VETERINARY HOSPICE CARE
The Nikki Hospice Foundation for Pets is dedicated to providing veterinary hospice care to terminally ill and dying pets in the comfort of their own homes and subscribes to a philosophy that addresses--very much like that espoused in human hospice programs--the physical, emotional and spiritual needs of these pets and of the people who love them. The techniques, skills and pharmacological protocols that are necessary to care for dying pets are very important to us as we believe that quality of life is essentially more important than extending a life that has lost meaning or when suffering is profound and can find no relief.
We believe that it is vital to help people say good-bye to their pets in their own unique way when their animals are about to depart this life, to offer veterinary care options that encircle the end of a pet’s life, to maximize quality of life for terminally ill or dying pets, and to embrace a pet parent’s right to make personal and private choices concerning a companion animal’s final days. We strongly feel that by teaching pet parents some simple techniques for pain and symptom control and by being available by phone and/or for home visits, veterinarians can still help pets who are nearing the end of their journey find solace and comfort while remaining in their own familiar surroundings and in the company of the people they love. Both pets and pet parents can benefit enormously from this kind of deep affection and palliative caring.
We also believe that all family members should share in the veterinary hospice experience, especially children, who should not be shielded from death but rather encouraged to participate in the final phases of a pet’s life so they may gain a deeper, and less frightening, insight into this natural cycle. With proper instruction in dispensing pharmaceuticals and with the support of a caring and well-qualified veterinary hospice team, all family members will not only enjoy the time they still have with their loyal and beloved friends but also come to a greater understanding of the validity and spiritual content of the human-companion animal bond. By adapting medications and treatments from human hospice models, veterinary hospice care allows pets to enjoy quality, comfortable time at home. And whenever clients feel that euthanasia is appropriate, if they do choose this option, the veterinary hospice team is there to assist with this process, in the privacy of the pet’s home.
We further believe that although veterinary hospice cannot change the outcome for a dying or terminally ill pet, it can improve the quality of the time it spends with its caregiver, allowing both to do special things together. Ultimately, it allows the family to take its leave of the pet by coming together for its final journey, by accomplishing good grieving, and by allowing healing and renewal. In this manner, the “circle of caring” can continue with other loyal friends the family may eventually wish to bring into their lives while still preserving precious memories of their last pet. Veterinary hospice care becomes appropriate and timely when a pet has been clinically diagnosed with a life-limiting illness and aggressive treatment has failed or the pet parent believes that further treatment will not improve its enjoyment of life. In essence, once the caregiver acknowledges that the disease has indeed “won,” the pet can become a candidate for home hospice care, under the sustained and loving attention of the caregiver’s family and the professional supervision and guidance of the hospice veterinarian and his/her staff.
The Nikki Hospice Foundation for Pets is proud to announce that at the end of 2000, several veterinarians who serve on our advisory board were asked to create generic guidelines for veterinary hospice care with a view to begin establishing standards and pharmacological protocols for end-of-life systems. The guidelines were presented to the Executive Board of the American Veterinary Medical Association (AVMA) in 2001, and were formally approved by the AVMA’s Executive Board in April of that year. They were officially made available to AVMA members on June 1, 2001, when they were published in the Journal of the American Veterinary Medical Association (JAVMA), and in March, 2003, were posted to the AVMA web site, where initially they could only be viewed by members. In March 2007, however, the guidelines were made accessible to the public in PDF format. The latest 2011 revision of the guidelines will be posted on this page very soon.
The NHFP wishes to make it clear that these guidelines, in conjunction with our philosophy, will henceforth form the basis for how our organization interprets the concept of veterinary hospice care and how we feel it should be practiced, so that the best interests of both the pet and the client are always foremost. All of our animal health care practitioners are asked to adhere to these guidelines when they join The NHFP, which can provide both the public and the veterinary community with initial guidance in hospicing a terminally ill pet. The NHFP is indebted to Eric Clough, VMD, and to Jane Clough, RN, who laid most of the groundwork for these guidelines and whose outline, “Completing the Circle of Care: Hospice for Pets” is still widely used by veterinarians. The outline can be requested directly from The NHFP by email, at firstname.lastname@example.org.
Veterinary medicine is a field that is constantly undergoing new and exciting changes, very much like human medicine, and it can often benefit from concepts and modalities which have been shown to have great validity for both human and non-human animals. Such is the case with veterinary hospice care, a term indicating the provision of end-of-life services to terminally ill or dying companion animals, thereby allowing clients to spend more quality time with them during a period which may either precede a euthanasia decision or take its place. These guidelines reflect the new and emerging status of veterinary hospice care as it is envisioned by The NHFP within the parameters of veterinary medicine in order to provide a more comprehensive and compassionate approach to dealing with the impending death of non-human animals.
The use of veterinary hospice care is to be considered as constituting good veterinary medicine in that it allows for a “good death” for the pet and consequently, “good” grieving for the client. This service must be offered in the context of a valid veterinarian/client/patient relationship, and it is recommended that appropriate client consent be obtained for all facets of veterinary hospice care. Training seminars will be available through The NHFP at various locations for those veterinarians wishing to learn more about veterinary hospice care, and it is incumbent upon animal health care practitioners who may be new to this field to pursue such education in order to learn how it can best be applied to their own practice.
Those board and advisory board members of The NHFP who have been practicing veterinary hospice care for some time, and who are actively involved in offering training seminars, all bring their expertise and their proven experience to this new field. Although no AVMA board certification currently exists for veterinary hospice care, The NHFP hopes that this will soon become a reality. For now, it should be kept in consideration that because the emergence and development of veterinary hospice care is an evolving process, especially in regards to current pharmacological protocols, this information may need to be modified from time to time.
Veterinary hospice care provides end-of-life palliative care to terminally ill or dying companion animals, and is modeled very closely on the concept of human hospice. As such, it represents a breakthrough in veterinary medicine in that it provides clients with an option that was previously unavailable to them. In the past, traditional veterinary medicine evaluated and aggressively treated animals who were terminally ill or declined to treat them if the condition was deemed hopeless. But in all cases, the end result was almost always euthanasia. Veterinary hospice care, on the other hand, allows the pet to spend quality time at home with the caregiver, under adequate sedation for pain control, until such time as the caregiver decides to euthanize or until death occurs.
When considering veterinary hospice care, the attending veterinarian should carefully assess the animal’s physical condition in order to determine if it qualifies as a “hospice” patient, based on the following: a) it has been given six months or less to live; b) it has a limited prognosis and a progressive disease with quality of life issues to consider; c) it has evidence of clinical decline such as multiple visits to the veterinarian, multiple or extended hospitalizations, a decline in functional status evidenced in three out of four ADLs (self-grooming, feeding, locating, ability to control urine or stool, righting, or ability to ambulate), impaired nutritional status, fluid retention or dehydration, weight loss or anemia, is symptomatic of pain, has dyspnea at rest, is unable to vocalize or vocalizes abnormally, or has lost the ability to smile or greet the caregiver or other family members. In many cases, hospice status may be applicable when the caregiver has decided not to pursue curative treatment and the caregiver, family members, the veterinarian and the veterinary staff have all been consulted and informed about the above.
In providing veterinary hospice care, veterinarians are offering benefits to the pets themselves, to their caregivers and families, and even to the veterinary staff as a whole. It is nonetheless imperative for everyone involved in the process to clearly understand the expected outcome, the time frame involved (what is the prognosis for the pet and the anticipated disease progression), how the palliative approach differs from the curative approach, when to expect the symptomatic and terminal phase of the chronic illness to begin manifesting itself, and what tasks the caregivers and their families will be facing.
As far as the pet is concerned, the veterinarian will have to deal with pain and symptom control, wound care, problems with incontinence and other aesthetics, and changes in behavior patterns. Special attention must be given to the caregiver’s perceptions of the pet’s comfort or discomfort (which are very similar to the perceptions encountered in the nurturance of a child) as well as the caregiver’s perceived ability to alleviate discomfort and feel a sense of satisfaction in his or her attempts to make the animal comfortable.
The veterinarian’s participation, knowledge, experience and open-mindedness are all of crucial importance. Both doctor and staff should be available at all times and be able to provide ready access to medications when needed. Being able to anticipate oncoming symptoms in the animal and routinely administer analgesics to minimize pain, as well as educate the caregiver in adequate home pain control, are all essential duties. As pain and suffering are both physical and metaphysical—with both the pet and the caregiver partaking in the experience—defining, assessing and interpreting pain adequately is an important step in veterinary hospice care.
Pain may be opiate dependent and therefore atypical (in bones, nerves, or muscles) or require an analgesic (non-opioid, weak opioid or strong opioid). Veterinarians are encouraged to begin administering these kinds of analgesics slowly, increasing them at a moderate rate so as to avoid side effects (which should always be anticipated and fully explained to the caregiver), to constantly evaluate the compounds being used and their efficacy in reaching the desired effect.
Symptoms which should always be defined, assessed, interpreted for the caregiver, and ultimately treated are dyspnea, coughing, sneezing, nausea, vomiting, constipation, seizures, fever, hemorrhages, agitation, restlessness, avoidance, vocalizing, pain and urinary retention, among others. Veterinarians should always work toward prevention, if possible, and recognize that these problems can be a source of great stress for the caregiver, especially if the animal begins exhibiting personality or behavioral changes. Often, the caregiver will need to maintain a “bedside” vigil and will require encouragement, understanding, and assistance in doing so.
The caregiver should be instructed in how to administer medications to the pet, as well as in how to dress and cleanse wounds and control minor hemorrhages, should these occur when the veterinary staff is not present. Medications should always be administered by a primary caregiver in order to minimize stress to the animal and the possibility of overmedicating the pet. Caregivers who wish to take on these tasks during their pet’s hospice experience must be able to rely on pre-prepared emergency kits (for both anticipated and unanticipated events) that can be safely used at home. These generally contain injectables which must deliver medication in an efficacious manner, often under conditions of questionable absorption, and may typically consist of zip-lock bags with pre-loaded syringes of the necessary medication(s).
Caregivers also need to know what to do when death occurs and who to call. During what can be a very difficult time of grieving and loss, caregivers must be able to locate someone on the staff (preferably a licensed grief therapist or mental health professional) who can provide them with adequate counseling. Ultimately, veterinary hospice care provides for “safe passage” for the pet in the comfort of the caregiver’s home and allows “growth” to occur at the end of life--ideally for both pet and client. For all involved, it is a unique learning experience and represents an opportunity for clients and their families to come together and share the lessons learned with the veterinary hospice team through cooperation, reconciliation and bonding. When clients return with a new pet, the trust and confidence they will have gained during the hospice experience will be renewed through the continuum of care, and the cycle truly comes full circle.
The NHFP makes available the information contained on this website in furtherance of The NHFP’s nonprofit status. While The NHFP makes every effort to present accurate and reliable information on this site, The NHFP does not endorse, approve, or certify such information, nor does it guarantee the accuracy, completeness, efficacy or timeliness of such information. Use of such information is voluntary, and reliance on it should only be undertaken after an independent review. Reference herein to specific commercially available products does not constitute or imply endorsement, recommendation or favoring of such products by The NHFP.
This revised and expanded edition of the author's 2000 bestseller, Why is Cancer Killing Our Pets?, examines the environmental, dietary, and lifestyle-related causes of cancer in pets and how to safeguard their well-being. This thorough and comprehensive guide provides readers with the knowledge of how to ward off the unforeseen causes of cancer and protect the safety and health of their pets. Readers whose pets have been diagnosed with cancer will benefit from the full spectrum of both conventional and alternative treatments presented in this book--from chemotherapy and laser surgery to herbal therapy, acupuncture, and touch therapy. In addition, readers will find guidance about caring for a sick pet and grieving his or her loss should the pet die.
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