable to stand on his own or hold himself up on his legs when assisted. He collapsed on his belly with his legs splayed out. He spent a lot of time sleeping, becoming somewhat alert only for what we called a tasty morsel. It seemed that we had more contact with his vet over the last two weeks of his life than all the 14 years before.
Finally, we scheduled a late afternoon appointment with the vet. Woody had an intravenous catheter inserted in a vein in his leg. We held him as he was given an anesthetic, and then a lethal dose of pentobarbital. His heart stopped within 15 seconds.
We took him home wrapped in an old sheet we used as a shroud, and placed him in the grave I had dug earlier in the day. We filled in the grave. The next day, I gathered rocks from our property to pile around the grave.
My spouse and I agreed that being unable to communicate with Woody about his wishes may have been the most difficult part of losing him. How much better it is to know the wishes of someone nearing the end of life. What the experience did was move us to review our own end-of-life decisions and consider anew whom our healthcare surrogates should be – an increasingly difficult choice as our friends get older. We don’t want to place the burden of surrogacy on our only child, so we have the same dilemma faced by many older people.
We think we made the right decision for Woody. But how much better it would have been to know what he wanted.
We don’t have that uncertainty with FEN clients, or those who request help where Medical Aid in Dying (MAiD) is available. When we argue for compassion, let’s recognize that the competent, suffering people who need relief are at least able to request it.
It seems to me that Woody’s death was delayed far beyond the appropriate moment. The dog may have have brief moments of pleasure, but the constant pain he was in, and the number of serious medications he was obliged to take, would indicate that mercy was too long in arriving.
I understand how you could come to that conclusion. Since I also suffer from an enlarged prostate and take the same medication prescribed for Woody, I think I was particularly sensitive to that problem. We needed to wait a few days after starting the tamsulosin and antibiotic (for UTI) to see if they would work. He did have some positive response to them, but they did not solve the problems. He was walking around, albeit with some weakness, until he became unable to support himself late in the evening. It was only after the second evening when he could not support himself that we discussed euthanasia with the vet, which was done the same day. These are all judgment calls based on inadequate information. I still wonder if we made the right decision. I take some solace from the opinion of our vet that it was the right time.
Thank you for your clarification. I now have a better picture of your time-table. I am sorry for your loss and have also tried very hard to stave off the moment of decision about a beloved pet. However, the older I get and the more deeply I feel that death is not to be feared, the more I understand it was my inability to let go that made me delay the moment to provide a pet with a peaceful end to a life well-lived. I truly wish it were possible to make that decision and carry it out for ourselves without drama and interference from well-meaning family and society.
Lamar,
I share your love of dogs and empathize with you about Woody. Regarding your issue of getting your end-of-life care representation in order, I recommend that you see: https://finalexitnetwork.org/surrogate-consultant/
If you had only had a copy of the HHHHHMM Scale for Woody, and for your own decision-making, you wouldn’t have been stuck with the agonizing feeling of having had to make “the choice” for him. There is no “choice” in Quality-of-Life, nothing to “decide” on: you just add up the scores and, when it’s too low it’s time to let go. We in the r-t-d movement would do well to HHHHHMM for ourselves.
Lamar, In no way should my comments be taken as criticism. I applaud you and your wife’s dedication and support of your friend who was a real part of your family, and make this suggestion only because I would prefer to die in my home rather than in a hospital as, I am certain, would most of our readers and pets. For that reason, Buddy, a Black Lab and a huge part of my life for 17 years, died on our den floor with his head in my lap. Fortunately, our family Vet readily supported my request for his personal service in our home, and Buddy died quietly, calmly surrounded by the normal sounds and smells he had experienced throughout his life while I stroked his big head and talked to him. It don’t get no better than that! Clyde H. Morgan
Last February we lost our 13-year-old puggle, Rumple, to an unexpected terminal disease. The onset was completely muddied because he went in for a tooth extraction (which became teeth – four). We had thought that his minor eating changes were related to mouth discomfort. His labs were borderline but OK, so the general-anesthesia procedure went forward.
He came home half a dog. No appetite, shaking on and off full time. He could go on walks and navigate the stairs; at the onset he could jump onto furniture. The treatment goal remained the same: try to stimulate his appetite through various treatment means. Trouble was, they got more and more invasive.
Because this came out of left field, commingled with the extractions, the recognition that he was seriously ill was delayed. Between he and I, solid medicinals were a nonstarter and I couldn’t even get stuff squirted into him. Eventually all our suffering deepened and we made the retrospectively awful decision to approve, during a night at the dog hospital (an enterprise way beyond the vet’s office), a gastro-nasal tube though which I would inject meds and food.
Little did I know. I spent 4-5 hours reconciling the many meds/foods into a preparation and delivery matrix. The tube was minuscule, requiring irrigation. And on and on. I had become Nurse Ratched to my dog. By the time we euthanized him, his demise played out over 18 days — exactly the length of time of both of my parents’ terminal hospitalizations that stimulated me to become an EOL reform advocate, write two books, do a TEDx talk, and present to the public what became my EOL lexicon.
Unlike Lamar, who is smarter than me, I didn’t think to Google, and so didn’t know about the pet quality of life scale. With it, we would have reluctantly, yet with resolve, ended Rumple’s life ~50 percent sooner. We had the unsubstantiated notion that, as a dog, he’d live to 15 or so. We never did learn whether his affliction was severely inflamed stomach tissue or cancer; doing so would’ve require yet another $$$$$$$ and painful level of medical treatment.
Despite our care, I feel guilty every day for extending and deepening his misery. And I wonder WTF it takes to learn. I think I finally have, for dogs and people.