Holding Cat Paw
“My dog needs to be put to sleep,” said the voice on the other end of the phone. “She has cancer, and we consulted with an oncologist, and we had an ultrasound done.” Before I could say a word, he continued: “We already asked about chemotherapy, and they said it would be $5,000, and after going through it with my cat already, I’m not sure I can do it again.” He paused for breath, waiting for my response.

“I’m so sorry about your dog,” I responded. “What is her name?” The man hadn’t even had a chance to tell me that, so rushed was he to convince me that this was the right decision for his family before I could suggest another course of treatment. It happens a lot in this line of work.

I never truly understood how often clients feel put on the defensive about their choices for terminally ill pets until I began my work as a hospice and home euthanasia veterinarian. I don’t believe it’s intentional on the part of most veterinarians, but the truth remains that there can be a big gap between veterinarians and owners when it comes to communicating about terminal disease and end-of-life care.

Why There May Be a Disconnect

Veterinarians are trained to cure disease. When you present a pet to us with a problem, our goals are simple: try to diagnose the problem and help you solve it. This is what we are prepared to do every day, and we do it well. In the past couple of decades, it has gotten even better. Between increased specialization and improved technology, pets can enjoy a level of care that rivals our own in many ways.

But not every pet owner wants to battle terminal disease to the bitter end. This amazing level of care comes at a financial cost, which may be out of reach for many pet owners. And in addition to the cost of treating terminal illness, many owners simply do not want to put their pet through the stress of aggressive therapy that will not eliminate the disease.

The most aggressive therapy does not always equal the best course of treatment, and that decision can only be made by an informed owner who has all the necessary information in front of him. It’s a vet’s job to provide information, to empower you to make choices right for your family and your pet, including how to keep your pet as comfortable as possible through a terminal disease when the family elects not to pursue treatment. 

Too often, pet owners feel like they are unable to say, “I don’t want to do that.” They may be concerned about appearing uncaring, embarrassed to say they really can’t afford thousands in veterinary bills, or they just may not be aware that palliative treatment is a valid alternative. Many veterinarians are gradually getting better at offering hospice care and palliative treatments to clients, but the field is still relatively new, and all too often, owners are unaware it exists. 

So how can owners be prepared for a conversation about end-of-life issues without walking away feeling guilty?

1. Take the time you need to understand what is happening.

The diagnosis of a terminal disease can be shocking, especially when it comes out of the blue: a limping dog who has not a sprained leg but bone cancer, for example. If this is not an emergency situation, don’t feel as though you need to make any decisions during this initial consultation. It will take some time to digest. Many owners find going home and taking time to research and talk leads to a much more constructive conversation the next day.

2. Don’t be afraid to set your limits at the start of the conversation.

Most veterinarians will tell you every option available to your pet; it wouldn’t be fair of us to make any assumptions about what you are or are not willing to do. That being said, if you know you are not interested in pursuing chemotherapy, for example, don’t be afraid to say so. Not all owners have a lifestyle that would allow them to care for a paralyzed dog. Defining your limits will help us focus the conversation on the needs of your specific family.

3. Ask about palliative care.

Choosing not to pursue curative therapy is not "giving up," nor is it an inferior choice — just a different one. Palliative care, where the focus is not on curing disease, but on making a pet as comfortable as possible, can be just as involved as curative-based protocols, but with a different goal. Providing pain management, maintaining hydration, managing mobility, decreasing nausea and maintaining caloric requirements are all ways we can help pets with terminal disease. Taking care of these humane needs fulfills our obligation to care for our pets just as much as electing to go the distance with a specialist.

When my cat Apollo suddenly developed a saddle thrombus last year, I was devastated. In this emergency condition, a large blood clot forms in the aorta and lodges right where the blood vessel divides to provide blood supply to each rear leg. The single blood clot can suddenly cut off blood supply to both rear legs. It’s known to be excruciatingly painful and difficult to treat. For those pets who do survive, recurrence is extremely likely.

I took Apollo to my local specialty hospital to confirm my suspicions. If my diagnosis was correct, I planned to make the decision to euthanize him. 

The cardiologist broke the news to me with a sympathetic sigh after performing an ultrasound. “He has a 50 percent chance of surviving the night,” he informed me. “I’ll get an estimate together for overnight hospitalization, but it will probably be about $2,500. Given his heart condition, I would anticipate two to three months or so before it happens again.” Before he could go any further, I stopped him. “No,” I said. “That’s not the right decision for us.”

Palliative care lasted only a few hours in our case, but it was all we needed to give the children a chance to say goodbye.

The doctor didn’t sneer or call me a bad owner or ask why I bothered coming in if I wasn’t going to take his recommendations. He reached over, put his hand over mine and simply said, “That’s what many people choose. And I support your decision.”

4. Don’t be afraid to ask questions or seek a second opinion.

If you’re worried that your vet will push a treatment with which you’re uncomfortable, try to have some specific questions or statements that can help you express your concerns without being confrontational, such as, "What is the benefit of that course of treatment versus comfort care?" And remember, if your vet has a compelling reason to recommend treatment, it’s his or her job to convince you of its worth. Alternatively, be comfortable emphasizing the fact that your concern is quality of life, not quantity of life. If a vet is very opposed to hospice care and you cannot come to a consensus, consulting with a vet who works in that field may be an option for an alternative opinion. 

As we learn more about how to keep pets comfortable at the end of their lives, more owners will be empowered to say “no,” not with guilt but with confidence and an understanding that you love your pet just the same no matter what you choose.

Dr. Jessica Vogelsang is a practicing veterinarian in San Diego, California. After working in emergency and general medicine for a decade, she recognized the need for better end-of-life care options for pets and now works as a hospice veterinarian with Paws into Grace.

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