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I am posting a New York Times article that speaks about a personal experience with end of life decisions.
Opinion – “Deciding When a Pet Has Suffered Enough”
By JESSICA PIERCE
Published: September 22, 2012
ODY died peacefully last year, Nov. 29. He was 14 and a half. Truth be told, Ody didn’t just die. I killed him. I paid a vet to come to my house and inject a chemical solution into a vein in Ody’s back leg.
People ask me how I knew it was time. There was no watershed, but a slow accumulation of miseries. Ody had been in serious decline for six months. Partial paralysis of his laryngeal muscles made it hard for him to breathe, and he would begin to pant at the slightest exertion. His once deep tenor bark had transformed into a raspy Darth Vader croak. The signals from his addled brain often failed to reach his body, so when I walked him he left a Hansel and Gretel trail of pee and poop behind him. His muscles atrophied, and his walk was crab-like and unsteady. He grew increasingly uninterested in food and people, his two great passions. Worst of all, he began falling more and more frequently and was unable to get up by himself.
Toward the end, I would wake in the night to scuffling sounds. I’d search the house and find Ody trapped behind the piano or tangled up in the exercise equipment. It was on the fourth such night that my husband said: “It’s time. We can’t do this to Ody anymore.”
Euthanasia is deeply entrenched in the culture of pet keeping in America, and for the vast majority of companion animals, death will be orchestrated by a human caretaker, the time and date chosen in advance and not, as it were, decided by “nature” or some higher power. Yet despite its ubiquity, we rarely question its moral appropriateness.
Euthanasia is typically thought of as a choice between suffering and death — and, indeed, it can offer relief from unyielding pain. But death is too often prescribed as a de facto treatment for suffering when much less aggressive possibilities exist. We can ease our animals into the valley of death, rather than abruptly shoving them off the cliff.
Pain is the barometer most often used to assess whether an animal should be euthanized, and one of the most important improvements we can make in caring for our pets is to provide them with better palliative care. Untreated or undertreated pain is epidemic among companion animals. Kevin Stafford, an authority on veterinary ethics, estimates that 10 million dogs in the United States suffer from osteoarthritis but that only a small fraction get treatment. Of those dogs that do, he says, many are treated ineffectually or are given too little pain medicine for too short a time. The only treatment many arthritic dogs receive is euthanasia.
Effective and affordable pain treatments for animals are available; many human pain drugs were developed using animals. We can also lessen the pain for ailing pets with structural alterations to our homes, like ramps.
Why, then, are so many animals in pain? The reasons are largely cultural. Some veterinarians, particularly older ones, have been taught that animals don’t feel pain (the same convenient skepticism under which the animal research juggernaut labors). Few vets specialize in palliative care, and treating pain effectively takes a tenacity that harried and underpaid vets may find difficult to muster on a daily basis. And pet owners can be inattentive, even lazy.
To be sure, animal pain can be tricky to recognize and treat. Cats and rabbits are notorious for their so-called stoicism, but dogs, too, may not display pain in ways we easily see. As with humans, responses to pain vary. Effective pain management often requires trial and error with various types of drugs, as well as the use of non-drug therapies like weight management, controlled exercise, physical therapy, massage, acupuncture and nutritional supplements.
Pain must be understood broadly, as it is in human medicine, to include psychological suffering. Ody’s physical ailments were mostly caused by neurological decline. The fact that he wasn’t obviously in physical pain made the decision to euthanize a difficult one, because I was left to make an imperfect judgment about his overall well-being.
Quality-of-life assessments have long been used within human end-of-life care, and similar tools for assessing our animals are increasingly available, well-refined and imminently useful. One nice example is the veterinarian Alice Villalobos’s“Pawspice” program, which directs pet owners to assess their pet on a 1-to-10 scale on seven measures — hurt, hunger, hydration, hygiene, happiness, mobility and “more good days than bad” — with the lowest number being the worst. During Ody’s final decline, I would force myself to think through this assessment. It was hard to be honest. Ody’s score just kept getting lower. But the exercise at least offered a measure of objectivity.
One of the most troublesome moral challenges involves money. We could say that money shouldn’t matter when an animal’s life is in the balance, but this is neither realistic nor fair to pet owners. We might feel a justified repugnance toward the financially well-positioned pet owner who refuses to cough up the money for an antibiotic or inexpensive pain medicine. But the question of money can be gut-wrenching, as when prolonged care for an ill animal is balanced against college education for a child. Luckily, basic palliative care is not particularly expensive, and the emerging field of animal hospice will allow more owners to give respite to their dying animals without going broke.
AT animal hospice, the therapeutic agenda is not abandoned, but its goals shift, sometimes subtly, from cure to compassionate care and comfort. We put aside the desire to fix — the stem-cell treatments, joint replacements, X-rays and biopsies, and the other marvels of modern veterinary medicine — and focus instead on managing pain and allowing death to unfold in its own time. When things get really ugly, we retain the option — still largely unavailable for our human loved ones — of a gentle release.
Unfortunately, the love we feel for our animals can inure us to their suffering. We may wait for our animal to “tell us she is ready,” but our love can make it hard to hear her cries. I couldn’t bear the thought of losing Ody, so I sugarcoated his suffering. I focused on caregiving, feeling vindicated when he showed his typical interest in hot dogs and processed cheese. When, prodded by my husband, I finally called the euthanasia vet, I asked her to come the following day. I need one more day with Ody, to say goodbye, I thought. After realizing that this extra day was for me, not for Ody, I called back, and when I was able to control my voice, I asked her to come as soon as she could.
When the vet arrived at our house that night to perform the procedure, Ody was crouched under the piano, peering out at the family and friends gathered to say farewell. Normally he was drawn to people, but not this night. I watched him turn and stumble off. I followed him onto the flagstone patio, where he stood still, his back legs with their awkward bent. It was a bitterly cold night. I sat next to him and wrapped my arms around his chest and buried my face in the soft red fur of his neck. I didn’t want this moment to end. A few minutes later, my husband opened the door and called, “The vet’s ready.” I sat for another long moment with Ody and then got up and moved toward the door, beckoning him after me. He stood still, looking into the dark. I got behind him and gently touched his back, urging him on.
Jessica Pierce is a bioethicist and the author of “The Last Walk: Reflections on Our Pets at the End of Their Lives.”